The first step in the management of convulsions consists of immediate attention to the maintenance of a patent airway and assisted or controlled ventilation with oxygen and a delivery system capable of permitting immediate positive airway pressure by mask. Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered i.v. The clinician should be familiar, prior to use of local anesthetics, with these anticonvulsant drugs. If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias and cardiac arrest. If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted.
Dialysis is of negligible value in the treatment of acute overdosage with lidocaine.
Debilitated, elderly and acutely ill patients should be given reduced doses. The ointment should be applied in a thin layer for adequate control of symptoms. A sterile gauze pad is recommended for application to broken and burned tissue. Subsequent removal of excess saliva with cotton rolls or saliva ejector minimizes dilution of the ointment. For use in connection with the insertion of new dentures, apply to all denture surfaces contacting mucosa.