FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Specified ventricular-arrhythmia pathways or IO infusion pain. The indication determines dose and route.
Contraindications & local exclusions
- The cited injection label excludes amide-local-anesthetic hypersensitivity, Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, or severe sinoatrial/AV/intraventricular block without an artificial pacemaker.
Precautions
- Monitor for neurologic toxicity, seizures, respiratory depression and conduction changes. Local anesthesia, arrhythmia treatment and IO pain use are distinct; use the exact preparation and OCEMS pathway.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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.
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
- SO-P-040 pediatric dose: 1 mg/kg 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
- PR-115 pediatric dose: 0.5 mg/kg 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.
VISUAL FIELD REFERENCE
Lidocaine: cardiac treatment and IO analgesia differ
Adult & pediatric guidance · ALS
Adult examples. Use the separate pediatric sections for dose maximums and repeat restrictions.
Adult cardiac indication
1 mg/kg IV/IO; may repeat 0.5 mg/kg once in 3–5 minutes under the applicable sequence.
Adult 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.
- Do not interchange IO analgesia and cardiac doses.
- Preservative-free formulation is specifically required for IO infusion analgesia in PR-115.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · PR-115 · SO-C-040 · SO-P-040
UNDERSTAND THE CARE
Why one medication page contains two different treatment tasks
Lidocaine’s antiarrhythmic use and its role in pain from IO infusion are separate indications. The patient, route, dose and product requirements must be selected from the correct branch. A concentration that looks familiar does not establish that a product is appropriate for IO analgesia.
Applying the guidance
For rhythm treatment, retain the arrest or pulsed-tachycardia sequence and reassess perfusion. For IO pain, check the current procedure, preservative-free formulation, slow administration and adult or pediatric repeat limit. Document the reason for administration explicitly so a later clinician does not confuse pain treatment with an antiarrhythmic dose.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Purpose
- Antiarrhythmic versus IO-infusion pain.
- Product
- Confirm formulation and concentration.
- Regimen
- Route, rate and indication-specific limits.
- Record
- State why it was given and the response.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- PR-115 — Intraosseous Infusion
- SO-C-040 — Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent
- SO-P-040 — Cardiopulmonary Arrest - Pediatric
- Product label — LIDOCAINE HYDROCHLORIDE injection, solution
- Name / formulation reference — Medication name and formulation terminology
Name the indication in every handoff
A medication history of “lidocaine administered” leaves out why it was given. Make the indication explicit: antiarrhythmic treatment under its cardiac pathway, or analgesia for infusion through an IO. The same drug name does not mean the two regimens, formulation requirements or repeat limits can be combined.
For IO pain, preserve the preservative-free requirement, slow administration and age-specific limits from PR-115. Continue checking the access and surrounding extremity. A report of pain should prompt attention to the access as well as the medication record; documenting an analgesic does not establish that the site remained suitable for infusion.
For example, a child receives lidocaine for IO-infusion pain and later has an arrest-related handoff. State the original indication and amount so the next clinician does not mistake it for the arrest antiarrhythmic dose. Keep both events in the cumulative medication history without assuming that one indication authorizes another.
Source: Intraosseous Infusion.