High-dose methylprednisolone in the treatment of spinal cord injuries

Article Abstract:

In recent years, there has been little change in drug treatments used for spinal cord injuries. Fewer complications after injury and increased patient survival have resulted primarily from improvements in nursing care and rehabilitation. Studies performed in the early 1970s indicated that low doses of steroids, such as dexamethasone, could enhance the rate of recovery following spinal cord injury in monkeys. Research performed in the 1980s and 1990s has focused on high doses of methylprednisolone in treating spinal cord injuries. The results of these studies indicate that high doses, but not low doses, of methylprednisolone improve neurological recovery (measured by increased sensation and response to pinprick) and motor recovery (measured by movement and muscle strength) following spinal cord injuries. One study found that beneficial effects appeared six weeks after treatment was started and continued for six months. It was also reported that, for optimal recovery of neurological function, treatment with methylprednisolone should be started within eight hours of the injury. Included in this article is a suggested method for calculating the correct patient dosage of methylprednisolone. Although it is not clearly understood why steroids are beneficial in treating spinal cord injuries the following theories have been suggested: steroids may increase nerve impulse transmission; they may increased blood flow in the spinal cord; or they may reduce lipid peroxidation (the damage of cell membranes by oxidation). Complications that can arise from treatment with high doses of steroids include delayed wound healing, infections, and gastrointestinal bleeding. It is concluded that short-term treatment with high-dose intravenous methylprednisolone is safe and can result in improvements in sensory and motor functions following acute spinal cord injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Methylprednisolone

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Treatment strategies in shock: use of oxygen transport measurements

Article Abstract:

Shock is a condition of decreased blood flow to the body's peripheral tissues, resulting in a lack of oxygen to the cells. Shock and its treatment have been always been categorized according to the cause, including diabetic, cardiac, electric, septic and anaphylactic (allergy reaction) shock. It can also be caused by severe diarrhea or vomiting, and not drinking enough fluids to make up for fluid loss. Recently it has been recognized that, regardless of the cause, all types of shock share similar mechanisms, and effective treatment must take all components of the circulation into account. Shock is characterized by a reduction in the amount of oxygen consumed by the cells. Oxygen delivery can be manipulated by blood transfusion, vasodilator therapy, and other methods. Oxygen consumption and response to therapy can be measured by using a pulmonary artery catheter to obtain blood samples. Oxygen delivery and measurement of response to therapy are reviewed, and a case study is provided to illustrate the concepts. Research has shown that increasing oxygen delivery increases oxygen consumption among patients with hemorrhagic and septic shock and adult respiratory distress syndrome. Maximization of oxygen delivery is recommended to support the higher metabolic rates observed for these conditions. The pulmonary artery catheter permits individualization of dosage and fluids. The goal of resuscitation should not be cardiac output or blood pressure, but oxygen consumption that does not vary with the amount of oxygen delivered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Oxygen therapy, Shock

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Back to basics

Article Abstract:

Helping spinal injury patients regain some form of self-control over their daily catheterization procedure can go a long way to improving both quality of life and the psychological impact of coming to terms with the disability. Community nurses are ideally placed to encourage spinal injury patients to learn the skills required for self-catheterization. Gaining control over urine emptying leads to less restrictions for the patient, which improves their mobility and social life.

Health aspects, Practice, Catheterization, Community health nursing

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