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Usefulness of self-administration of intramuscular lidocaine in the prehospital setting for ventricular tachyarrhythmias unassociated with acute myocardial infarction (the “Shahal” experience in Israel)

  • Arie Roth
    Correspondence
    Address for reprints: Arie Roth, MD, Department of Cardiology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel.
    Affiliations
    From the Department of Cardiology Tel-Aviv Sourasky Israel

    From the Department of Cardiology, Sheba Medical Center Israel

    From the Department of Cardiology, Assaf Harofeh Medical Center Israel

    From the Department of Cardiology, the Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel

    From the Shahal Medical Services, Tel-Aviv, Israel
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  • Naomi Malov
    Affiliations
    From the Department of Cardiology Tel-Aviv Sourasky Israel

    From the Department of Cardiology, Sheba Medical Center Israel

    From the Department of Cardiology, Assaf Harofeh Medical Center Israel

    From the Department of Cardiology, the Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel

    From the Shahal Medical Services, Tel-Aviv, Israel
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  • Yoram Bloch
    Affiliations
    From the Department of Cardiology Tel-Aviv Sourasky Israel

    From the Department of Cardiology, Sheba Medical Center Israel

    From the Department of Cardiology, Assaf Harofeh Medical Center Israel

    From the Department of Cardiology, the Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel

    From the Shahal Medical Services, Tel-Aviv, Israel
    Search for articles by this author
  • Zwi Schlesinger
    Affiliations
    From the Department of Cardiology Tel-Aviv Sourasky Israel

    From the Department of Cardiology, Sheba Medical Center Israel

    From the Department of Cardiology, Assaf Harofeh Medical Center Israel

    From the Department of Cardiology, the Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel

    From the Shahal Medical Services, Tel-Aviv, Israel
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  • Shlomo Laniado
    Affiliations
    From the Department of Cardiology Tel-Aviv Sourasky Israel

    From the Department of Cardiology, Sheba Medical Center Israel

    From the Department of Cardiology, Assaf Harofeh Medical Center Israel

    From the Department of Cardiology, the Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel

    From the Shahal Medical Services, Tel-Aviv, Israel
    Search for articles by this author
  • Elieser Kaplinski
    Affiliations
    From the Department of Cardiology Tel-Aviv Sourasky Israel

    From the Department of Cardiology, Sheba Medical Center Israel

    From the Department of Cardiology, Assaf Harofeh Medical Center Israel

    From the Department of Cardiology, the Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel

    From the Shahal Medical Services, Tel-Aviv, Israel
    Search for articles by this author
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      Abstract

      We report on the experience accumulated by the subscribers of SHAHAL cardiac services who self-injected intramuscular lidocaine (using an automatic injector “LidoPen”) for documented ventricular tachyarrhythmias which were not associated with an acute myocardial infarction. SHAHAL provides professional care to its subscribers who telephone a monitor center and describe their symptoms, whereupon therapeutic measures are decided upon. Patient data are stored in a central computer, and the center can dispatch mobile intensive care units. All subscribers carry a portable transtelephonic electrocardiographic transmitter and are provided with the LidoPen. Indications for self-injection were: transmission of a wide-QRS tachycardia (rate >100 beats/min), symptomatic multiple or complex ventricular premature complexes in association with chest discomfort, and when the time of arrival of a medical team to the patient was estimated to be at least 8 to 10 minutes. Successful usage of the LidoPen was reported in 137 cases (123 patients). An additional 11 patients failed to use the injector properly. There was a success rate in abolishing rapid sustained ventricular tachycardia (27 of 76 patients) and nonsustained ventricular tachycardia and/or multiple and complex ventricular ectopic activity (8 of 30 patients) of 33% (total 35 of 106 patients). In another 9%, those arrhythmias were slowed markedly. The remaining 31 cases were eventually interpreted as being of supraventricular origin. No complications attributed to the use of the injector were reported and its use was found to be both feasible and effective in the prehospital setting.
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