Category: Circulation/Cardio
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Pharmacology – Drugs for Ventricular Arrhythmias – Lidocaine
Added on day of publication – Can it be used? Yes – there is some evidence – e.g. here – supporting its use, and in other countries including America it is one of the ‘first line options’ (Ray and Clemins, 2025). But should it be used in the UK? Here’s what the BNF says:
Intravenous lidocaine hydrochloride can be used for the treatment of ventricular tachycardia in haemodynamically stable patients, and ventricular fibrillation and pulseless ventricular tachycardia in cardiac arrest refractory to defibrillation, however it is no longer the anti-arrhythmic drug of first choice.
https://bnf.nice.org.uk/treatment-summaries/arrhythmias/#:~:text=Intravenous%20lidocaine%20hydrochloride%20can%20be,arrhythmic%20drug%20of%20first%20choice.Remember, the Resuscitation Council’s 2021 tachycardia algorithm does not mention lidocaine. It’s always worth checking your local and country-specific guidelines before following any treatment algorithm.
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If you, like me, have never internalised the whole ‘Hi I See…’/HIS thing for areas of the heart…
If you, like me, have never internalised the whole HISS thing for areas of the heart and are fed up with people telling you it’s easy, or to visualise it, STOP trying. Keep it simple. People think this is simple but it is only for them. Instead, think about where you apply the ECG leads. Visualise that.
V1 and V2 are placed on the sternum. You can think sternum for septal, or ‘high anterior’ (as they are high up on the front of the chest).
Leads v3 and v4 are placed on the front of the chest. They are anterior.
To see where leads V5 and V6 go, you have to turn an image of the heart to the left. They are lateral leads!
To remember the limb leads, inFerior is avF, which has two more: ii, and iii. Now all you need to remember is that lateral is I and avL.
Does it work for you? Let me know. Now to go back and tell my old student paramedic self….
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Dig a Little Into the Research on Caffeine and Hypertension and You’ll Notice It’s a Bit of a Minefield
Not convinced? Add your thoughts below.
Links, in the order in which they appear:
https://www.mdpi.com/2072-6643/15/13/3060
