Lidocaine

Question 1

Lidocaine Trade Name

Answer 1

Xylocaine

Question 2

Lidocaine Classification

Answer 2

Medscape:
Class I antidysrhythmic; sodium channel blocker; local anesthetic

Question 3

Lidocaine Mechanism

Answer 3

Medscape:
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction

Capital:
Blocks sodium channels to prolong Phase 0 of the action potential thus decreasing ventricular automaticity. Little effect on atrial tissue.

Question 4

Lidocaine Onset of Action

Answer 4

Capital: 1-5 mins

Question 5

Lidocaine Duration of Action

Answer 5

Capital: 15-120 mins

Question 6

Lidocaine Indications

Answer 6

CT Protocols:
Antiarrhythmic used for control of ventricular dysrhythmias. Anesthetic for nasotracheal intubation and intraosseous.

Capital:
Ventricular fibrillation (VF) or ventricular tachycardia (VT) cardiac arrest refractory to defibrillation. Hemodynamically stable regular wide-complex tachycardia (VT). Malignant PVCs. Local anesthetic for IO placement

Question 7

Lidocaine Contraindications

Answer 7

Capital:
Bradycardia, High degree heart block, Hypersensitivity, Hypotension (except in cardiac arrest), Cardiogenic shock

Question 8

Lidocaine Side Effects/ Precautions/ Comments

Answer 8

Capital:
Confusion, Bradycardia, Heart block, Hypotension, CHF/pulmonary edema, Cough, Shortness of breath, Nausea, Dizziness, Seizures

Metabolic clearance is reduced in patients taking beta-blockers and patients with liver disease. Reduce dose by 50% in elderly patients or in patients with liver/renal disease

Question 9

Lidocaine Adult Dose

Answer 9

CT Protocols:
Cardiac Arrest
1 mg/kg IV/IO, Repeat dose 0.75 mg/kg up to a maximum dose of 3 mg/kg.

Tachycardia
1 – 1.5 mg/kg IV/IO. (considered second-line therapy to Amiodarone). May repeat once in 5 minutes to maximum of 3 mg/kg. If successful, consider a maintenance infusion of 1 – 4 mg/minute.

Nasotracheal Intubation
* 2% lidocaine jelly.

Intraosseous Access
* 1 - 2.5 mL of 2% lidocaine.

Question 10

Lidocaine Pediatric Dose

Answer 10

Capital:
VF/VT arrest: 1 mg/kg IV/IO (max 100 mg) every 3-5 minutes, maximum 300 mg total.

Maintenance infusion: 20-50 mcg/kg/min. IO anesthesia: 40-100 mg titrated to pain slow push.

Question 11

Lidocaine
Max Dose Adult (Pediatric)

Answer 11

CT Protocols:
3mg/kg (300mg)

Question 12

Lidocaine Routes of Administration

Answer 12

IV/IO

Question 13

Lidocaine How Supplied

Answer 13

150mg/ml vials or prefilled syringes