Paediatric Acute care Guidelines PMH Emergency Department

Medication

  • Salbutamol is a β agonist that can be used intravenously in severe acute asthma in the Emergency Department
  • It is used initially as an intravenous bolus, but can be continued as an intravenous infusion (in a Paediatric Intensive Care Unit)

Actions

  • Salbutamol acts on the β2 adrenoreceptors in the smooth muscle of the bronchi causing bronchodilation

Indications

  • Acute severe asthma
  • Inadequate response to continuous nebulised salbutamol

Contraindications

  • Patients with known hypersensitivity to salbutamol
  • Care should be taken with patients with hypertension, hyperthyroidism, myocardial insufficiency or diabetes

Adverse

  • Muscle temors, especially of the hands
  • Tachycardia
  • Nausea and vomiting
  • Headaches, agitation and hyperactivity
  • Palpitations
  • Feelings of warmth
  • High doses can cause peripheral vasodilatation resulting in hypotension
  • Overdose can result in chest pain, SVT and pulmonary hypertension

Dosage

  • Intravenous Continuous Infusion: 1-5 micrograms/kg/min (start at 1 microgram/kg/min, discuss with PICU if considering a higher dose). Infusion rate will be adjusted according to patient response.

Preparation

Continuous Infusion
  • Drug: 3mg/kg Salbutamol
  • Diluent: 500ml bag of 0.9% Saline or 5% Dextrose
  • Rate of 10ml/hour = 1 microgram/kg/minute
  • Titrate infusion 1 – 5 micrograms/kg/min according to patient response

 

Administration

  • Administer infusion via a pump
  • Set volume to be infused on the pump to prevent overdose
  • Always prime the line with the diluted salbutamol solution to prevent any delay in the patient receiving the medication

Special

  • The patient will require 1 : 1 nursing care
  • Continuous cardiac monitoring
  • 5 minutely obseravtions for the first 10 minutes – heart rate, respiratory rate, blood pressure, oxygen saturations
  • 15 minutely observations thereafter
  • Consider Paediatric Intensive Care review
  • Consider placing a second intravenous cannula (for further treatment as salbutamol is incompatible with many other drugs)

References

PMH ED Guidelines:  Salbutamol Intravenous – Last Updated 03/09/14

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