Solu Medrol - What are its uses? How to use?

[chbare]

In my case, the fact that the regional trauma center wanted to give steroids and the patient had a good outcome would lead a reasonable person to believe that the use of steroids was a beneficial treatment.

I believe the initial question asked if anyone had any experience with Solu Medrol and what were they. I gave my opinion and then kicked in the nuts for expressing my opinion. I am to the point of giving up on this site as there seem to be a group who only want to blast anyone who doesn't share their burnt out attitude.

Unfortunately those who want to use this site to grow as providers end up getting shot down. Why don't those of you with your bad attitudes go start a new site like crappy EMS providers.com and blast each

other!!!

No nut kicking intended. I was simply challenging you to look at the science and the big picture. As I stated, I am not saying it is wrong; however, always consider the science and evidence behind what we do. Sometimes people are going to call you out on your ideas, you are going to need evidence to back your thoughts up in some cases.

In fact, Spenac called me out earlier in this thread. Instead of taking it personally, I looked at the evidence and had to agree with his stance. This makes me a better provider and also makes me look outside of my little box. Nothing wrong with challenging somebody, if done in a professional manner.

Take care,

chbare.

[mark]

I've also seen it used for treating airway burns/inhalation injuries.

-Mark

[spenac]

I never have used Solu-Medrol nebulized but I have used Decadron as per nebulizer. An old ICU trick to help reduce laryngeotracheal swelling, especially for new trachs. I remember using in a patient that had an idiopathic reaction to Bumex. He was already trached but the reaction caused severe swelling I nebulized the Decadron (along with the usual tx regime) and appeared to work.

In regards to Diabetics I do make note of it. They may have to receive additional Insulin or be placed on supplement therapy. As well, I am sure to observe for previous oral therapy such as Prednisone and I may withold administration of additonal steroids. Again, a case by case matter.

I had a Paramedic mention using it nebulized but I can not find anything in my books or the web saying it is OK to use nebulized. Is this something he dreamed up or is there some documented actual use for going nebulized?

So I need to monitor Blood Glucose Levels closely on my long transports if I administer Solu-medrol or other steroids, correct?

In my case, the fact that the regional trauma center wanted to give steroids and the patient had a good outcome would lead a reasonable person to believe that the use of steroids was a beneficial treatment.

I believe the initial question asked if anyone had any experience with Solu Medrol and what were they. I gave my opinion and then kicked in the nuts for expressing my opinion. I am to the point of giving up on this site as there seem to be a group who only want to blast anyone who doesn't share their burnt out attitude.

Unfortunately those who want to use this site to grow as providers end up getting shot down. Why don't those of you with your bad attitudes go start a new site like crappy EMS providers.com and blast each other!!!

Thank you for providing your answer. I do not think anyone meant to attack but one was a little to blunt with his illustration of face punch as to needing more than one time to make it a firm policy, which I presumed you had other experience/information to include in your educated conclusion. I do agree this site has become a little to blunt and I am guilty of it way to often myself. I ask you to please stay and help get it back to a site that actually discusses medicine rather than only jokes and fights. Thank you again.

Wonder if crappy ems providers dot com exists. Probably be the most visited EMS site in a short time.

[Mateo_1387]

So I need to monitor Blood Glucose Levels closely on my long transports if I administer Solu-medrol or other steroids, correct.

I would not say that it is necessary to monitor the glucose closely, unless under special circumstances you deem it necessary. I threw it out there to invoke some thinking about the metabolic effects of Solu Medrol. For example, Solu Medrol can increase glucose levels.

Typically, patients can present with multiple problems. Although there may be an acute inflammation problem, the patient may have secondary metabolic problems, such as diabetes. It is just something more to add to the mix.

[BushyFromOz]

Our IC guys use Hydrocortisone 250mg for severe respiratory ditress (yeah, go figure) So your asthma, COPD'ers etc etc. They are chnaging Dexemethesone in the near future.

[VentMedic]

I had a Paramedic mention using it nebulized but I can not find anything in my books or the web saying it is OK to use nebulized. Is this something he dreamed up or is there some documented actual use for going nebulized?

So I need to monitor Blood Glucose Levels closely on my long transports if I administer Solu-medrol or other steroids, correct?

Many COPD patients may be diabetic or on the border from long term steroid use. Glucose monitoring is essential.

Nebulized or MDI steroids may already be in use by the patient. Pulmicort (budesonide) is available in liquid for nebulization or MDI. It is also found in Symbicort. Flovent is in MDI form by itself and in the Advair diskus and MDI. Decadron (dexamethasone) can also be nebulized. In the hospital we may hold the nebulized or MDI corticosteroids while the patient is receiving them IV.

We also budesonide and Decadron nebs for airway inflammation post extubation. Steroids IV may be started 24 hours prior to extubation or before if there is edema and inflammantion.

Update in Chronic Obstructive Pulmonary Disease 2007

http://ajrccm.atsjournals.org/cgi/content/full/177/8/820

Steroids in acute exacerbations of chronic obstructive pulmonary disease: are nebulized and systemic forms comparable?

http://www.co-pulmonarymedicine.com/pt/re/...#33;8091!-1

New EPR3 (American) guidelines for Asthma management:http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

http://www.nhlbi.nih.gov/guidelines/asthma/index.htm

Canadian Asthma Guidelines:

http://www.lung.ca/cts-sct/guidelines-lignes_e.php

These guidelines take most of the mystery out of these medications and like ACLS, they are updated as new research is made available. A complete new set of guidelines is published every few years to reflect the most recent changes. There is controversy like with any other medical treatment so it is important that you stay current with the medical journals rather than just waiting for JEMS to publish a warm and fuzzy watered down 6th grade reader note on the subject.

[AnthonyM83]

Steve_EMT. Don't take it personally and don't back off because of such comments. Take them as opportunities to explore how others in EMS think and evaluate things. I appreciate you sharing your experience about Solu-Medrol.

I believe people were responded to when you moved into adopting it and becoming a believer in it based one incident where we don't know what the outcome would have been otherwise (though I'm sure it helped in that incident). It's just a certain style of thinking about stuff. Really useful and the same thought processes I see in many EMS leaders and educators.

I was taken aback when I first started...it was a change from EMT school...but it was actually really refreshing and gave me some faith in EMS.

[FL_Medic]

One incident of anecdotal evidence made you a firm believer? One must consider the numerous complications associated with using steroids for SCI and the fact that there is limited definitive evidence proving that steroids cause measurable functional improvement.

I am not saying do not use steroids; however, try to look at the big picture rather than isolated anecdotal cases where the treatment may or may not have been an actual factor leading to a positive outcome.

Take care,

chbare.

Good statement. When you have swelling to an extremity from an injury, what is used to treat it? I think with the future implementation of hypothermia, steroids won't be used for possible SCI anyhow.

[Arizonaffcep]

Yes indeed. In fact, recent article reviews does indicate outcomes are not improved with steroid use. So, now I wonder how this will all relate to the etomidate, adrenal suppression, "stress dose" with steroid arguments with RSI and septic shock patients? Still up in the air for now.

Take care,

chbare.

Can anyone post some studies that show a direct link between etomidate and RSI (specifically)? I have found many studies that show PROLONGED use inhibits the adrenal steroidogenesis, but nothing that shows a single use for RSI is detrimental at all.

[chbare]

It is well documented that a single dose of etomidate will cause adrenal suppression. However, equating that to poor outcomes in patients is an ongoing debate.

http://emergency-medicine.jwatch.org/cgi/c...full/2008/201/5

Take care,

chbare.