Ipratropium Bromide

UNCONTROLLED WHEN PRINTED

Introduction

An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm
Combined with a nebulised short-acting beta-2 agonist (e.g. salbutamol), ipratropium bromide produces significantly greater bronchodilation than a short-acting beta-2 agonist alone

Indications

Severe bronchospasm:

Adult:

Paediatric:

Contraindications

Precautions / Notes

COVID-19 / Febrile Respiratory Illness

Please review guidance on Nebulisers
Crews should allow the patient to administer their own Ipratropium Bromide MDI via spacer wherever possible
Allow patient to self-administer Ipratropium Bromide per their asthma management plan or under crew direction; stand clear and wait a minute before approaching the patient
If you have to use SJA supplied Ipratropium Bromide MDI, assess whether it can be reused and wipe with Clinell wipe after use. Discard the MDI in the sharps bin if the patient is very unwell or highly symptomatic of infectious respiratory condition.
Note: If administering St John supplied medication, crews are NOT to leave the remainder of the medication with the patient. This is a violation of the St John WA poisons licence and the Medicines and Poisons Act 2014.
Crews may tolerate lower oxygen saturations in patients with infective respiratory symptoms prior to considering intervention, as the use of MDI’s may precipitate a cough. See Oxygen Delivery for specifics regarding SpO2 tolerance.

Management

Adult:

Nebulised (combined with salbutamol):
- 500 microg in 2 mL (250 microg/mL)
- Dilute solution for nebulisation to 2-3ml with sodium chloride 0.9%
- Repeat nebulised dose every 20mins; maximum of 3 doses.
MDI:
- 8 puffs (160 microg), 1 breath per puff - if possible, give via spacer
- Repeat MDI dose every 20 minutes; maximum of 3 doses.

Paediatric:

	< 6 years	> 6 years	Subsequent dose if required	Notes
Nebulised	250 microg in 1 mL	500 microg in 2 mL	Repeat nebulised dose every 20 minutes; maximum of 3 doses.	Dilute solution for nebulisation to 2-3mL with sodium chloride 0.9%
MDI	4 puffs (80 microg)	8 puffs (160 microg)	Repeat MDI dose every 20 minutes; maximum of 3 doses	Give via spacer