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Steroid Protocol: for Spinal Cord Injury

- Discussion:
    - methylprednisolone given as bolus of 30 mg / kg  body wt
    - followed by infusion at 5.4 mg / kg / hour for 23 hours;
    - if given w/ in 8 hrs, benefit from methylprednisolone was seen in patients whose injuries were initially
           evaluated as neurologically complete, as well as in those believed to have incomplete lesions;
    - excluded pts:
           - patients who are more than 8 hours from injury (these patients may actually do worse w/ steroids);
           - those w/ involvement of nerve root or cauda equina only;
           - gunshot wounds (see GSW to the Spine);
           - life-threatening morbidity
           - those who were pregnant
           - under 13 years of age;
           - addicted to narcotics
           - receiving maintenance steroids for other reasons

- Note: upto 40% of spine injured patients who receive steroids can be expected to develop some GI bleeding;
              - hence, PUD prophylaxis is warrented

Original Articles: A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the Treatment of Acute Spinal-Cord Injury:
       Results of the Second National Acute Spinal Cord Injury Study

Potential Benefits of High-Dose Methylprednisolone in Acute Spinal Cord Injuries