Premature Ventricular Contractions (PVC)

Section 4 - CARDIAC

4.05 PREMATURE VENTRICULAR CONTRACTIONS (PVC)

CONSIDER MEDICAL ETIOLOGY OF PVC’s AND REFER TO APPROPRIATE PRACTICE PARAMETER:

• Hypoxia, INITIAL MEDICAL CARE (2.01).
• Side-effects of other drugs, etc.
• INITIAL MEDICAL CARE (2.01). - OXYGEN @ 100% via NRB mask or assist with BVM.
• Treat if PVCs are consistent in patients with signs and symptoms which suggest angina / myocardial infarction:
  • 6 per minute
  • Multifocal
  • R on T phenomena
  • Runs of V-Tach / Couplets

• Administer LIDOCAINE 1 to 1.5 mg/kg IVP, IO
  • Patients receiving LIDOCAINE need to receive a full loading dose titrated to suppress the PVC’s.
    • In patients over age 70 or in those with known hepatic disease, administer LIDOCAINE gradually up to a full initial loading dose or until a maximum of 1.5 mg/kg administered.
  • If recurrent or refractory and patient is symptomatic, administer bolus of LIDOCAINE 0.5 mg/kg IVP, IO and repeat as necessary up to a total administration of 3 mg/kg.
    • In patients over age 70 or in those with known hepatic disease, repeat doses need to be carefully titrated to suppress PVC’s given over a long period of time. These patients may have reduced lidocaine clearance therefore can reach toxic levels or develop seizures with doses lower than 3 mg/kg.