Check before giving

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

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.

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.

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.

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.

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

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.