Lidocaine (Xylocaine)

Question 1

Class

Answer 1

Antidysrhythmic

Question 2

Actions (3)

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 (3)

Answer 3

• Symptomatic PVC’s
• VT and VF that persist after defibrillation and Epi
• Wide-complex tachycardias of unknown origin

Question 4

Doses/Routes

Answer 4

Cardiac Arrest VF/VT SO: 1.5 mg/kg IV/IO

Question 5

Standard Prep

Answer 5

• 100 mg/5 cc
• Infusion premix 2 gm/500 mL D5W
• 2% Jelly

Question 6

Pediatric Dose

Answer 6

Cardiac Arrest VF/VT SO: 1 mg/kg IV/IO if Amio unavailable

Question 7

Contraindications (3)

Answer 7

• Conduction system disorders, ie. 2nd and 3rd degree heart block, Stokes-Adams syndrome, WPW
• Ventricular escape rhythm
• Hypersensitivity

Question 8

Side Effects (9)

Answer 8

• Early toxic signs: Tinnitus, twitching, slurred speech, confusion, paresthesia, SZ
• Later signs: Hypotension and heart block
• Lido takes about 2 minutes to reach the central circulation

Question 9

Precautions (2)

Answer 9

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