ACLS and Lidocaine | ACLS-Algorithms.com

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    • ACLS says

      That is correct. However, you would only hang amiodarone or lidocaine if there was continued anti-rhythmic activity during the post-arrest phase. According to the American Heart Association, antiarrhythmics would be used during the post-cardiac arrest phase only if arrhythmias persist.

      If arrhythmias do persist then the antiarrhythmic that was used to achieve ROSC would be utilized.

      Kind regards,
      Jeff

  1. Hill says

    What size NS bag would you dilute Lidocaine 100mg/5 mL into? And how much mg/mL would need to be diluted to reach appropriate maintenance drip?
    For example if I use a 1000mL NS bag how much mg of lidocaine would need to be diluted into bag?

    • ACLS says

      An IV infusion of lidocaine by adding 1g of lidocaine (using 25 ml of a commercially available 4% or 5 ml of a 20% injection) to 1 L of D5W injection to provide a concentration of 1 mg/ml.

      Kind regards, Jeff

  2. Ahmad says

    When would you give Lidocaine in refractory Vfib after giving multiple defibrillations and 2 doses of Amiodarone (300mg and 150mg)?

    • ACLS says

      lidocaine may be given at any time after the two doses of amiodarone. It just needs to be given at the beginning of a cycle of CPR in order to ensure good distribution within the central circulation.

      Kind regards,
      Jeff

    • ACLS says

      Yes, lidocaine can be used for the treatment of cardiac arrhythmias. It is an alternative to amiodarone.

      Kind regards,
      Jeff

    • ACLS says

      Ideally, you would use actual body weight. However, in emergencies, the weight is not always known. I have see estimated weights or weights reported by family used.

      Kind regards,
      Jeff

  3. Jennifer Wolcott says

    I had a student ask why the second dose of lidocaine for refractory VF was lower. Is this due to concerns for toxicity?

    • Jeff with admin. says

      Amiodarone is the primary medication that is used for refractory ventricular fibrillation. The lower second dose is due to the long half-life of amiodarone and the risk for toxicity if ROSC occurs.

      The same is true for lidocaine even though the half life is much shorter than amiodarone.

      Kind regards,
      Jeff

    • Jeff with admin. says

      I have never heard of any person being treated for bradycardia using lidocaine. Lidocaine is an antiarrhythmic and would not be indicated for bradycardia.

      The correct treatment for hypertensive bradycardia would be to initiate transcutaneous pacing as soon as possible and possibly utilize atropine while waiting for transcutaneous pacing.

      Also, according to AHA protocol an intravenous infusion of epinephrine or dopamine could be used for the treatment for hypotension and bradycardia.

      Kind regards,
      Jeff

    • Chase says

      I just had a provider want me to spike a lidocaine drip on a patient with multiple PVCs. The patient was asymptomatic despite shortness of air related to abdominal bloating. I was concerned because if the patient decompensated into VT, lidocaine is not first treatment. Why would the provider have wanted lidocaine instead?

      • Jeff with admin. says

        There would be no indication for lidocaine drip in this case. I haven’t seen someone start a lidocaine drip it years. There is no research that I know of that supports the use of a lidocaine drip to suppress asymptomatic PVCs.
        Kind regards, Jeff

    • Brian says

      Treat the Rate, before the Rhythm. Symptomatic Unstable Bradycardia should be paced regardless of the rhythm

  4. Curt says

    Chris, Bob’s question is a little outside the scope of cardiac arrests where the data the ACLS guidelines come from. He appears to be concerned with a patient with frequent PVCs (perhaps multiple short runs of VT) with signs and symptoms that suggest decompensation. While amiodarone can suppress these, a number of other agents may be valuable. Your suggestion to involve a cardiologist or electrophysiologist is a good one.

  5. Bob says

    Dinosaur EMT-P here. Confusing old algorithms with new is always a huge fear. Then the terminology changes too. “Monomorphic Wide VT” (PVCs?) I was looking for information regarding Lidocaine VS Amioderone in the case of decompensated PVCs > than 6-min. I couldn’t find ANYTHING referencing PVCs. Used to be a cardinal rule, an absolute thing. I understand all the good things about Amioderon and I certainly understand and practice the theory that PVCs are typically a result of poor oxygenation, improve the oxygenation typically the PVCs will sort themselves out. Please bring me out of the stone age…

    • Chris with admin. says

      I’ve never heard of decompensated PVCs. I’m not sure I really understand the question. PVCs are not treated with medication via the ACLS Algorithms. Amiodarone is the first drug of choice for V-Tach simply because it’s the only drug that has been validated with research. If someone is having recurring PVCs and have never seen a cardiologist, they should see a cardiologist.

      Kind regards,
      Chris

    • Willy Lauder says

      For the most part, we are no longer too concerned with PVC’s, so long as they are perfusing. Even then, there are lots of reasons PVC’s happen so taking them away is high on the priority list. Finding out why they occur is the treatment. Sometimes taking them away causes more problems later.

  6. Sandeep says

    If there is shortage of Lidocaine 2% hcl injections that are specifically marked for cardiac arrhythmia can we use the Single dose 2% (20mg/ml) 10mL Vial NDC 0409-4282-02 for cardiac arrhythmia.
    Thank you

  7. Greg says

    Why would lidocaine be appropriate for ventricular tachyarrhythmias? As a sodium channel blocker (Ib) it shortens the ERP, wouldn’t that be counter-intuitive to treating a tachycardia?

    • Jeff with admin. says

      No. Lidocaine is not mandatory on a crash cart. It would be wise to have it available but it is not mandatory. It would be wise to stock some type of antiarrhythmic and if not amiodarone then lidocaine would be a good second choice.
      Keep in mind, hospitals set their own policies for what should go on a crash cart. You need to check with your facility to see what is “mandatory” on their crash carts. They can set the policy.
      Kind regards,
      Jeff

      • ACLS says

        When lidocaine is used during cardiac arrest, boluses should be administered rapid IV push and followed by 20 mL of normal saline.

        Kind regards,
        Jeff

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