Lidocaine is a local anesthetic used by dentists, dermatologists, and anyone doing a local procedure. Our focus is on the anti-arrhythmic properties though.
- Ventricular Arrhythmias
- Digoxin-induced toxicity arrhythmias
- Loading Dose
- Intravenous infusion
- CNS Toxicity: tinnitus, respiratory depression, seizure
Used for antiarryhtmic intravenous use only: Lidocaine has a high therapeutic index meaning it’s very safe yet we still have tragedies associated with this drug. This is a drug that doesn’t work right away when you start an IV infusion because you don’t get the blood levels quickly enough. So what you do is you give them a loading dose (bolus) intravenously.
So at first, we’d shoot in 100mg of lidocaine into their veins. At the same time, we’d start an infusion bag, grab a syringe from the crash cart that had 2 grams of lidocaine, mix it up in the IV bag, hang the bag and start a slow IV drip into the patients veins.
Something went wrong with our system: Here’s what happened many times. A patient had ventricular arrhythmia going on and a code was called. The physician responding to the code would call for a lidocaine bolus shot and the nurses would accidentally inject the 2 gram syringe instead of the 100mg syringe into the vein, giving over 20 times the dose and the patient would die in a minute. In a code situation, things are moving fast and you’re doing everything you can to save a persons life and sometimes we’re not thinking. And this happened over and over and over again.
Health care professionals, again, had to make a change to stop these errors. The solution to this was that the manufacturers figured out that they could add dextrose to the solution to make it stable and so instead of a 2 gram lidocaine syringe, you now have a premixed 500ml bag in your crash cart. So the only lidocaine syringe in your crash cart is the 100mg syringe
If the patient is diabetic, what do you do? You continue because their blood sugar is not an issue already. The atrial fibrillation is the issue. You hang that IV. It’s a slow drip anyway, so just do it.