High Dose Steroids for Spinal Cord Injury

Verify the patient's identity in accordance with institutional policy

  1. Perform hand hygiene and apply gloves.
  2. Assess the patient's level of consciousness.
  3. Obtain the patient's baseline neurologic status, including motor function and sensory levels.
  4. Obtain the patient's vital signs, including blood pressure, cardiac rate and rhythm, respiratory rate and effort, and pulse oximetry.
  5. Assess the patient's skin color, temperature, and level of moisture.
  6. Obtain a history of additional traumatic injuries.
  7. Initiate and maintain spinal immobilization.
  8. Establish continuous cardiac monitoring.
  9. Establish intravenous (IV) access.
  10. Obtain medication as prescribed by the emergency physician or advanced practice nurse.

Preparation of the Infusion

Withdraw enough fluid from the bag of normal saline solution to account for the volume of medication to be added and the manufacturer's overfill of the IV fluid bag.

  1. Mix and add 4 g of methylprednisolone sodium succinate to the prepared 250-ml IV bag.

 Loading Dose 

  1. Prime the tubing with the prepared mixture before starting the infusion.
  2. Administer a loading dose of 30 mg/kg over 15 minutes.
  3. Infuse the loading dose at the appropriate rate for the patient's weight. Rates are in milliliters per hour (ml/hr), but infuse for 15 minutes only.
  4. After the loading dose has infused, turn off the methylprednisolone for 45 minutes, and run IV fluid at a keep-open rate.

 Maintenance Dose

  1. Over the next 23 hours, infuse the previously prepared solution at a rate of 5.4 mg/kg per hour.
  2. If treatment is initiated 3 to 8 hours after injury, continue the infusion for 27 hours at a rate of 5.4 mg/kg per hour.

Post Procedure

  1. Continue maintenance of spinal immobilization.
  2. Monitor vital signs, including cardiac rate and rhythm, respiratory rate and rhythm, blood pressure, pulse oximetry, and level of consciousness.
  3. Monitor neurologic status, including motor function and sensory levels.
  4. Assist with and prepare for patient's admission to hospital.
  5. Discard used supplies, remove gloves, and perform hand hygiene.
  6. Document the procedure in the patient's record.
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