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.
COVID-19 / Febrile Respiratory Illness
  • Please review guidance on Nebulisers
  • Crews should allow the patient to administer their own Salbutamol MDI via spacer wherever possible
  • Allow patient to self-administer Salbutamol 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 Salbutamol 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 for specifics regarding SpO2 tolerance and Oxygen Delivery for COVID-19 precautions.
Management

MDI / Space chamber as per Clinical Skill

Adult/Child > 6 years:

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

Paediatric < 6 years:

  • 2-6 puffs (200-600 microg), 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

  • Use 1-2 nebules (5-10 mg in 2.5-5 mL) 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
    5 mg in 2.5 mL
  • Metered Dose Inhaler (MDI)
    100 microg 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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