A nurse is monitoring a patient who recently received a local anesthetic for signs of local anesthetic systemic toxicity (LAST). Which of the following clinical manifestations should the nurse recognize as early signs of LAST?

A. Respiratory arrest and coma: These are late, life-threatening manifestations of local anesthetic systemic toxicity (LAST) that occur after CNS and cardiovascular collapse. Recognizing early signs is critical to preventing progression to this severe stage. B. Ventricular arrhythmias and cardiac arrest: These are also late signs of LAST, resulting from the anesthetic’s depressant effects on cardiac conduction. By the time these occur, toxicity is advanced and may require immediate resuscitation measures. C. Hypotension and tachycardia: Although cardiovascular symptoms may eventually develop, they are typically preceded by neurological signs. Early identification and management of CNS symptoms can often prevent progression to cardiovascular compromise. D. Tinnitus, metallic taste, and perioral numbness: These are classic early signs of LAST and indicate CNS involvement. They often occur within minutes of administration and should prompt immediate intervention to stop drug absorption and initiate supportive care.