Re: IV Lidocaine Administration

[Guest guest]

<< Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?..........So does anybody know of recent

research

indicating that the loading dose should be reduced as well as the

maintenance dose?>>

I was very surprised by what you found in the literature....my understanding

was that ACLS said the loading dose was supposed to be reduced by 1/2.

Unfortunately, I cannot cite any literature for such (prior to your post, I

would have referred you to ACLS/JAMA text!)

<<How many are currently reducing all lidocaine administrations by

one/half in those over 70? >>

Our protocol is just that; over 70 years, the bolus dose is 1/2 the standard

dose.

Physiologically, it would seem that the loading (bolus) dose would be at least

as much of concern for hepatic function as the maintenance drip. My " gut "

reaction would be that a bolus dose would be more likely to overwhelm the

diminished hepatic resources of an elderly patient than a maintenance

infusion....but I cannot cite any research to support this premise.

Good luck,

------------------------------------------------------------------------

[Guest guest]

Boy Gene!

Could you have found a harder one? You

don't like to make anything easy!

Let me dig, and i'll get back to you.

Les

E. Gandy wrote:

Am starting an extended ACLS course tomorrow and

the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50%

in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both

of

which clearly state that the loading dose is not to be reduced but

that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition,

page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using "lidocaine toxicity in the elderly"

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

------------------------------------------------------------------------

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[Guest guest]

hey g-man,

what is the difference in the acls course and the extended course?

also, why would you want to vere from the acls algorithymns?

guess, im having a brain block today--(must be because i just got a day

older)..help me out gene with this one and so that i can understand...

thanks

randy,emtp

emt@...

[] IV Lidocaine Administration

>Am starting an extended ACLS course tomorrow and the following

>controversy has arisen.

>

>Should the initial loading dose of lidocaine in either VF/PVT or Stable

>VT be reduced by 50% in patients over 70, or should only the

>maintenance infusion be reduced?

>

>One of our physicians favors reducing all lidocaine doses by 50% in

>those over 70.

>

>The only information I can find is in the 1992 JAMA article upon which

>the current ACLS guidelines are based and in the ACLS manual, both of

>which clearly state that the loading dose is not to be reduced but that

>the maintenance infusion should be reduced in those with known hepatic

>disease or over the age of 70. However, Tintinalli's 4th edition, page

>396 states, without reference, that some have suggested reducing the

>loading dose by one-half to one-third in those over 70. The chapter

>bibliography contains nothing I can identify as being supportive.

>

>A Medline search a while ago using " lidocaine toxicity in the elderly "

>turned up 86 articles, 6 of which addressed the subject, but none of

>which are later than 1986. So does anybody know of recent research

>indicating that the loading dose should be reduced as well as the

>maintenance dose?

>

>How many are currently reducing all lidocaine administrations by

>one/half in those over 70?

>

>Gene Gandy

>--

> E. Gandy, JD, EMT-P

>EMS Professions Program Director

>Tyler Junior College

>Tyler, TX

>ggan@...

>

>Check out our website at: http://www.tyler.cc.tx.us/emmt/

>

>

>------------------------------------------------------------------------

>NextCard Internet VISA - 2.9% intro APR

>Earn free airline tickets WITH DOUBLE Rew@rds points.

>http://ads./click/63/0/nextcard

>

>

>

>

[Guest guest]

The extended course is what we do in paramedic class. It's 48 hours of

intense ACLS designed to allow the student to achieve absolute proficiency in

all the suggested scenarios. That means intense and repeated megacode

practice.

The reason I asked the lidocaine question is that the medical director of

one of the services we work with has changed their protocol to require that

both the loading dose and maintenance infusions be cut in half. That doesn't

jibe with what I understand ACLS guidelines to require; I wanted to be sure

that there hadn't been a change I don't know about. We will continue to

teach the ACLS algos as best we understand them, while pointing out that they

are only guidelines and that any individual medical director is free to

modify them in any way she desires.

Gene

Randy Dees wrote:

> hey g-man,

> what is the difference in the acls course and the extended course?

> also, why would you want to vere from the acls algorithymns?

> guess, im having a brain block today--(must be because i just got a day

> older)..help me out gene with this one and so that i can understand...

>

> thanks

> randy,emtp

> emt@...

>

> [] IV Lidocaine Administration

>

> >Am starting an extended ACLS course tomorrow and the following

> >controversy has arisen.

> >

> >Should the initial loading dose of lidocaine in either VF/PVT or Stable

> >VT be reduced by 50% in patients over 70, or should only the

> >maintenance infusion be reduced?

> >

> >One of our physicians favors reducing all lidocaine doses by 50% in

> >those over 70.

> >

> >The only information I can find is in the 1992 JAMA article upon which

> >the current ACLS guidelines are based and in the ACLS manual, both of

> >which clearly state that the loading dose is not to be reduced but that

> >the maintenance infusion should be reduced in those with known hepatic

> >disease or over the age of 70. However, Tintinalli's 4th edition, page

> >396 states, without reference, that some have suggested reducing the

> >loading dose by one-half to one-third in those over 70. The chapter

> >bibliography contains nothing I can identify as being supportive.

> >

> >A Medline search a while ago using " lidocaine toxicity in the elderly "

> >turned up 86 articles, 6 of which addressed the subject, but none of

> >which are later than 1986. So does anybody know of recent research

> >indicating that the loading dose should be reduced as well as the

> >maintenance dose?

> >

> >How many are currently reducing all lidocaine administrations by

> >one/half in those over 70?

> >

> >Gene Gandy

> >--

> > E. Gandy, JD, EMT-P

> >EMS Professions Program Director

> >Tyler Junior College

> >Tyler, TX

> >ggan@...

> >

> >Check out our website at: http://www.tyler.cc.tx.us/emmt/

> >

> >

> >------------------------------------------------------------------------

> >NextCard Internet VISA - 2.9% intro APR

> >Earn free airline tickets WITH DOUBLE Rew@rds points.

> >http://ads./click/63/0/nextcard

> >

> >

> >

> >

[Guest guest]

Okay Guy's,

I think I've found it in the NEW ACLS Text,

on page 1-19, 1st column;

"Several clinical conditions, such as advanced

age and compromised liver function, dictate lower loading doses of lidocaine.

Such patients should receive a single loading dose of 1 mg/kg."

Sound like AHA suggested reducing the loading

dose by one-third.

Gene, hope this is what you were looking for.

Les

E. Gandy wrote:

Am starting an extended ACLS course tomorrow and

the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50%

in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both

of

which clearly state that the loading dose is not to be reduced but

that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition,

page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using "lidocaine toxicity in the elderly"

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

------------------------------------------------------------------------

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[Guest guest]

JAMA, October 28, 1992, Vol. 268, No. 16, at page 2206: "The half-life

of lidocaine increases after 24 to 48 hours. Thus, with prolonged

infusions, the dose should be reduced after 24 hours or blood levels should

be monitored. The dose should be reduced in decreased cardiac output

(eg. in acute MI, congestive cardiac failure, or shock from whatever cause),

in patients older than 70 years, and in those with hepatic dysfunction.

These patients should receive the normal bolus dose

first, followed by half the normal maintenance infusion."

The ACLS Textbook says: "Although the loading

dose of lidocaine does not need to be reduced,

the maintenance dose should be decreased by 50% in

the presence of impaired hepatic blood flow (acute myocardial infarction,

congestive heart failure, or circulatory shock) because total body clearance

of lidocaine is reduced. The maintenance dose should also be reduced

by 50% in patients older than 70 years because they have a reduced volume

of distribution."

It also discusses the requirement of a loading dose to achieve therapeutic

levels rapidly. That's why, I assume, the initial dose is not reduced.

If you don't reach therapeutic level, then it doesn't do any good.

Gene Gandy

DPEMS500@... wrote:

In a message dated 11/2/98 2:23:35 AM !!!First Boot!!!,

ggan@... writes:

<< Should the initial loading dose of lidocaine in either VF/PVT

or Stable

VT be reduced by 50% in patients over 70, or should only

the

maintenance infusion be reduced?..........So does anybody know

of recent

research

indicating that the loading dose should be reduced as well as

the

maintenance dose?>>

I was very surprised by what you found in the literature....my understanding

was that ACLS said the loading dose was supposed to be reduced by 1/2.

Unfortunately, I cannot cite any literature for such (prior to your

post, I

would have referred you to ACLS/JAMA text!)

<<How many are currently reducing all lidocaine administrations

by

one/half in those over 70? >>

Our protocol is just that; over 70 years, the bolus dose is 1/2 the

standard

dose.

Physiologically, it would seem that the loading (bolus) dose would be

at least

as much of concern for hepatic function as the maintenance drip.

My "gut"

reaction would be that a bolus dose would be more likely to overwhelm

the

diminished hepatic resources of an elderly patient than a maintenance

infusion....but I cannot cite any research to support this premise.

Good luck,

------------------------------------------------------------------------

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[Guest guest]

BINGO! Thanks very much. I don't have

the latest copy of the Textbook, so that's what I was looking for.

Gene Gandy

Les wrote:

Okay Guy's,

I think I've found it in the NEW ACLS Text,

on page 1-19, 1st column;

"Several clinical conditions, such as advanced

age and compromised liver function, dictate lower loading doses of lidocaine.

Such patients should receive a single loading dose of 1 mg/kg."

Sound like AHA suggested reducing the loading

dose by one-third.

Gene, hope this is what you were looking for.

Les

E. Gandy wrote:

Am starting an extended ACLS course tomorrow and

the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50%

in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both

of

which clearly state that the loading dose is not to be reduced but

that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition,

page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using "lidocaine toxicity in the elderly"

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

------------------------------------------------------------------------

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[Guest guest]

Howdy y'all!

The reason for concern with lidocaine is because it is metabolized in the

liver. We make a rather arbitrary assumption (IMHO) that by the time we've

reached 70 our hepatic function has declined sufficiently to increase the

half-life of lidocaine. While everyone's liver function declines with age,

there is nothing magic about our 70th birthday that says we'll become toxic

with 1.5mg/kg of lidocaine.

My point in bringing this up is to beware of 'black and white' standards. It

is possible that a 65 year old with poor cardiac output (ie cardiac arrest)

wouldn't be able to tolerate 1.5mg/kg while a 75 year old with good hepatic

function and perfusion would benefit from a full dose.

It all comes down to sound judgement. Of course, we have to have the

fundamental understanding of the mechanism of action of these meds before we

can develop that judgement.

Take care,

Jeff

*******************************************

L. Jarvis, MS, EMT-P

Department Chair, EMS Technology

Temple College

http://www.templejc.edu/ems

[] Re: IV Lidocaine Administration

In a message dated 11/2/98 2:23:35 AM !!!First Boot!!!, ggan@...

writes:

<< Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?..........So does anybody know of recent

research

indicating that the loading dose should be reduced as well as the

maintenance dose?>>

I was very surprised by what you found in the literature....my understanding

was that ACLS said the loading dose was supposed to be reduced by 1/2.

Unfortunately, I cannot cite any literature for such (prior to your post, I

would have referred you to ACLS/JAMA text!)

<<How many are currently reducing all lidocaine administrations by

one/half in those over 70? >>

Our protocol is just that; over 70 years, the bolus dose is 1/2 the standard

dose.

Physiologically, it would seem that the loading (bolus) dose would be at

least

as much of concern for hepatic function as the maintenance drip. My " gut "

reaction would be that a bolus dose would be more likely to overwhelm the

diminished hepatic resources of an elderly patient than a maintenance

infusion....but I cannot cite any research to support this premise.

Good luck,

------------------------------------------------------------------------

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NextCard Internet VISA -- Apply online now!

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[Guest guest]

I would also suggest judicious use with the patient who has either chronic

or acute congestive heart failure. Hepatic circulation is compromised due

to the pathology of the disease and grandpa can become confused and toxic

real quick with a full dose of lidocaine. Like and Gene said, the

ACLS guidelines are just what they say they are; Guidelines.

Easley

President

UHCS, Inc.

______________________________________________________________________

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[Guest guest]

Les what is the date on that copy of the ACLS Text that your reading from???

Is that an update to what i got in Apr97??

Guess I also need to get my boss and have him run this also across our med director for his " nickle & dime " .

Let me know the scoop please sir.

Thanks,

randy emtp

emt@...

[] Re: IV Lidocaine AdministrationOkay Guy's, I think I've found it in the NEW ACLS Text, on page 1-19, 1st column; " Several clinical conditions, such as advanced age and compromised liver function, dictate lower loading doses of lidocaine. Such patients should receive a single loading dose of 1 mg/kg. " Sound like AHA suggested reducing the loading dose by one-third. Gene, hope this is what you were looking for. Les E. Gandy wrote: Am starting an extended ACLS course tomorrow and the following controversy has arisen. Should the initial loading dose of lidocaine in either VF/PVT or Stable VT be reduced by 50% in patients over 70, or should only the maintenance infusion be reduced? One of our physicians favors reducing all lidocaine doses by 50% in those over 70. The only information I can find is in the 1992 JAMA article upon which the current ACLS guidelines are based and in the ACLS manual, both of which clearly state that the loading dose is not to be reduced but that the maintenance infusion should be reduced in those with known hepatic disease or over the age of 70. However, Tintinalli's 4th edition, page 396 states, without reference, that some have suggested reducing the loading dose by one-half to one-third in those over 70. The chapter bibliography contains nothing I can identify as being supportive. A Medline search a while ago using " lidocaine toxicity in the elderly " turned up 86 articles, 6 of which addressed the subject, but none of which are later than 1986. So does anybody know of recent research indicating that the loading dose should be reduced as well as the maintenance dose? How many are currently reducing all lidocaine administrations by one/half in those over 70? Gene Gandy -- E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ ------------------------------------------------------------------------ NextCard Internet VISA - 2.9% intro APR Earn free airline tickets WITH DOUBLE Rew@rds points. http://ads./click/63/0/nextcard

[Guest guest]

Randy,

It is the Red

one,

top left corner has a diagonal strip that reads

"New Chapters on Stroke and Acute Myocardial Infarction"

stock

number 70-1086, 3-98. All the new text have the

"Emergency

Cardiovascular Care Programs"

logo

on them. The new text are also color coded:

Adult - Red;

Child

- Blue; and Pediatric

- Purple.

The

text can be purchased through several vendors. Two vendors that I use are:

Laerdal Medical Corporation

1- URL: http://www.laerdal.com/

Physico-Control Corporation

1- URL: http://www.physio-control.com/

Hope this helps,

Les

Randy Dees wrote:

Les what

is the date on that copy of the ACLS Text that your reading from???Is

that an update to what i got in Apr97??Guess I also need to get my boss

and have him run this also across our med director for his "nickle &

dime".Let me know the scoop please sir.Thanks,randy emtpemt@...

-----Original

Message-----

To: egroups

<egroups>

Date: Sunday, November 01,

1998 11:50 PM

Subject: [] Re: IV

Lidocaine Administration

Okay Guy's,

I think I've found it in the NEW ACLS Text,

on page 1-19, 1st column;

"Several clinical conditions, such as advanced

age and compromised liver function, dictate lower loading doses of lidocaine.

Such patients should receive a single loading dose of 1 mg/kg."

Sound like AHA suggested reducing the loading

dose by one-third.

Gene, hope this is what you were looking for.

Les

E. Gandy wrote:

Am starting an extended ACLS course tomorrow and

the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50%

in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both

of

which clearly state that the loading dose is not to be reduced but

that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition,

page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using "lidocaine toxicity in the elderly"

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

------------------------------------------------------------------------

NextCard Internet VISA - 2.9% intro APR

Earn free airline tickets WITH DOUBLE Rew@rds points.

http://ads./click/63/0/nextcard

[Guest guest]

Les,

Muchas gracias for the info.

A coincidence is that I signed a purchase order last week for the new books.

Now I'll be looking for any other changes there may be. Let's let

each other know of any significant differences.

I appreciate your input on my question.

It has saved me lots of research time.

It's my understanding that Physio-Control may

have pulled out of the book market. At least this is what

I was told at AHA in Austin last month. We have found Laerdal to

be an excellent company to work with. There's also another one, but

I don't have the name handy.

Gene Gandy

Les wrote:

Randy,

It is the Red

one,

top left corner has a diagonal strip that reads

"New Chapters on Stroke and Acute Myocardial Infarction"

stock

number 70-1086, 3-98. All the new text have the

"Emergency

Cardiovascular Care Programs"

logo

on them. The new text are also color coded:

Adult

- Red;

Child

- Blue; and Pediatric

- Purple.

The

text can be purchased through several vendors. Two vendors that I use are:

Laerdal Medical Corporation

1- URL: http://www.laerdal.com/

Physico-Control Corporation

1- URL: http://www.physio-control.com/

Hope this helps,

Les

Randy Dees wrote:

Les what

is the date on that copy of the ACLS Text that your reading from???Is

that an update to what i got in Apr97??Guess I also need to get my boss

and have him run this also across our med director for his "nickle &

dime".Let me know the scoop please sir.Thanks,randy emtpemt@...

-----Original

Message-----

To: egroups

<egroups>

Date: Sunday, November 01,

1998 11:50 PM

Subject: [] Re: IV

Lidocaine Administration

Okay Guy's,

I think I've found it in the NEW ACLS Text,

on page 1-19, 1st column;

"Several clinical conditions, such as advanced

age and compromised liver function, dictate lower loading doses of lidocaine.

Such patients should receive a single loading dose of 1 mg/kg."

Sound like AHA suggested reducing the loading

dose by one-third.

Gene, hope this is what you were looking for.

Les

E. Gandy wrote:

Am starting an extended ACLS course tomorrow and

the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50%

in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both

of

which clearly state that the loading dose is not to be reduced but

that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition,

page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using "lidocaine toxicity in the elderly"

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

------------------------------------------------------------------------

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[Guest guest]

Gene,

Not a problem, we are all a big team, with

hopefully the same goal in mind, to educate folks to save lives, or as

my slogan go's "HELPING YOU HELP OTHERS".

Plus, Medic System

Alumni have to stick together.

I heard the same thing about Physico-Control,

but have not had time to call and confirm it. On the back of all

the new book, the names and addresses of the four

"Authorized Distributors" of AHA materials.

The other two are :

Channing L. Bete Co., Inc.

1- URL: www/channing-bete.com

Labsource/ECC

1- URL:

www.labsource-ecc.com

Les

E. Gandy wrote:

Les,

Muchas gracias for the info.

A coincidence is that I signed a purchase order last week for the new books.

Now I'll be looking for any other changes there may be. Let's let

each other know of any significant differences.

I

appreciate your input on my question. It has saved me lots of research

time.

It's my understanding that Physio-Control may

have pulled out of the book market. At least this is what

I was told at AHA in Austin last month. We have found Laerdal to

be an excellent company to work with. There's also another one, but

I don't have the name handy.

Gene Gandy

Les wrote:

Randy,

It is the Red

one,

top left corner has a diagonal strip that reads

"New Chapters on Stroke and Acute Myocardial Infarction"

stock

number 70-1086, 3-98. All the new text have the

"Emergency

Cardiovascular Care Programs"

logo

on them. The new text are also color coded:

Adult

- Red;

Child

- Blue; and Pediatric

- Purple.

The

text can be purchased through several vendors. Two vendors that I use are:

Laerdal Medical Corporation

1- URL: http://www.laerdal.com/

Physico-Control Corporation

1- URL: http://www.physio-control.com/

Hope this helps,

Les

Randy Dees wrote:

Les what

is the date on that copy of the ACLS Text that your reading from???Is

that an update to what i got in Apr97??Guess I also need to get my boss

and have him run this also across our med director for his "nickle &

dime".Let me know the scoop please sir.Thanks,randy emtpemt@...

-----Original

Message-----

To: egroups

<egroups>

Date: Sunday, November 01,

1998 11:50 PM

Subject: [] Re: IV

Lidocaine Administration

Okay Guy's,

I think I've found it in the NEW ACLS Text,

on page 1-19, 1st column;

"Several clinical conditions, such as advanced

age and compromised liver function, dictate lower loading doses of lidocaine.

Such patients should receive a single loading dose of 1 mg/kg."

Sound like AHA suggested reducing the loading

dose by one-third.

Gene, hope this is what you were looking for.

Les

E. Gandy wrote:

Am starting an extended ACLS course tomorrow and

the following

controversy has arisen.

Should the initial loading dose of lidocaine in either VF/PVT or Stable

VT be reduced by 50% in patients over 70, or should only the

maintenance infusion be reduced?

One of our physicians favors reducing all lidocaine doses by 50%

in

those over 70.

The only information I can find is in the 1992 JAMA article upon which

the current ACLS guidelines are based and in the ACLS manual, both

of

which clearly state that the loading dose is not to be reduced but

that

the maintenance infusion should be reduced in those with known hepatic

disease or over the age of 70. However, Tintinalli's 4th edition,

page

396 states, without reference, that some have suggested reducing the

loading dose by one-half to one-third in those over 70. The chapter

bibliography contains nothing I can identify as being supportive.

A Medline search a while ago using "lidocaine toxicity in the elderly"

turned up 86 articles, 6 of which addressed the subject, but none of

which are later than 1986. So does anybody know of recent research

indicating that the loading dose should be reduced as well as the

maintenance dose?

How many are currently reducing all lidocaine administrations by

one/half in those over 70?

Gene Gandy

--

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

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[Guest guest]

I'm sorry Les, looks like Greek to me.....

Goodman EMT-P

Nursing Type Student....

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