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Class
Antiarrhythmic, Class 1 B Sodium Channel Blocker
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Pharmacology and Actions
- - Depresses automaticity of Purkinje Fibers; therefore, RAISES stimulation threshold in the ventricular fibers (makes fibers less likely to fibrillate).
- - Little antidysrhythmic effect on atrial muscle at subtoxic levels
- - Cardiovascular effects:
- - Decreased conduction rate and force of contraction, mainly at toxic levels
- - Prolongs phase 4 depolarization and shortens action portential
- - CNS stimulation
- - Tremors, restlessness, clonic convulsions followed by respiratory depression and respiratory failure at higher doses
- Onset of action: less than 4 minutes
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Indications
- - Ventricular tachycardia or wide-complex tachycardia with pulses
- - Recurrent or refractory ventricular fibrillation/pulseless v-tach
- - Following successful defibrillation
- - Pre-intubation in head injuries (minimizes the rise in ICP)
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Contraindications
- - Not used for Supraventicular Rhythms or Bradycardias
- - Hypersentivity to any of the caines
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Precautions and Side Effects
- - CNS disturbances
- - Sleepiness, dizziness, disorientation, confusion, and convulsions
- - Cardiovascular
- - Hypotension, bradycardia, decreased myocardial contractility and increased AV blocks at toxic levels only
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Dosage (Adult)
- - V-Fib / pulseless V-Tach: 1-1.5mg/kg IV / IO, repeat in 3-5 minutes at 0.5-0.75mg/kg (half of initial dose). Max dose 3 mg/kg
- - Pulsing V-Tach: 1mg/kg IV / IO, repeat every 5-10 minuets at 0.5mg/kg to a max dose of 3 mg/kg.
- - Maintenance drip (hang after successful conversion of rhythm with lidocaine to a pulsing sinus rhythm >60bpm: 2-4mg.min (usally start at 2mg/min - titrate up as needed). USE 4 mg/ML concentration.
- - Pre-intubation head injury only: 1mg/kg IV / IO
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Dosage (pediatric)
- - V-Fib / pulseless V-Tach: 1mg/kg IV / IO, repeat in 3-5 minuets. Max dose 3mg/kg
- - Pulsing V-Tach: 1mg/kg IV / IO, repeat at 0.5mg/kg every 5-10 minuets to a max dose of 3 mg/kg
- - Maintenance Drip (hang after successful conversion of rhythm with lidocaine to a pulsing sinus rhythm > 60bpm): 20-50 mcg/kg/min.
- - Pre-intubation head injury only: 1mg/kg IV / IO
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How Supplied
- - 100 mg in 5 mL pre-load syringe (2% solution)
- - 1g in 250ml pre-mixed bag OR 2g in 500 mL pre-mixed bag (20% solution)
- - 1g in 5cc vials (20% solution) for mixing - NOT TO BE USED AS BOLUS
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