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LIDOCAINE (XYLOCAINE)
                              Class/Mechanism of Action
         •  Antiarrhythmic
              ˚  Suppresses the automaticity of cardiac conduction tissue.
                                    Indications
         •  Labeled Indications
             Acute treatment of ventricular arrhythmias from myocardial infarction (alternative to amiodarone
              ˚ when amiodarone is not available)
         •  Off-Label Indications
             Hemodynamically stable monomorphic VT and polymorphic VT
              ˚ Pulseless VT/VF (unresponsive to defibrillation, CPR, and vasopressor administration)
              ˚   ˚ Monomorphic VT is secondary to drug, when amiodarone is not available
                                  Contraindications
         •  Hypersensitivity to lidocaine or any component of the formulation
         •  Prophylactic use in AMI
         •  Bradycardia, severe degrees (2nd or 3rd) of SA, AV, or intraventricular heart block
         •  Wolff-Parkinson-White syndrome, Adam-Stokes syndrome
                            Adverse Reactions/Precautions
         •  Continuous EKG monitoring is necessary.
         •  Increased ventricular rate may be seen when given to a patient in A-Fib.
         •  At high doses, monitor closely for CNS toxicity, seizures, depression, and respiratory depression.
         •  D/C immediately if toxicity develops
         •  The elderly may have an increased chance of CNS and cardiovascular side effects.
                                Dose/Administration
                                                    PEDIATRIC
                      ADULT
                                              (Always reference Broselow Tape)
         Cardiac Arrest from VF/VT       Shock Refractory VF/pVT
         (if Amiodarone is not available)  •  IV/IO
         •  IV/IO                            Initial dose: 1mg/kg loading dose
             Initial dose: 1–1.5mg/kg         ˚ Continuous Infusion: 20–50mcg/kg/min
              ˚ For refractory VF, may give an additional     ˚ infusion (repeat bolus dose if infusion initiated
              ˚ 0.50.75mg/kg IV push, q5–10min  >15min after initial bolus therapy)
             ■   Maximum: 3 doses or a total of 3mg/kg
             ■   Follow with continuous infusion
              1–4mg/min after ROSC
         Perfusing Arrhythmia (if Amiodarone is
         not available): Stable VT, Wide Complex
         Tachycardia, Significant Ectopy
         •  IV/IO
              ˚  1–1.5mg/kg. Repeat 0.5–0.75mg/kg q5–10min
               Maximum cumulative dose: 3mg/kg
             ■
             ■   Follow with continuous infusion 1–4mg/
              min (20–50mcg/kg/min)
         Flush after Initiation of IO
         •  May add 2–3mL Lidocaine 2% (without
           epinephrine) to 5mL NS flush
         Local Anesthesia During Tube/Finger
         Thoracostomy
         •  Draw 10mL 2% Lidocaine and locally anesthetize
           the incision area
         Decompression Illness/Arterial Gas Embolism
         •  IV/IO
              ˚  1.5mg/kg
        134  •   MEDICATIONS
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