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LIDOCAINE (XYLOCAINE)

CLASS:

  • Antidysrhythmic

ACTIONS:

  • 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

INDICATIONS:

  • Symptomatic PVC's

  • VT and VF that persist after defibrillation and epinephrine

  • Wide-complex tachycardias of unknown origin

CONTRAINDICATIONS:

  • 2nd & 3rd degree heart blocks.

  • Hypersensitivity

  • Stokes-Adams syndrome,

  • WPW

  • Ventricular Escape rhythms

STANDARD PREP:

  • 100 mg/5 cc Infusion Premix 2 gm/500 ml D5W

  • 2% Xylocaine jelly

DOSES / ROUTES:

  • See Hawaii S.O.

  • ACLS – Follow Algorithm

  • 2% Xylocaine jelly for ET tube lubrication

PEDIATRIC DOSE:

  • See Hawaii S.O. & PALS Algorithm

SIDE EFFECTS:

  • Tinnitus, twitching, slurred speech, confusion, and paresthesias, seizures are early toxic signs.

  • Later signs: hypotension & heart block.

  • Lidocaine takes about 2 minutes to reach the central circulation

PRECAUTIONS:

  • 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.