Greater Sydney Area HEMS

Chris “Willko” Wilkinson (SCAT paramedic) shared this handy trick of the trade during a recent simulation session.

Scenario

Road primary job to a school where a 6 year old girl is in severe respiratory distress with known asthma. On arrival sats are 85% on a non rebreather, RR40, poor air entry bilaterally and responding only to pain. Minimal response to IM adrenaline (Review of adrenaline in asthma)

Airway secured by rapid sequence intubation. We see a good CO2 trace but she is very hard to bag.

Question

How can we deliver salbutamol to the bronchioles of this patient in the prehospital setting?

Options in our kit:

1. Salbutamol metered dose inhaler but patient is intubated
2. 5mg IV salbutamol but no infusion pump.
3. 5 x 5mg salbutamol nebules but no T-piece in our interhospital pack.

MacGyver Answer