Lidocaine (Xylocaine)

Question 1

Class

Answer 1

Antidysrhythmic

Question 2

Actions

Answer 2

Decreases automaticity of Purkinje pacemaker cells by reducing the slope of Phase 4 diastolic depolarization
Decreases the potential for reentrant pathways
Increases the fibrillatory threshold of myocardial cells in the setting of acute MI

Question 3

Indications

Answer 3

Sympatomatic PVC’s
VT and VF that persist after defibrillation and epinephrine
Wide-complex tachycardias of unknown orgin

Question 4

Contraindications

Answer 4

Conduction system disorders , ie. 2nd and 3rd degree heart blocks
Stokes-Adams syndrome, WPW
Ventricular Escape rhythms
Hypersensitivity

Question 5

Side Effects

Answer 5

Tinnitus, twitching, slurred speech, confusion, and paresthesias, seizures are early toxic signs. Later signs, hypotension, and heart block
Lidocaine takes about 2 minutes to reach the central circulation

Question 6

Precautions

Answer 6

Dose should be reduced in decreased cardiac output states (AMI, CHF, shock), in patients >70 y.o., and those with hepatic dysfunction, but not initial dose in CPA situations.
In code resuscitation antecubital IV preferred and immediately after each IV med, to follow with a 20- to 30 cc IV fluid bolus, and elevation of arm if possible in the field.