Lidocaine

mikie

mikie

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Ok, this is probably going to sound like a silly question, but I'm going to ask anyways :blush:

The lidocaine used in ACLS, how does it differ from the lidocaine used as a local anesthetic (for sutures, etc)? I can't be the same, can it?

I'm sure the answer is difficult, pharmacology speaking...but something would be nice.

Thanks!
 
Oh, yes. Indeed it can.

OKOK.
Same chemical, different strengths are used for different purposes. Additives are used for appropriate uses, to alter the pH, or, in cases where you want it to last a long time, epi is added to constrict local vessels. This can have side effect by cutting off vital blood flow to a digit, concha of the ear, etc and cause necrosis. Used in dental work, the epi goes into your central circulation relatively rapidly and some folks can't take it, requiring the use of other local anesthetics such as carbocaine.

Viscous lidocaine is the same chemical as well but in a gel. Too much can be deadly:

http://en.wikipedia.org/wiki/Csilla_Molnár


 
That's why lidocaine is contraindicated in heart blocks. It "numbs" the ventricles, and in a situation where the impulse isn't getting down to the ventricles, numbing the ventricles is a bad, bad thing.
 
pumper12fireman said:
That's why lidocaine is contraindicated in heart blocks. It "numbs" the ventricles, and in a situation where the impulse isn't getting down to the ventricles, numbing the ventricles is a bad, bad thing.
Click to expand...

NO, NO , NO , NO, NO !!! That is NOT why it is NOT used!!!

Who continues to teach such non-sense?


As well it is the same Lidocaine! Lidocaine comes in various forms. Lidocaine 1% and 2% and then there those with (Epi) called with (without -without EPi) for vasculature areas such as the scalp (which is contraindicated for use in dermal areas of the nose, penis, and toes)

Sodium Bicarbonate can be added to reduce the stinging (the pH causing the pain).

R/r 911
 
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Naples Fire test question:lol:
 
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Ridryder911 said:
NO, NO , NO , NO, NO !!! That is NOT why it is NOT used!!!

Who continues to teach such non-sense?


R/r 911
Click to expand...

The guy that taught me that has helped contribute to a few different textbooks. So, I researched for a bit and wasn't able to come up with anything different, other than lidocaine used in heart blocks may worsen the heart block. The patho of "the numbing" effect is what was always taught to me, through different people as well. I'm curious, not arguing, why then, it's contraindicated?
 
It "numbs" the ventricles, and in a situation where the impulse isn't getting down to the ventricles, numbing the ventricles is a bad, bad thing.
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Can you provide a reference to where you saw this in writing?


Does anything in the lecture linked below look familiar pertaining to Class 1B meds?

http://www.musc.edu/pharm/antiarrhyth2_3.pdf
 
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VentMedic said:
Can you provide a reference to where you saw this in writing?


Does anything in the lecture linked below look familiar pertaining to Class 1B meds?

http://www.musc.edu/pharm/antiarrhyth2_3.pdf
Click to expand...


No sir, I can't. I just specifically remember our arrhythmia instructor speaking of that. Saying, exactly that. It was something along the lines of "in a sick heart, trying to numb the ventricles can be a bad thing", in reference to amiodarone vs lidocaine discussion.

And yes it does look familiar. I went back and reviewed a lecture very similar to that and I see now where that is definitely incorrect.
 
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Lido alters the depolarization threshold of the heart muscle by blocking the sodium channels in the cell membranes...by blocking these channels, you won't have an action potential. That's kind of dumbing it down, but hopefully it's accurate (I'm tired, and hope to not get too into this subject...or be wrong).
 
Lido can reduce ventricular irritability, but can impede

conductive pathways by the same token. If your conductive pathways are already insulted*, making them even less capable is unhelpful.
Roger, Ryder.



*Hey, Purkinje, your mama dress you like that?!".;)
 
ding.....ding...ding.. we have a winner !

I cannot stand the description of "numbing" the heart as I have heard it repeated more than here. I don't care who, what they wrote, authored, etc.. then they should had known better.

I had a newbie tell me that once ( I said once) after a writing a dissertation, he fully understood the difference....

R/r 911
 
Ridryder911 said:
ding.....ding...ding.. we have a winner !

I cannot stand the description of "numbing" the heart as I have heard it repeated more than here. I don't care who, what they wrote, authored, etc.. then they should had known better.

I had a newbie tell me that once ( I said once) after a writing a dissertation, he fully understood the difference....

R/r 911
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C'mon... You have to numb Vance and Virgina Ventricle... so that Sidney Sinus can do his thing.

Sound about right, Rid?
 
Jon said:
C'mon... You have to numb Vance and Virgina Ventricle... so that Sidney Sinus can do his thing.
Click to expand...

I was happy to see Dubin's book become a standard even with his past. Dr. Caroline made a great contribution to EMS education and in all fairness, she may have known some of her audience's lack of prerequisites and preparation.
 
Ridryder911 said:
ding.....ding...ding.. we have a winner !

I cannot stand the description of "numbing" the heart as I have heard it repeated more than here. I don't care who, what they wrote, authored, etc.. then they should had known better.

I had a newbie tell me that once ( I said once) after a writing a dissertation, he fully understood the difference....

R/r 911
Click to expand...

OH come on Rid! You know as well as I do that's why we use it! It numbs the heart so we can't feel the pain of the MI we just had, that's why we push it!

Don't give me that stuff about Lidocaine blocking fast Na+ channels, that's all stuff made up by self-important physiologists and pharmacists.

ALSO there is NO literature supporting your position, I insist it's simply magic at work.
 
mycrofft said:
conductive pathways by the same token. If your conductive pathways are already insulted*, making them even less capable is unhelpful.
Roger, Ryder.



*Hey, Purkinje, your mama dress you like that?!".;)
Click to expand...

Youre so cute!!:lol:
 
I to have questions about this drug. I know its a sodium channel blocker and it is used for to treat arrhythmias. I realized that it slows conduction time therefore it may/should convert tachydysrhythmias.

However my drug book specifically says that it increases electrical stimulation threshold, which made me think it took more electrical activity to overcome the drugs effects. Which I believed was why the 1% solution was used to mitigate pain for certain procedures.

Know I also realize the 2% is used for cardiac. Question is, when using this 1% how does slowing the pain signal help with pain, if it is going to get there anyhow?

Thanks
 
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