Lidocaine HCl (Xylocaine®)

Indications:

• Ventricular fibrillation
• Wide-complex tachycardia (WCT) and hemodynamically significant PVCs
• Pain related to intraosseous infusion (BioTel authorization required for pediatric)
• Premedication for Pharmacologically-Assisted Intubation (PAI)

Contraindications:

• Life-sustaining ventricular escape rhythms associated with bradycardia or 2° or 3° heart blocks
• Hypersensitivity

Precautions:

• Contact BioTel for patients over 65 years of age, history of liver disease, or CHF
• Contact BioTel prior to administration if the patient has any "caine" allergy
• Short half-life; bolus may need repeating, and if bolus converts rhythm, repeat bolus may be necessary especially in prolonged transport time
• Continually monitor ECG, blood pressure and level of consciousness
• Maximum total, cumulative dose of lidocaine is 3 mg/kg

Side Effects:

• Initially: drowsy, lightheadedness, blurred vision
• Toxicity: hypotension, change in level of consciousness, seizures, cardiovascular collapse, bradycardia

Adult Dose:

Standing order:

• VF/pulselessVT unresponsive to defibrillation and amiodarone, or when amiodarone cannot be used:

• 1.0 – 1.5 mg/kg IV or IO push (maximum dose 100 mg).

• Consider continuous IV/IO infusion for stable WCT if amiodarone is unavailable or cannot be used – Contact BioTel
• Premedication for Pharmacologically-Assisted Intubation (PAI):
  • 1.0 mg/kg IV or IO push
• Pain related to intraosseous access in conscious patients:
  • 40 mg (2 mL) IO prior to Normal Saline flush

BIOTEL AUTHORIZATION ONLY                                   

• Consider continuous IV/O infusion for frequent, hemodynamically significant PVCs during Post-cardiac arrest care (amiodarone preferred).

Pediatric Dose:

Standing order

• VF/pulselessVT unresponsive to defibrillation and amiodarone, or when amiodarone cannot be used:
  • 1.0 mg/kg IV or IO push (maximum dose 100 mg).

BIOTEL AUTHORIZATION ONLY

• Consider for unstable, sustained Wide Complex Tachycardia when synchronized cardioversion cannot be performed: 1.0 mg/kg IV/IO push .
• Consider continuous IV/IO infusion for frequent, hemodynamically significant PVCs following synchronized cardioversion or for frequent, hemodynamically significant PVCs during Post-cardiac arrest care (amiodarone preferred).
  

Route: • IV or IO push (no faster than 50 mg/minute in conscious patients)

Drug Action:

• Suppresses ventricular ectopy
• Blocks conduction of pain impulses

Class:

• Ventricular Antiarrhythmic
• Local Anesthetic

Onset: 30 seconds - 90 seconds

Duration: 10 minutes - 20 minutes