Indications: Alternative to Amiodarone in Cardiac arrest from VF or pulseless VT unresponsive to CPR, Defibrillation, and at least one dose of Epinephrine...
Stable monomorphic VT with preserved ventricular function
Stable polymorphic VT with normal baseline QT interval and preserved LV function when ischemia is treated and electrolyte balance is corrected
Can be used for stable polymorphic VT with baseline QT- interval prolongation if Torsades suspected
Mechanism of Action: Lidocaine depresses the automaticity of Purkinje fibres, raising the stimulation threshold in the Ventricular muscle fibres, which makes the ventricles less likely to fibrillate.
Route: IV/IO
Dosage for Cardiac Arrest: Initial dose is 1-1.5 mg/kg IV/IO. For refractory VF we may give an additional 0.5-0.75 mg/kg IV push and repeat it in 5-10 minutes; maximum 3 doses or a total of 3 mg/kg
Adult Infusions:
For stable VT, wide-complex tachycardia of uncertain type, significant ectopy: Doses ranging from 0.5-0.75mg/kg and up to 1-1.5 mg/kg may be used
Repeat 0.5-0.75 mg/kg every 5-10 minutes; maximum total dose: 3 mg/kg
Maintenance Infusion 1-4 mg/min (30-50 mcg/kg per
minute)
PALS:
VF/Pulseless VT the IV/IO Initial dose is 1 mg/kg IV/IO loading dose.
Maintenance: 20-50 mcg/kg per minute IV infusion. We need to repeat the bolus dose if the infusion was initiated more than 15 minutes after initial bolus therapy.
The Endotracheal dose is 2-3 mg/kg
For RSI 1-2 mg/kg IV/IO can be used.
Precautions: Lidocaine is Contraindicated for Prophylactic use in AMI patients; Reduce maintenance dose, not the loading dose in presence of impaired liver function or LV dysfunction
Discontinue infusion immediately if signs of toxicity develop
Side effects can include: Muscle twitching; Slurred speech; Hearing Loss; Altered LOC; Seizures; Caution in use with Renal pts
Alternative to Lidocaine: Amiodarone
Disclaimer: This video is for educational purposes only and is not intended as medical advice. While we strive for 100% accuracy, errors may occur, and medications or protocols may change over time.
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