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Hey gang,
I need a bit of input from you guys on Solumedrol therapy for Spinal Cord Injury on scene responses.
My program has a protocol for the standard Solumedrol regimen for SCI, but we do not carry the medication on board at this time.
My task is to determine whether or not it is essential to carry Solumedrol in a quantity sufficient for the initial loading dose. My medical director would prefer that any changes or modifications be done via evidence-based research rather than following a current trend in therapy.
Considering that most scene flights are short (under 30-40 minutes enroute time back to the ER), Is it really imperative that Solumedrol be initiated in this already busy environment, or is the effectiveness the same if iinitiation were delayed, say an hour?
A bit of research I have found indicates that there is a 6 hour window in which to start therapy. Obviously "The Sooner, The Better" applies. Another article advocates that if Solumedrol cannot or is not initiated within the forst 3 hours post injury, that the standard 23 hour infusion be extended to 48 hours. This was associated with a higher rate of immunosuppression complications (pneumonia).
My inclination is it could wait until you arrive at the trauma center, but that a higher level of care demands that it be started in the pre-hospital environment (when feasable).
What do you think? And do you have any research that would be beneficial?
Thanks,
Ronnie Daniel
Baptist Health MedFlight - Little Rock, AR