Dexamethasone in RTA

in the pediatric setting, dexamethasone does not play a significant routine role in the acute management of children involved in road traffic accidents (RTAs):

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1. Pediatric Traumatic Brain Injury (TBI):

• Dexamethasone is not recommended.
• Similar to adults, corticosteroids (including dexamethasone) have shown no benefit in improving outcomes in pediatric TBI.
• They may actually increase risks such as hyperglycemia, infections, and gastrointestinal bleeding.
• Guidelines like those from the Brain Trauma Foundation advise against steroid use in pediatric TBI.

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2. Spinal Cord Injury:

• No clear evidence supports dexamethasone or any steroid in pediatric spinal cord trauma.
• Corticosteroids are generally not recommended, especially in the first 24–48 hours, due to risk of complications and lack of proven benefit.

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3. Airway Edema / Facial Trauma:

• In cases of upper airway swelling (e.g., after maxillofacial trauma, intubation, or crush injuries to the neck), dexamethasone may be used to reduce edema and risk of obstruction.
• This is not routine but can be life-saving in selected cases.

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4. Adrenal Insufficiency / Chronic Steroid Use:

• If a child with known adrenal insufficiency or on chronic corticosteroids is involved in an RTA, stress-dose steroids (including IV dexamethasone) may be indicated to prevent adrenal crisis.

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5. Anti-Emetic Use (supportive care):

• Rarely, dexamethasone is used as an antiemetic in trauma-related nausea/vomiting, but not a common practice in pediatric emergency trauma care.

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In short:

Dexamethasone has a limited and selective role in pediatric RTAs. It is not used routinely for head injury, spinal trauma, or general trauma support. Its use is reserved for:

• Managing airway edema
• Children with adrenal insufficiency
• Rare supportive scenarios (e.g., severe inflammation, antiemesis)