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MMG to Lidocaine

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Review of EMS medication Lidocaine

All right class uh we’re gonna move into a medication uh kind of near and dear to your heart if you’ve ever got stitches before this is the drug that they give you to numb you up so uh but we’ve got a lot of uses for lidocaine so we got a lot of things to cover with this um and let’s see if a little bit of humor here uh yeah where’s the lidocaine the nurses like

Oh my god right there we go so what lidocaine hydrochloride otherwise known as xylicane again and it’s used to treat life-threatening dysrhythmias it’s also used as a local anesthetic uh but it’s got other uses as well um besides the anesthetic properties it helps decrease the endocranial spike associated with using suction neocholine and it actually prolongs a

Little bit of the succinylcholine effects so the class of drug that it is it’s an antiarrhythmic a class 1b it’s a sodium channel blocker okay so it blocks the sodium channels which does not allow the ion exchange therefore causing the numbness it’s a central nervous system agent and again we use it as a local anesthetic to numb numb people up uh doing sutures uh

If you’re gonna start an iv actually you can inject just a small little bit of uh two percent lidocaine up underneath the vein so it doesn’t hurt near as bad um so again it pre it depresses ventricular automaticity so it doesn’t allow the the impulse to allow it to generate its own impulse or allow it to be excited especially during when you’ve got a um you’ve

Got irritated tissue and when you’ve got hypoxic tissue there you got damaged tissue the lidocaine actually prevents it from from depolarizing like it should and it does that do the phase four action um and again increases ventricular fibrillary threshold so if you got a patient in v fib it makes it to where it’s harder to enter that threshold it does suppress

A lot of re-entry arrhythmias so if you’ve got a an additional pathway between the atria and the ventricles instead of the the bundle of hiss and the and the av node again it will help suppress those and again it blunts the the the chances of having intracranial pressure with rsi but i got to stress that point it prevents the spike from happening it does not

Actually reduce intracranial pressure so again usually takes the less than three minutes iv to um to to activate one to two minutes if you go through the endotracheal tube and the duration is roughly two to four hours it takes a couple passes through the liver in order to get that get that out of the system so we also use it to pre-medicate a patient uh with

Before succinylcholine especially if you have a closed head injury we usually do this because it also helps block the vagal response with the with using the laryngoscope blade so again as we lift that unfortunately stimulates the vagus nerve it can slow down the heart again it’s an alternative to amiodarone and cardiac arrest for v-fib pulseless v-tac the 2020

Guidelines actually said hey you can use it interchangeably with the amiodarone which i’m personally glad of but again um the amiodarone has good uses we’ll talk about it when we get to there it is more of a potassium and sodium channel blockers so it it it works upon a different mechanism all right but it’s a very good ventricular dysrhythmic if there’s a

Problem with the ventricles it’s a great drug to use uh again suppresses pvcs uh if you are in v fib or vtec it is is a drug of choice for those uh post cardioversion again to prevent them from going back into a lethal arrhythmia and we also use it in pain management if you’ve started an io the drilling of an io hurts very little the when you start pushing

Fluids through an io you’ll want to come to jesus and it hurts it hurts terribly is what it hurts and and you want to numb that cavity just like you would an iv site uh again so again by the way just as a reminder you can use it to treat arrhythmias but it can also give you arrhythmia so be aware of that let’s see here and some of the side effects the big ones

Blurred vision tinnitus which is ringing in the ears you can actually if you give this medicine can cause seizures uh it’s very common to get for them to get the euphoric the lightheaded a little bit of confusion that’s kind of a normal thing for central nervous system side effects on these guys your cardiovascular effects again hypotension um they can cause an

Arrhythmia it will definitely slow down a heart rate so if you got a slow heart we don’t give it at all it can cause cardiac arrest if you push it you push it too fast it can widen the qrs complex out um all of these again nausea vomiting is kind of a common side effect with this and every now and then you’ll get one who actually starts to break out in a rash

Has an anaphylactic reaction um so again if they know that they’ve got a a history of sensitivity to the canes they work on a little different mechanism but they’re all sodium channel blockers so that can cause problems don’t give lidocaine for that if they have bradycardia and they’re throwing pvcs remember that a pvc is going to be a escape beat and if you

Kill those you will actually kill the patient because the back up mechanism you’re shutting down all right the high degree heart blocks if the second third degree heart blocks if they have it stay away from the lidocaine a matter of fact if they have any bifesicular or or left bundle right bundle branch blocks you probably should not be using lidocaine if they

Have a low blood pressure again it’s gonna you need to not give this drug okay stokes adam syndrome which is a sudden transient episode of syncope and occasionally featuring seizures if you give it to a stoke saturn patient they will probably go into another seizure on you they have wolf parkinson white syndrome again you’re you’re not going to give this drug uh

We don’t just give it prophylactically for an acute heart attack we just don’t do it not anymore uh when i first got in the business we did it was to prevent the patient from going into v fib we found out maybe that was a really bad idea again a wide complex escape beats uh with a bradycardia again if it’s bradycardia we shouldn’t be using this drug or any type

Of ventricular blocks again we don’t use it uh if they’re in a february flutter i would probably there’s better agents to use i would not use uh lidocaine on those folks except for some really rare dumb circumstances and again most of the time that’s going to be a doctor telling me what that dumb circumstance is and then to do it um there’s been a great debate by

The way which one is the better antidysrhythmic whether it’s ambiodrone or lidocaine uh i gotta be honest with you um i’m about six one half dozen the other it depends on the situation really does um but i can tell you right now usually for an anti-dysrhythmic lidocaine is not your first line drug it’s your second line drug we usually give the lidocaine more for

The numbing agent or we’re giving it for again uh you’re trying to blunt the uh the intracranial pressure when you’re doing a drug assisted innovation okay again the problem is if you do give this drug if you give high doses of lidocaine and again it can extend out the liposuction neocholine if you got beta blockers or dopamine it could uh precipitate toxicity it

Slows down processing in the liver and the problem is you give too much lidocaine that’s when you get the toxic effect the seizures the confusion the the low blood pressure if they got congestive heart failure or mi which is kind of ironically if you’re having any of those things that are in the red on the screen uh you want to reduce the half elderly patients

If they’re over the age of 70 they’ve got any liver problems or renal problems cut the dose in half okay it’s better to give them a half dose and then another half dose than another half dose than to give them the full blast dose okay uh be careful using that simultaneously with any of these drugs up here the reason that i say that is because again you can have a

Toxic effect from it and again the metabolic clearance in these patients uh beta adrenergic blockers are patients with decreased cardiac function or liver function disease they it is decreased so again if they’re on a beta blocker the oll drugs again it’s going to take longer for this drug to get out usually 75 100 milligrams will maintain adequate blood levels

For about 20 minutes usually when we give lidocaine we actually give a maintenance drip with it okay so once we reach the therapeutic level for these folks we continuously infuse it to maintain the level all right again minimize intracranial pressure spikes that bradycardia occurs with pvcs always treat the bradycardia first and lidocaine is not your treatment

For bradycardia it is the exact opposite of what you should be using all right um high doses of lidocaine can produce can end up in coma or death and avoid lidocaine if you’re going to reprofusion arrhythmias after fiber analytic therapy so if you give the the clot busting drugs i can guarantee you they’re going to throw some arrhythmias lidocaine is probably not

Your drug to follow up with all right cross ray activity with local anesthetic so it will add to the effects if they’re already under some sort of local anesthesia again the drug is metabolized in the liver alright so it takes a time to get that out and again this half-life is kind of long and again um usually we find it in the red box as 100 milligrams and 5 mls

Okay the other way they do supply it is a pre-mix of of one gram and 500 mls and then the other way that we actually use it and lidocaine jelly um so instead of ky jelly the lidocaine jelly it has a numbing effect so that the patient doesn’t feel it as bad dosing this is where it gets hairy um dosing cardiac arrest it’s one to 1.5 milligrams per kilogram iv

Push every three to five minutes and then you repeat it with a half of a dose okay so if i started out and i gave 100 milligrams my second dose would be 50 third dose 50 up till i reach 3 milligrams per kilogram my max dose is 3 milligrams a kilogram and i can tell you right now that is a healthy dose of lidocaine okay so uh a matter of fact i’d be kind of leery

Getting up around the three milligram per kilogram range if you have stable vtec wide complex tachycardia again we usually use a half of a dose of that so again 50.5 to 0.75 milligrams a kilogram up to 1 to 1.5 okay pvcs is usually 1.5 milligrams per kilogram iv push all right and then you use half the dose again until you reach a max of three milligrams per

Kilogram for rsi it’s usually 1.5 milligrams per kilogram guys if you do one milligram per kilogram that’s fine okay uh kind of depends on the protocol the protocols usually say one to one point five milligrams per kilogram if you’re giving it to numb up the io you’re going to give it through the i o and you’re going to push it about 20 milligrams it’s actually

20 to 40 milligrams uh io and you push it you can repeat that one time again this is the numb the inside of the bone cavity where all the nerves are okay if you’re going to do a maintenance infusion all right this is the uh usually when it’s 1 gram and 250 ml or 2 grams and 500 okay but it gives you a concentration of four milligrams per milliliter okay so we

Administer it at two to four milligrams a minute if you give only one dose of lidocaine we usually start it at two if you give two doses we usually give three if we get the third dose we start at four okay and then you reduce the maintenance infusion by fifty percent if the patient’s over seventy so again if i normally would start it at two milligrams a minute

That only started at one milligram a minute and when you guys start to learn drug calculations we’re going to definitely go over that and how to set it correctly so your pediatric bolus is usually one milligram per kilo and again uh for a i o if you have to sedate i usually start with five uh five milligrams of iv push and then or i o push and then i i slowly

Give it until they they the discomfort goes away uh again guys i will tell you for pediatric maintenance infusions um guys uh in all the time i’ve ever done this don’t worry about the pediatric infusion there so mix 300 and 250 and it gives you one mic per kilo per minute and you usually start and again so again 10 10 to 50 micrograms per kilogram per minute

Is the the lidocaine pediatric maintenance bolus dose all right remember the bola stones one milligram per kilogram okay that’s what we’re after all right we can give it iv io it can actually be given through the endotracheal tube the problem with going down the et tube is is that it’s called drowning a patient and so we don’t really like to do that sometimes

We actually mix the lidocaine in with the with the ky jelly to help numb the throat when you’re doing an endotracheal innovation uh this is a very acceptable thing to do in certain protocols uh and again your pregnancy class pretty safe drug uh we we it’s again it’s it’s given to a lot of pregnant patients uh again episiotomies they have no problem uh with the

Matter of fact they want to be numb all right that’s going to do it for the the lidocaine uh again study this drug hard especially the main how to make the maintenance strips make sure that you understand that and make sure you understand the dosing regiment i’ll see you guys on the next video

Transcribed from video
MMG to Lidocaine By The Mad Medic Learning Network