# Lidocaine

Separate antiarrhythmic dosing from preservative-free IO-infusion analgesia.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/lidocaine/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Do not interchange IO analgesia and cardiac doses.
- Preservative-free formulation is specifically required for IO infusion analgesia in PR-115.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [PR-115 — Intraosseous Infusion](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12408.pdf)
- [SO-C-040 — Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf)
- [SO-P-040 — Cardiopulmonary Arrest - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf)

## Use in OCEMS

- I-15 lists lidocaine for VF/pulseless VT, wide-complex tachycardia with a pulse, and pain during IO infusion.
- These are distinct pathways. For unstable VT with a pulse, follow the cardioversion sequence in SO-C-040.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Cardiac indication | 1 mg/kg IV/IO; may repeat 0.5 mg/kg once in 3–5 minutes under the applicable sequence. |
| IO infusion pain | 20 mg of preservative-free 2% lidocaine slowly through the IO over 1 minute. May repeat once, total 40 mg. I-15 lists a 3-minute repeat interval. |

## Pediatric

- SO-P-040 persistent VF/pulseless VT: 1 mg/kg IV/IO, maximum 100 mg, one dose only, as the alternative to amiodarone in the arrest sequence.
- PR-115 IO pain in children age 14 and younger: 0.5 mg/kg preservative-free 2% lidocaine, maximum 20 mg, slowly over 1 minute. Do not repeat.

## Pediatric weight table — Persistent VF / pulseless VT

- Source: SO-P-040. Dose rule: 1 mg/kg; route: IV/IO once.
- 1 mg/kg IV/IO, maximum 100 mg, one dose only, as the arrest alternative to amiodarone. Base contact is required under the arrest pathway.
- This arrest regimen differs from the smaller IO-infusion pain dose.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO once | Volume at 2% = 20 mg/mL |
| --- | --- | --- |
| 3 kg | 3 mg | 0.15 mL |
| 4 kg | 4 mg | 0.2 mL |
| 5 kg | 5 mg | 0.25 mL |
| 6 kg | 6 mg | 0.3 mL |
| 8 kg | 8 mg | 0.4 mL |
| 10 kg | 10 mg | 0.5 mL |
| 12 kg | 12 mg | 0.6 mL |
| 15 kg | 15 mg | 0.75 mL |
| 20 kg | 20 mg | 1 mL |
| 25 kg | 25 mg | 1.25 mL |
| 30 kg | 30 mg | 1.5 mL |
| 35 kg | 35 mg | 1.75 mL |
| 40 kg | 40 mg | 2 mL |
| 45 kg | 45 mg | 2.25 mL |
| 50 kg | 50 mg | 2.5 mL |
| 60 kg | 60 mg | 3 mL |

## Pediatric weight table — IO-infusion pain

- Source: PR-115. Dose rule: 0.5 mg/kg; route: IO over 1 minute.
- Age 14 and younger: 0.5 mg/kg preservative-free 2% lidocaine slowly over 1 minute, maximum 20 mg. Do not repeat.
- Use only the preservative-free 2% (20 mg/mL) preparation. Follow PR-115 placement confirmation and flush instructions.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IO over 1 minute | Volume at Preservative-free 2% = 20 mg/mL |
| --- | --- | --- |
| 3 kg | 1.5 mg | 0.075 mL |
| 4 kg | 2 mg | 0.1 mL |
| 5 kg | 2.5 mg | 0.125 mL |
| 6 kg | 3 mg | 0.15 mL |
| 8 kg | 4 mg | 0.2 mL |
| 10 kg | 5 mg | 0.25 mL |
| 12 kg | 6 mg | 0.3 mL |
| 15 kg | 7.5 mg | 0.375 mL |
| 20 kg | 10 mg | 0.5 mL |
| 25 kg | 12.5 mg | 0.625 mL |
| 30 kg | 15 mg | 0.75 mL |
| 35 kg | 17.5 mg | 0.875 mL |
| 40 kg | 20 mg | 1 mL |
| 45 kg | 20 mg | 1 mL |
| 50 kg | 20 mg | 1 mL |
| 60 kg | 20 mg | 1 mL |

## Preparation & reassessment

- A 2% solution contains 20 mg/mL; inventory lists 100 mg/5 mL. Verify the formulation and indication.
- Confirm IO placement and monitor the limb for extravasation. For cardiac use, reassess rhythm and perfusion and follow the full resuscitation/electrical-treatment sequence.