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Wed Apr 23 22:10:39 BST 2008

Patrick:

It seems to me that there's an equal or larger risk of getting sued
for engaging in treatments that not only do not help but may actively
hinder recovery in SCI, if that argument's coming up.

My $0.02.

Ashton

On Wed, Apr 23, 2008 at 1:41 PM, Offner, Patrick
<PatrickOffner at centura.org> wrote:
> 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/
>  Your most  unhappy customers are your greatest source of learning. Bill
>  Gates.
>  P  Please don't print this e-mail unless you really need  to.
>
>
>
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Steroids in spinal cord injury ?