Another round of that FOAM-EY goodness for you all…
I. OUTPATIENT PNEUMOTHORAX – Probably not ready for prime time but here’s Sanjay and Mike waxing poetic regarding pneumothorax management.
http://www.emrap.org/episode/february2015/paperchase02
II. PNEUMOTHORAX AND PIGTAILS – If you are convinced, here’s how to put in the pigtail
III. CORD SYNDROMES – Here’s the quick and dirty synopsis — http://lifeinthefastlane.com/ccc/spinal-cord-anatomy-and-syndromes/
Should I give steroids to the patient with cord compression? Ask yourself what’s going on…
- Neoplasm – Give it!
- Infections – Nope
- Epidural hematoma – Nope
- Trauma – Nope
- Disk Herniation – Probably
When should I give steroids?
Tintinalli encourages “When one clinically suspects epidural compression, especially due to tumor, treat with dexamethasone, 10 milligrams IV, before obtaining any confirmatory tests“.
Realize that there is no convincing evidence behind this statement. But when working up cord compression there is an inevitable delay to arrange an MRI, a delay to definitive neurosurgical or radiation management, and a delayed onset of action for steroids.
Juxtapose those delays against the possibility of irreversible spinal cord damage with as little as one hour of spinal cord ischemia.
Finally consider the low risk of harm with a single dose of 10 mg of decadron.
Considering above, I would squirt in 10 mg of decadron ASAP in hopes of combating neoplastic vasogenic edema and preserving long term function. QED
