NORTH COAST MERGENCY MEDICAL SERVICES Policy # 5309

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Policies: 01/10/98

1. Class:

1. Ventricular antidysrhythmic.

2. Indications:

1. Premature ventricular contractions (coupled, multi formed, R on T phenomenon or greater than 6 per minute) with chest pain, or hypotension.
2. Ventricular tachycardia.
3. Recurrent ventricular fibrillation.

3. Therapeutic Effects:

1. Suppresses ventricular ectopic activity by decreasing the excitability of the heart muscle and its conduction system.

4. Contraindications:

1. Absolute:

1. Bradycardia.
2. Asystole.
3. Idioventricular rhythms.
4. Hypersensitivity.
5. 2nd or 3rd degree heart block.

1. Relative:

1. Renal dysfunction.
2. CHF.
3. Patients over 70 years old. (Consider lower doses and/or very slow IV for these patients.)

5. Adverse Effects:

1. Slurred speech.
2. Altered level of consciousness.
3. Toxic levels can cause seizures.
4. Muscle twitching.

6. Administration and Dosage:

1. Adult:

1. Symptomatic PVC’s with a pulse: 1 mg- 1.5 mg/ kg IVP, followed by additional 0.5 mg-0.75 mg/ kg boluses every 5-10 minutes, to a total of 3 mg/ kg. If lidocaine is successful, initiate IV infusion at 2 mg- 4 mg/ minute.
2. Ventricular fibrillation or Pulseless ventricular tachycardia: 1 mg-1.5 mg/ kg IV. (ET dose: 2 to 2.5 times normal dose.) Repeat every 3-5 minutes as needed. Total maximum dose 3 mg/ kg. If Lidocaine is successful, initiate IV infusion at 2 mg-4 mg/ minute.

1. Pediatric:

1. 1 mg/ kg IV, IO, or ET (ET administration dilute with NS to volume of 3- 5 ml).
2. Infusion rate: Dose of 20-50 mcg/kg/min.

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