Paramedics need to understand a wide array of medications and a crucial drug used is salbutamol, especially in respiratory emergencies. It is especially used in respiratory emergencies because it is a bronchodilator, these emergencies include patients who are suffering from a chronic obstructive pulmonary disease (COPD) bronchitis and asthma. This article will provide all the essential information for paramedics using salbutamol on road, this will consist of the indications for when to use it, precautions, how it is administrated, and the mechanism of action.
Salbutamol is an important bronchodilator used for a patient suffering from asthma and chronic obstructive pulmonary disease. The term bronchodilator refers to the relaxation of muscles within the airway, basically describing the role of the drug within pre-hospital care. Salbutamol can relax the muscle within the lungs by stimulating its beta-2 receptors when this happens the smooth muscle surrounding the airways relaxes therefore since the airway has been widened, air can now pass through much easier. Thus, salbutamol is an important drug for respiratory emergencies, and considering this is an important part of any paramedic’s drug kit.
Salbutamol is an effective life-saving medication, but just like most medications, its precautions and contraindications are vital to consider before administrating it to the patient. Two of the primary precautions for paramedics to be cautious of is a patient with any form of pulmonary oedema and ischaemic heart disease. Pulmonary oedema is a medical condition that is a result of fluid accumulating in the lungs, using a bronchodilator like salbutamol, may worsen this condition by opening up the airway to only be filled up with further fluid. Ischemic heart disease is a condition where there is a lack of blood flow to the heart as a result of narrowed/blocked blood vessels, beta 2 receptors are not only in the lungs but also located around other parts of the body, including the heart, salbutamol may stimulate these beta 2 receptors which will then increase heart rate, cardiac output, and blood pressure which can be extremely problematic for patients with this disease. Salbutamol has two contraindications, allergy, and a patient less than 1 year of age, a patient belonging to either of the two categories must not be administered with salbutamol. While salbutamol is an effective medication for treating respiratory diseases, it is essential to always consider the list of contraindications and precautions before administration, otherwise, a respiratory condition can turn into something worse and inflict a negative outcome for the patient.
Salbutamol can be administered in various ways and depending on the situation of the patient will determine the route of administration. The three routes of administration for salbutamol include the use of a nebulizer, metered dose inhaler, and intravenous injection. Using a nebuliser as the route is the most common way of administration, to do this the paramedic pours the medication into the nebuliser, then the mask is placed on the patient, and the liquid in the nebuliser is converted into a mist that can be easily inhaled, hence why it is most commonly used for respiratory emergencies. Metered dose inhalers are another way to administer salbutamol, it is a handheld device with a canister inside that can be attached to a mask, which the patient uses to inhale all the medication. MDIs are useful for rapid treatment as they are already prepared to go, they just need to be shaken to combine the medication with the propellant and attached to the mask, the only major downside to the MDI is that the dose is typically much smaller than what is used for salbutamol but, depending on the patient's situation an MDI can be the best course of action. The third route to take when administering salbutamol is through intravenous injection. Salbutamol is only typically administered through IV when administration via the mouth is not possible, this can be a result of serve asthma attack or patients who are nauseous and vomiting, otherwise, under most circumstances, a nebuliser is the best route to take when giving salbutamol. Therefore, it is essential to take a case-by-case approach, look at the patient, and think about experience, knowledge, and practice to decide what is best for the patient.
The dosages described by the drug therapy protocol used by the Queensland Ambulance Service (QAS), have guidelines on dosages to give patients experiencing asthma and bronchospasm. In regards to bronchospasm, the paediatric dosages through a nebuliser is 2.5mg for 1-5-year-olds and 5mg for 6 years and older, both are single dose only. When administering through an MDI, the dose for 1-5 years is 600mics, single dose and for 1-5years it is also 600mics but can be repeated every 10 minutes as necessary, Patients older than 6 years can receive 1.2mg repeated every 10 minutes as needed. For adults receiving salbutamol, the dose is 5mg nebulised as needed; through MDI the dose is 1.2mg, repeated every 10 minutes as needed. For patients needing salbutamol administered via IV, the dose commences at 5mic/min and increases by 2.5mic/min as determined by the patient's respiratory status, though, it is very important to note that administering salbutamol via intravenous injection is only to be done by a critical care paramedic, it is not within the scope of practice for other paramedics. Hence, if there is any doubt about the dose that the patient may need, take into account the drug therapy protocol procedures and the severity of the patient to determine the appropriate dose.
Take into account the above information to treat the patient below in these case studies. Note that there can be multiple answers and treatment plans for patients, work on creating your plan, as this will help further your knowledge within the field.
1, A 24-year-old male patient has a history of asthma and after a run on the beach is experiencing shortness of breath and is unable to finish their sentences. Upon assessment, the patient has an oxygen saturation of 90%, 32 breaths a minute, 140/90 blood pressure, and 120 bpm heart rate. Assuming the patient has no allergies what would you do to treat this patient?
A. Post using your primary and secondary survey, you decide your patient is experiencing symptoms of asthma and decide to administer salbutamol, after checking the medication is in date and confirming with your partner/patient, you nebulise 5mg and continue to reassess the patient, giving more medication as needed while also considering other courses of treatment and beginning transport.
2, A 4-year-old patient experiencing chest tightness and shortness of breath. On assessment, the patient's oxygen saturation is 92%, 29 breaths per minute, 130/85 blood pressure and heart rate of 110 beats per minute. Assuming the patient has no allergies and you have full parent consent, what is your course of action and how does this patient differ from the case above?
A. After using the necessary aspects of your primary and secondary survey, you decide to nebulise 2.5mg of salbutamol, checking to expire date of the medication and continuing to reassess the patient's vitals before deciding if it is necessary to administer further medication after your patient is stable, you transport your patient with their parent/guardian to the hospital to receive further treatment and/or receive a plan for if this is to happen in the future. This case differs from the one above because of the patient's age, therefore the dose instead of 5mg is 2.5 for the younger patient and consent is gathered from the parent/guardian rather than directly from the patient.
In conclusion, the use of salbutamol is used widely by paramedics, especially in the treatment of symptoms of asthma and chronic obstructive pulmonary disease. Paramedics must have a thorough understanding of the medication, its pharmacology, routes of administration, dosages, indications, precautions and contraindications as all this is important to utilize the medication in respiratory emergencies.
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