526	D. Agrawal
Step 5	Avoid steroids
	Routine use of steroids is not recommended in SCI.
Step 6	DVT prophylaxis
	Low-dose heparin in combination with pneumatic compression stockings for a
	minimum period of 3 months is recommended.
	Vena cava filters are recommended for patients who fail anticoagulation or who
	are not candidates for anticoagulation and/or mechanical devices.
Step 7	Closed reduction/traction
	Early closed reduction of cervical spinal fracture-dislocation injuries with
	craniocervical traction is recommended for the restoration of anatomic
	alignment of the cervical spine in awake patients.
Step 8	Maintain nutrition
	Nitrogen requirements are the same as in severe head-injured patients.
	Caloric requirements may be lower due to muscle paralysis and flaccidity.
	Indirect calorimetry may be more accurate in assessing the caloric require-
	ments in these patients.
Step 9	Operative intervention—decompression and fusion
	All cervical SCIs with radiological evidence of cord compression should
	undergo spinal cord decompression and fusion as early as possible.

Suggested Reading

1.Brain Trauma Foundation, American Association of Neurological Surgeons. Guidelines for management of severe traumatic brain injury. J Neurotrauma. 2007;24(Suppl 1):S24–30.

This gives an excellent overview of evidence-based head injury management as well as gaps in our knowledge on this subject. A “must” reading for all those who manage severe head-injured patients.

Websites

1.www.aans.org

The American Association of Neurological Surgeons website has guidelines for both head and spinal injured patients which is freely downloadable.

2.https://www.braintrauma.org/coma-guidelines/

This website has useful information on the latest research in head injuries and the outcome of various trials.