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Discussion

Steroid Protocol

Okay, let's talk a bit about this protocol.

I had a young patient come into my ER s/p fall approx 20ft with impact to back Upon arrival, pt with no sensation below waist, no rectal tone, absent reflexes. Airway patent. Confirmed damage noted on CT and later MRI. Steroid protocol was initiated. This is my first encounter with the protocol. I'm familiar with steroids used as anti-inflammatories and using the med in this situation makes sense. However, after reading several articles, I'm finding that most research shows it's more harmful for the patient (infectious process, longer ICU stays). Does anybody have input on this? Does your hospital embrace this policy? Are there alternatives?

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Very astute of you to notice.

You are obviously using your thinking cap.

The "steroid protocol" has you giving a dose that is 30 times the normal dose (approximately) of solumedrol - like you're giving THIRTY doses of Solumedrol 125 mgIV.... YES that is a HUGE dose.... and it is NOT without possible complications.

It is a long discussion on here to discuss how the clinical trials on this were limited and lacking and how a premature release of trial information had people swarming to use this stuff with ONLY minor clinical benefit....

You might want to do a little background research on the net; look for the trials that started it all "NASCIS, NASCIS-II" and "NASCIS-III".

It is an area of controversey; it is NOT the standard of care (look up legal definition of "standard of care" - it's not the definition most of us use)....

But, yes, back to your point, this is a WHOPPING dose of steroids, fraught with potential complications and unfortuntately society has placed the burden of expecting this treatment from us health care providers.

I'm NOT saying it doesn't help - obviously it does, but what is the risk/benefit ratio? Obviously it may be worth it to give to a pt who "might" be a full quadraplegic, but would it also be useful to someone who may only get some sensory return to hands but not motor????

Ethical questions I am sure.

The "steroid protocol" IS NOT the "Golden Ticket" that a lot of health care providers think it is.

  • Author

Thanks much. That's what I needed to know. :)

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