Lidocaine Administration in the Treatment of Frequent Non-Perfusing Multi-focal PVCs

QUESTION

You are treating a 60 kg female who is presenting with frequent non-perfusing multi-focal PVC’s.  Your protocols call for a lidocaine bolus of 1 mg/kg, followed by a lidocaine drip at a dosage of 2 mg/min. The pre-filled syringe for the lidocaine bolus comes packaged as 100 mg/10 ml.

What is the concentration of lidocaine?  mg/ml

How many ml of lidocaine do you push?  ml

You have a 500 ml bag of D5W to which you add 2 g of lidocaine.  You use a mini-drip solution set.

What is the concentration of this lidocaine mixture?  mg/ml

How many gtt/min do you give?  gtt/min

ANSWER

Lidocaine Administration in the Treatment of Frequent Non-Perfusing Multi-focal PVCs

Introduction

In medical emergencies, accurate administration of medications is vital for patient safety and effective treatment. This essay addresses a scenario involving the administration of lidocaine to a patient presenting with frequent non-perfusing multi-focal PVCs. We will calculate the concentration of lidocaine in a pre-filled syringe and determine the appropriate dosage for the patient. Additionally, we will explore the concentration of a lidocaine mixture in a 500 ml bag of D5W and calculate the infusion rate in gtt/min using a mini-drip solution set.

Concentration of Lidocaine in the Pre-filled Syringe

Given that the pre-filled syringe contains 100 mg of lidocaine in 10 ml, we can calculate the concentration as follows:
Concentration = Amount of Lidocaine / Volume of Solution
Concentration = 100 mg / 10 ml
Concentration = 10 mg/ml

Lidocaine Bolus Administration

As the patient weighs 60 kg, the lidocaine bolus dosage is 1 mg/kg. Therefore, we will administer:
Bolus Dosage = Patient’s Weight x Bolus Dosage
Bolus Dosage = 60 kg x 1 mg/kg
Bolus Dosage = 60 mg

To determine the volume of lidocaine to push, we divide the bolus dosage by the concentration:
Volume = Bolus Dosage / Concentration
Volume = 60 mg / 10 mg/ml
Volume = 6 ml

Therefore, 6 ml of lidocaine is administered as a bolus.

Concentration of Lidocaine Mixture in D5W

We add 2 g of lidocaine to a 500 ml bag of D5W. To calculate the concentration, we need to convert grams to milligrams:
Concentration = Amount of Lidocaine / Volume of Solution
Concentration = 2 g x 1000 mg/g / 500 ml
Concentration = 4 mg/ml

Hence, the concentration of the lidocaine mixture in the D5W bag is 4 mg/ml.

Infusion Rate in gtt/min

Given that we are using a mini-drip solution set, the flow rate is usually 60 gtt/ml. We will calculate the infusion rate in gtt/min:
Infusion Rate = Lidocaine Dosage / Concentration x Flow Rate
Infusion Rate = 2 g x 1000 mg/g / 4 mg/ml x 60 gtt/ml
Infusion Rate = 50 gtt/min

Therefore, the lidocaine infusion should be administered at a rate of 50 gtt/min using the mini-drip solution set.

Conclusion

Accurate medication administration is critical in emergency situations. In this scenario, we determined the concentration of lidocaine in a pre-filled syringe to be 10 mg/ml and administered a bolus dosage of 6 ml to the patient. Furthermore, we calculated the concentration of lidocaine in a D5W bag to be 4 mg/ml and established an infusion rate of 50 gtt/min using a mini-drip solution set. By carefully calculating concentrations and dosages, healthcare professionals can ensure patient safety and effective treatment.

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