UNCONTROLLED WHEN PRINTED
Introduction
  • Short acting Beta 2 agonist that causes relaxation of bronchial smooth muscle (bronchodilation).
  • Onset: 2-5 minutes maximum by 10 minutes.

Pharmacology Review

Indications

Bronchospasm and respiratory distress associated with wheeze:

Critical Care & Special Operations Paramedics only
  • Hyperkalaemia secondary to crush injury
Contraindications
  • Known hypersensitivity to salbutamol
  • Cardiogenic pulmonary oedema
  • Age <12 months
Precautions / Notes
  • A spacer / MDI is the preferred route for salbutamol administration where the patient presents with influenza like illness.
  • The use of a Metered dose inhaler (MDI) and spacer is equally as effective as nebulisation, in all asthma situations, where the patient is still able to adequately inhale.
  • Use of a nebuliser is recommended where the patient loses this ability.
  • Ambulance Transport Officers (ATO) are only authorised to use salbutamol MDI in a known asthmatic patient with respiratory distress.
  • If hypoxic, nebulise salbutamol in preference to MDI, to address both hypoxia and bronchospasm. The nebulised route also makes it possible to administer Ipratropium Bromide simultaneously.
Management

MDI / Space chamber as per Clinical Skill

Adult/Child > 6 years:

  • 4-12 puffs (400-1200 mcg), repeat every 20 minutes (or sooner if needed) for the first hour

Paediatric < 6 years:

  • 2-6 puffs (200-600 mcg), repeat every 20 minutes (or sooner if needed) for the first hour
Using an MDI with spacer:
  • Press once firmly on the MDI to discharge 1 puff into the spacer
  • Instruct the patient to breathe in and out normally for 4 breaths 
  • Repeat 1 puff at a time until the appropriate number of puffs have been taken
  • Repeat as clinically required as per dosing schedule above

Nebulised as per Clinical Skill

  • 5 mg with 6-8 L/min oxygen in a nebuliser mask
  • Give salbutamol via continuous nebulisation in life threatening asthma
  • Repeat as clinically required
Critical Care & Special Operations Paramedics only
Crush Injury
  • Give salbutamol via continuous nebulisation
Special Considerations
  • Muscle tremor
  • Tachycardia, palpitations
  • headache

References
References
Presentation
  • Salbutamol nebules
    5mg in 2.5mL
  • Metered Dose Inhaler (MDI)
    100mcg per puff

Salbutamol Packet

Salbutamol Nebules

Salbutamol Box

MDI

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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Date of Issue

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