Development of a methylprednisolone protocol for use in acute spinal cord injuries

Acute spinal cord injury is a serious medical condition that results in 10,000 new cases of paralysis each year. Initial physical damage to the spinal cord is followed by chemical damage, resulting in cell death and scar tissue formation. Methylprednisolone therapy has proven effective in suppressing the chemical damage, particularly when started within 8 hours of injury. A protocol developed by the Pharmacy Department at Methodist Medical Center in Dallas, Texas, is described. This protocol facilitates accurate, efficient preparation and administration of this emergency therapy. The protocol takes advantage of the pharmacist's unique expertise to lessen the risk of calculation errors and mistakes in preparation, by providing a tailored drug admixture for administration at a fixed flow rate. The protocol and a sample of the pharmacy work sheet are presented.