Aggressive supportive care (including airway management) and application of ACLS
Ventilate with 100% FiO2 - bolus dose of 50-100mg IV succinylcholine paralyzes without depressing CNS or CV
Hypercapnia, hypoxia, acidosis all worsen toxic effects
Manage seizures with benzodiazepines; propofol is an option but may worsen cardiovascular<unk> 
Early activation of ECMO or consideration for transfer to ECMO center as cardiac arrest is often refractory to ACLS.
1 amp of sodium bicarbonate IV q2 min for:
VT or VF
Severe acidosis
Lipid emulsion, (Intralipid) 20% solution
Lipid sink, binds to<unk><unk> 
1.5 mL/kg bolus over 1 minute
Then, 0.25 mL/kg/min for 20 min or until hemodynamic stability achieved
↑ to 0.5 mL/kg/min if hemodynamic status declines
Maximum total dose 12 mL/kg.
Consider drawing extra blood as will interfere with labs
ACLS modifications per ASRA (Am Soc of Regional Anesthesia):
Avoid vasopressin
Avoid calcium-channel blockers and beta-blockers
Amiodarone preferred in ventricular dysrhythmias
Ventilate with 100% FiO2 - bolus dose of 50-100mg IV succinylcholine paralyzes without depressing CNS or CV
Hypercapnia, hypoxia, acidosis all worsen toxic effects
Manage seizures with benzodiazepines; propofol is an option but may worsen cardiovascular<unk> 
VT or VF
Severe acidosis
Lipid sink, binds to<unk><unk> 
1.5 mL/kg bolus over 1 minute
Then, 0.25 mL/kg/min for 20 min or until hemodynamic stability achieved
↑ to 0.5 mL/kg/min if hemodynamic status declines
Maximum total dose 12 mL/kg.
Consider drawing extra blood as will interfere with labs
↑ to 0.5 mL/kg/min if hemodynamic status declines
Avoid vasopressin
Avoid calcium-channel blockers and beta-blockers
Amiodarone preferred in ventricular dysrhythmias
Local anesthetic systemic toxicity
Anaphylaxis
Nitrogen narcosis
Anxiety
Calcium channel blocker toxicity
Methemoglobinemia - local anesthestics oxidize Fe2+ to Fe3+ in Hb
Cholinergic crisis
Phenothiazines