@milinner do you have a source for this?
I based it off the extra info that stressed IV steroids first, and another card (b54bdd8f-590f-4f49-9cf6-01d8e64c9c28) that stressed steroids first. Unless the extra info is only referring to epidural SCC from metastasis? So not 100% sure now. I can’t really find an outside source to confirm.
@milinner I’ve been trying to reconcile this with a few resources including Tintinalli’s, Rosen’s, UTD, Amboss, WikEM, AnKing, Internet Book of Critical Care, OME, EM Secrets…
It appears that there is ongoing historical controversy over steroid use in suspected epidural spinal cord compression (ESCC) dating back to initial studies in the 70s. Several sources state steroids are an option for treatment or should be given empirically, especially for malignant ESCC. However, if spinal epidural abscess (SEA) is suspected, steroids should be avoided as they will worsen the infection. There is also a card ( aa931b64-a697-42f7-a0a7-034387012a49 ) specifically about SEA management and to avoid steroids in it, even with concomitant SCC.
I would vote that we leave the cloze order as-is, reflecting the accompanying UWorld table, and with an explanatory note in the Extra section. Thoughts?
That sounds like a great plan, I agree. Thank you for doing that research!