Lidocaine 2% G3

Question 1

Lidocaine Class

Answer 1

• Antiarrhythmic (Class Ib)
• Anesthetic

Question 2

Lidocaine MOA

Answer 2

• Cardiac: combines with fast sodium channels, inhibiting repolarization recovery, decreasing myocardial excitability and conduction velocity
• Local anesthetic: inhibits ion transport across neural membrane, blocking conduction of sensory nerve impulses
• RSI: may decrease ICP response during laryngoscopic placement of ET tube

Question 3

Lidocaine Indications

Answer 3

• Suppression of VF, PVT, stable monomorphic VT, poly VT with normal QT interval; after treatment of ischemia and electrolyte imbalances has been achieved.
• May be used to treat stable Torsades de Pointes (poly VT with prolonged QT); consult medical control
• Local anesthetic post-IO insertion before marrow displacement with saline push
• Pre-intubation for head trauma or suspected intracranial hemorrhage with suspected increased ICP

Question 4

Lidocaine Adult dose

Answer 4

• VF/PVT, wide-complex tachycardia, more than 5 PVCs in a minute, refractory A-fib or flutter, SVT:
  • 1- 1.5 mg/kg IV/IO push , may repeat with 0.5- 0.75 mg/kg IV/IO push in 5-10 min. PRN
  (max total dose 3 mg/kg)
• Infusion after ROSC:
  • 1 – 4 mg/min, (1G in 250 mL NS gives 4 mg/mL).
• Post IO insertion pain management:
  • 2 mL (40mg) of 2% Lidocaine and wait 2 min., to be given after IO confirmation but before marrow displacement

Question 5

Lidocaine Contraindications

Answer 5

• Known hypersensitivity
• 2o or 3o AV heart blocks in the absence of functioning pacemaker
• Wolff-Parkinson-White, Stokes-Adams syndromes or wide-complex VT escape beats with bradycardia

Question 6

Lidocaine Adverse reactions

Answer 6

• CV: hypotension, dysrhythmias, cardiac arrest
• Other: drowsiness, confusion, seizures, slurred speech, nausea & vomiting

Question 7

Lidocaine Pediatric dose

Answer 7

• VF/PVT:
  • 1 mg/kg IV/IO push, may repeat in 3 – 5 min. one time (max total dose 100 mg)
• Infusion after ROSC:
  • 20 – 50 mcg/kg/min (250mg in 250 mL gives 1 mg/mL [1000 mcg/mL]).
• RSI:
  • 1 – 2 mg/kg IV/IO push (max total dose 100 mg)