Methylprednisolone for Acute Spinal Trauma

NASCIS protocol
   1)  within 3 hrs of injury-
         - 30 mg/kg initial IV bolus over 15 minutes,
            followed by 5.4 mg/kg/hrs x 23 hrs
   2)  within 3-8 hrs of injury-
         - 30 mg/kg initial IV bolus over 15 minutes,
            followed by 5.4 mg/kg/hrs x 47 hrs

- always use gastrointestinal ulcer prophylaxis while patient on high dose steroids
- often need to use sliding scale insulin coverage while on steroids

These conditions were not included in the study:
   - cauda equina syndrone
   - gun shot wounds
   - pregnancy
   - age<13 yrs
   - patients on maintenance steroids