Field administration of steroids for known or suspected SCI

[Griff]

This question may have been covered already; if it has been then I apologize .

In trauma assessment last night, my medic class was going over spinal cord injuries. We've seen a lot of conflicting information from different sources regarding corticosteroid administration in the field for a SCI, and I was hoping someone here had some experience with the subject. Our medic instructor said it was complete garbage from an EMS perspective, but the doctor I spoke with in the ER swore by it (the sooner the better, in his opinion). I don't believe we carry corticosteroids for this purpose anymore in my state, but I have heard some services still use them. Any thoughts?

 

[VentMedic]

but the doctor I spoke with in the ER swore by it (the sooner the better, in his opinion).

Ask that ER doctor if he can give corticosteroids to a SCI without consulting a neurologist or neurosurgeon first.

Many years ago we carried dexamethasone for TBIs. We also carried methylprednisolone which was used for asthmatics and allegic reactions. However, that dosing is not nearly what it takes to run a high dose treatment initiation for SCI. The side effects and complications of such high doses of steroids can be significant which is why many ED doctors wait for a neuro specialist to assume control of the patient.

 

[Fox800]

From what I understand, corticosteroid therapy is questionable as to how much it may help. In any case, EMS providers don't carry enough of the product to provide the proper dose. The standard dose of methylprednisolone for an SCI is 30mg/kg, which for a 180lb/81kg pt. comes out to over 2400mg. The standard packaging of methylprednisolone is a 125mg vial.

 

[Akulahawk]

SCI is an area where you can see some benefit from corticosteroid use... however, you're going to be seeing those improvements from limiting the inflammatory response to that injury. The doses required to do that in SCI happen to be quite large. In the case of an SCI where the cord is actually transcected, you won't see any gains below the area of the injury. I just don't see much benefit in corticosteroid use in complete transcection cases. Now then, there's some indication that other substances (a specific blue dye) may offer some significant benefit, but you won't see ER Docs or even Neurologists turning their patient Smurf Blue anytime soon as that stuff is still in early research. It did show some promise in mouse studies though...

 

[VentMedic]

SCI is an area where you can see some benefit from corticosteroid use... however, you're going to be seeing those improvements from limiting the inflammatory response to that injury. The doses required to do that in SCI happen to be quite large. In the case of an SCI where the cord is actually transcected, you won't see any gains below the area of the injury. I just don't see much benefit in corticosteroid use in complete transcection cases. Now then, there's some indication that other substances (a specific blue dye) may offer some significant benefit, but you won't see ER Docs or even Neurologists turning their patient Smurf Blue anytime soon as that stuff is still in early research. It did show some promise in mouse studies though...

It is actually not new and for some injuries we have been initiating high dose corticosteriods early. However, that is after the type of injury has been confirmed and whether immediate surgical intervention is required. A couple of highly publicized sports related spinal injuries where the athletes were treated with steroids have put it back into public headlines again. In the hospitals, we take it case by case.

 

[Akulahawk]

It is actually not new and for some injuries we have been initiating high dose corticosteriods early. However, that is after the type of injury has been confirmed and whether immediate surgical intervention is required. A couple of highly publicized sports related spinal injuries where the athletes were treated with steroids have put it back into public headlines again. In the hospitals, we take it case by case.

I never said it was new... in fact I've been aware of use of high-dose corticosteroids for quite a number of years. I just don't see much benefit of use of those steroids in complete transcection cases beyond stomping on the inflammatory response to limit further damage around the area of insult. In incomplete transections or where the cord was pinched, I can see how use of the steroids can prove quite useful in limiting secondary injury from localized edema.

Case by case administration, IMHO is exactly how this should be handled. I'd hate to see routine use of corticosteroids in SCI become or completely routine for all SCI patients without a LOT of research supporting such routine use. I haven't seen that yet...