Lidocaine

Aliases: Xylocaine 

Indications: V-Fib or Pulseless V-Tach (pVT) Cardiac Arrest, Post Resuscitation Care, Wide Complex Tachycardia with a Pulse, Pain Management for IO Flush, Eye Injury, Pain Management for Kidney Stone     

Contraindications: Second- and third-degree heart blocks, CHF   

Concentrations: 

Injection: 20mg/mL

Dosing

Adult:

Indication	Dose	Route	Note
-V-fib or pVT Cardiac Arrest  -Wide Complex Tachycardia with a Pulse	100 mg	IV Push	-May repeat every 4 minutes PRN.  -Max total dose 3 mg/kg
IO Flush	40 mg	Slow IO Push	Dilute in 10 mL with IVF

Pediatric:

Indication	Dose	Route	Note
-V-fib or pVT Cardiac Arrest  -Wide Complex Tachycardia with a Pulse	1 mg/kg Max: 100 mg	IV Push	-May repeat every 4 minutes PRN.  -Max total dose 3 mg/kg
IO Flush	0.5 mg/kg Max: 40 mg	Slow IO Push	Dilute in 10 mL with IVF

Precautions: CNS depression may occur when the drug exceeds 300mg/hr. Lidocaine should be used with caution when administered concomitantly with Procainamide and beta-blockers as drug toxicity may result. 

Adverse/Side Effects: Drowsiness, seizures, confusion, hypotension, bradycardia, heart blocks, nausea, vomiting, and respiratory and cardiac arrest   

Class: Antiarrhythmic (Class 1b), Sodium channel blocker    

Mechanism of Action: Lidocaine depresses depolarization and automaticity in the ventricles and increases the ventricular fibrillation threshold by increasing phase IV repolarization.  

Onset of Action	Peak Effect	Duration of Action
45 to 60 seconds	Fast	10 to 20 minutes