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Wed Apr 23 21:41:04 BST 2008

We still do it--but talk about not doing. We keep being told that it is
the "local standard of care" and to not do it would get us sued.
Moreover, our spine surgeons(who don't read any literature as far as I
can tell) still order it. Unfortuantely my vehement protestations fall
on deaf ears... 

Patrick J. Offner MD MPH
Chief, Surgical Critical Care
St Anthony Central Hospital

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Tuesday, April 22, 2008 10:15 PM
To: trauma-list at trauma.org
Subject: Re: Steroids in spinal cord injury ?

No, NO, NO, NO NO

In a message dated 4/22/2008 11:06:45 P.M. Central Daylight Time,
ivanhronek at yahoo.com writes:

Be a  better friend, newshound, and know-it-all with Yahoo! Mobile. Try
it now.  
I got an approval from Sandy Miller to post this here, anyone feels
strongly about it ?

At the PGA (Postgraduate Assembly of the  NYSSA)last December, the
question came up in a discussion during a panel  (I missed the main talk
because of another meeting).

This is for  those who deal with acute spinal cord injured patients. 
The question asked  was: given a patient who is both head and spinal
cord injured,would you  use megadose steroids? To my surprise--and
shock--the panelist answered  yes. I didn't get a chance to make a
comment myself because time was  up.

Now, I had thought that it was generally understood by now that the
evidence for any good effect of steroids in SCI is at best questionable,
and that the evidence for harm from steroids in acute brain injury is
unequivocable. Hence my shock. Certainly, if you have to be most
concerned with any injury, one to the brain should be at the top of the
list.

So, my question for the list: does anyone  still use megadose steroids
for spinal cord injured pts? If so, why? If  not, why not? If you have a
pt with SCI who also has a head injury, would  you use them then? If so,
why?

Shameful self-promotion: I have an  article on this in the current issue
of Jopurnal of Neurosurgical  Anesthesiology, and just finished our
chapter on Trauma and Burns for the  next issue of Barash, so I have
gone over the literature pretty  thoroughly. I'll post some references
if you like; I'm running out of time  now.

Sanford M. Miller, MD

Ivan Hronek MD
SFMC, Los  Angeles
cell: 310  487-3288
http://health.groups.yahoo.com/group/Anesthideas/
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Gates.
P  Please don't print this e-mail unless you really need  to.

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Steroids in spinal cord injury ?