Lidocaine

Provider Level

AEMT/RN/Paramedic

Class

Antiarrhythmic (Class Ib), Local Anesthetic

Mechanism of Action

Blocks fast sodium channels in the Purkinje network and ventricular myocardium, decreasing automaticity and increasing the ventricular fibrillation threshold. Also blocks nerve impulse conduction when used locally.

Indications

Ventricular fibrillation, pulseless ventricular tachycardia, stable ventricular tachycardia, suppression of malignant premature ventricular contractions, pain management during intraosseous infusion.

Contraindications

Hypersensitivity to amide-type local anesthetics, prophylactic use in acute myocardial infarction, second or third-degree AV block in the absence of an artificial pacemaker, Stokes-Adams syndrome, severe sinoatrial block.

Routes

IV, IO, ET, SQ, Dermal

Onset / Duration

Onset 1 to 5 minutes. Duration 15 to 120 minutes.

Adverse Effects

Seizures, altered mental status, slurred speech, tinnitus, muscle twitches, bradycardia, hypotension, heart block, respiratory arrest.

Precautions & Interactions

Use caution in patients with hepatic disease, heart failure, marked hypoxia, severe respiratory depression, hypovolemia, or shock. Toxicity risk is increased in elderly patients or those with reduced hepatic blood flow.

Special Considerations

Continuous ECG monitoring is required during systemic administration. Monitor closely for signs of central nervous system toxicity such as perioral numbness, tinnitus, and visual disturbances which often precede seizures.