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Total Spinal 

 

 

Signs

 

  • Numbness or weakness in upper extremities

  • Nausea/vomiting

  • Dyspnea/respiratory depression

  • Loss of consciousness

  • Bradycardia

  • Hypotension

  • Dilated pupils

 

 

Management

 

  • Supportive care:

    • Assess need for intubation and/or cardiopulmonary resuscitation

    • Maintain oxyvenation/ventilation & protect against aspiration

    • Support hemodynamics:

      • IV fluid bolus, atropine, epinephrine (10 - 100ug IV, increase as needed)

    • If pregnant: left uterine displacement & fetal heart rate monitoring

    • Consider sedation when hemodynamically stable

  • Change position based on baricity (careful with reverse trendelenberg & hypotension → venous pooling)

  • Support until spinal wears off

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