Indications of Steroids in Emergency Department

Steroids 

Steroids are a commonly used group of medications in the Emergency Departments. There are plenty of indications to use them, some remain controversial while others are widely accepted. Most side effects result from long-term usage but its worth having a discussion with the patient when prescribing steroids to take away. 

Mechanism of Action

• Steroids work by reducing the production of leukotrienes and prostaglandins 
• Inhibits phospholipase A2 and expression of COX-2
• Stimulate the bone marrow to produce neutrophils resulting in leukocytosis\
• Halting inflammatory cascade

https://step1.medbullets.com/endocrine/109043/glucocorticoids

Potential Side Effects of Steroids 

• Impair immunity
• Hyperglycemia
• Hypertension
• GI Ulcers
• Delay Wound Healing
• Increase Risk for Cardiovascular diseases 
• Weight gain
• Osteoporosis
• Myopathy
• Avascular Necrosis
• Depression/Mood changes

Tapering is not generally needed for short courses (up to 2 weeks)

Indications (Not an exhaustive list)

• Intracranial SOL
• Strep Pnemo Meningitis
• Pharyngitis (steroids did decrease the duration of symptoms by about 24-48 hours.)
• Asthma/COPD
• Allergic Reactions
• Connective Tissue Flare 
• Bells Palsy 
• Gout
• ?Headache (Steroids prevent recurrence)
• Septic Shock
• Temporal Arteritis 
• Addisons Crisis (Hypoadrenal Shock)
• ?Pnemonia 
• ?Back Pain in selected patients 

Take Home

• Discuss pros and cons of prescribing steroids
• Short courses from ED do not require tapering 

Posted by:

              

     Lakshay Chanana

     

     ST4 Trainee

     Royal Infirmary of Edinburgh

     Department of Emergency Medicine

     Edinburgh

     Scotland

     @EMDidactic