Case Presentation: A 78-year-old female with dextrocardia presented to the hospital from her outpatient dermatologist for hypotension, hypoxia, and altered mental status. She became diaphoretic, dyspneic (SpO2 78%), and hypotensive with systolic blood pressure in the 80s after applying topical lidocaine for a microneedling procedure. Initial exam noted diaphoresis, diffuse facial erythema and flushing, orolabial [...]