Lidocaine for intubation in full arrest


Forum Ride Along
Hey y'all, have an interesting question:

So, I understand a lot of protocols call for lidocaine IV prior to RSI, the idea being that it blunts the cardiac response to laryngoscopy, protects ICP from spiking, etc. But here's something I got to thinking about after watching a megacode on youtube. Pt is in full arrest, ALS protocols are initiated, first round of epi is given. Fingerstick is 22, so lead medic instructs to prepare D50 and lido for intubation.

Here's the core of my question:

If you're giving epi because your BP (and ultimately your CPP) is in the crapper, (and, there is no reason to suspect the need for a neuro-protective intubation) why would you go ahead and give the lido to keep your pts pulse, BP and ICP from going up a little bit?


Forum Crew Member
RSI is purely for patient's with an intact gag reflex, which patients in cardiac arrest don't have. Furthermore, I'm not sure why you would tube someone prior to or shortly following administration of D50 if hypoglycemia is the suspected cause of the arrest (likewise if a narcotic overdose was the suspected cause and you decided to give Narcan). If you give them the dextrose and get them back and conscious, then you ARE going to have to sedate them because you've stuck an unnecessary tube down there throat.

Either they were giving the lidocaine for V-tach/V-fib, and you misunderstood it as pre-RSI therapy, or they're very confused about what in the heck they're doing trying to RSI a person who's already in arrest.


You have my stapler
If the patient is in arrest, it's going to be hard to have an effect cardiovascularly or on ICP no matter how much of a butcher you are with a layrngoscope...
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Forum Captain
.......why would you go ahead and give the lido to keep your pts pulse, BP and ICP from going up a little bit?
In full arrest you normally don't give it.

And in non-arrest patients, its still debateable whether of not its needed, or even causes enough increases to worry about