ACLS Drugs – Lidocaine
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Article at a Glance
- Lidocaine is a calcium channel blocker antiarrhythmic used in treating VF and pulseless VT.
- The dosage of lidocaine is 1-1.5 mg/kg as a first dose and the second dose is half the first for a total of 3 mg/kg.
- Side effects of lidocaine include hypotension, altered mental status, seizures, and slurred speech.
- The provider should administer lidocaine and follow with a saline bolus.
Lidocaine is a class I antiarrhythmic, which means it is part of the sodium channel blocker family. Since 2018, it is the first line antiarrhythmic that we can use in Advanced Cardiac Life Support (ACLS). Lidocaine is indicated for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) that is refractory to defibrillation — meaning that when you shock the patient, it doesn’t work. So after going back to chest compressions, we’re going to administer an antiarrhythmic. We can use lidocaine or amiodarone. Either one is fine. Lidocaine is an antiarrhythmic in the sodium channel blocker family (Class I).Introduction to Lidocaine
Related Video – ECG Rhythm Review – Ventricular Fibrillation
Related Video – ECG Rhythm Review – Ventricular Tachycardia
Dosing
The dosing parameters for lidocaine are 1–1.5 mg/kg. Next, we’ll learn why there is such a range. Here is an example: a manufacturer’s package: 100 mg in 5mL.
Lidocaine comes packaged as 100mg in 5mL.
Think about this dosing example: If I wanted to administer 1mg/kg and I wanted to use that whole ampule — the whole 100 milligrams — my patient would have to weigh 100 kg (or 220 pounds). If I gave the whole thing, 100 mg at a dosing of 1 mg/kg, my patient weighs 220 pounds.
Now, if I wanted to administer 1.5 mg to my patient and use the whole vial, all 100 mg, my patient would have to weigh 66 kg (or about 146 pounds). So what does that mean? In short, if your adult patient weighs between 146 pounds and 220 pounds, administer the whole 5 mL, or 100 mg, and you will be dosing that patient within the recommended dosing parameters of 1–1.5 mg/kg. For elderly patients, you may want to cut the dose in half. Follow your local protocols.
Related Video – What is the Dosage Calculation?
Next, we will cover the initial and subsequent dosing for lidocaine. The first dose of lidocaine is 1–1.5 mg/kg. A second dose, if required, would be half of that, or 0.5–0.75 mg/kg.
If a second dose of lidocaine is required, the second dose is half the first dose.
Side Effects
Our next topic is the side effects of lidocaine. Side effects of lidocaine, based on what is published, are altered mental status, slurred speech, hypotension, and seizures. Watch for hypotension with the administration of any antiarrhythmic.
As for seizures, it is rare. However, every time I’ve administered lidocaine within the context of ACLS, my patient was at that time, almost dead, and that they had no pulse and were not spontaneously breathing. I’ve never actually seen a seizure with lidocaine, but it is something to watch for.
Read: ACLS Drugs – Epinephrine
Drug Administration
Keep in mind how we administer the medication. Remember, antiarrhythmics have to get to the heart to be effective. After you administer that medication by IV route, you follow it with a 10–20 mL syringe bolus of saline to help push that drug to the heart.
If they’re in ventricular fibrillation (VF), they have no cardiac output. Compressions provide maybe 20 or 25% of the normal cardiac output, so we have to help that medication get to the heart quickly and in sufficient concentration to cause an effect.
Related Video – What is Cardiac Output?
Follow the lidocaine with a saline bolus to help push the drug to the heart.
Summary
Lidocaine has several usages in ACLS. After reading this article, you now understand the dosing information, side effects, and administration.
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