Which four drugs comprise the LEAN acronym for endotracheal administration?

• A. Lidocaine, Epinephrine, Atropine, Naloxone
• B. Lidocaine, Epinephrine, Adenosine, Naloxone
• C. Lidocaine, Esmolol, Atropine, Naloxone
• D. Lidocaine, Epinephrine, Amiodarone, Naloxone

Answer: (A)

Endotracheal administration uses a simple set of drugs that can be given through the tube when IV/IO access isn’t available. The four drugs in this mnemonic are Lidocaine, Epinephrine, Atropine, and Naloxone. Lidocaine is an antiarrhythmic that historically could be given via the endotracheal route to help with ventricular arrhythmias during resuscitation. Epinephrine is essential for resuscitation to improve perfusion by causing vasoconstriction and enhancing blood flow to the heart and brain. Atropine is used to treat symptomatic bradycardia by increasing heart rate. Naloxone reverses opioid-induced respiratory depression if opioid overdose is suspected. Together, these four drugs form the LEAN endotracheal drug set. Other drugs like Esmolol, Adenosine, or Amiodarone aren’t part of this mnemonic.