Makindo Medical Notes

Related Subjects: |Initial Trauma Assessment and Management |Thoracic Trauma Assessment and Management |Flail Chest Rib fractures |Resuscitative Thoracotomy |Haemorrhage control |Traumatic Brain Injury |Traumatic Cardiac Arrest |Abdominal trauma |Tranexamic Acid |Silver Trauma |Cauda Equina

Trauma: Post-Traumatic Stress Disorder (PTSD): The risk of developing PTSD after a traumatic event is approximately 8.1% for men and 20.4% for women.

About

• PTSD involves ongoing symptoms related to extreme stress following a traumatic event.
• Symptoms must persist for 1 month or longer for a diagnosis.
• Symptom onset typically occurs within the first month post-trauma but can manifest up to 6 months later.
• Defined in ICD-10, DSM-5, and other diagnostic criteria.

Aetiology

• Individuals with current PTSD may exhibit abnormally low cortisol levels compared to controls.
• Long-standing PTSD is associated with structural changes, including a smaller hippocampus.

At-Risk Groups

• Victims of violent crime (e.g., physical and sexual assaults, abuse, bombings, riots).
• Service members and personnel in high-risk roles: military, police, journalists, prison, fire, ambulance, and emergency workers, including those who are retired.
• Victims of war, torture, state-sanctioned violence, terrorism, and refugees.
• Survivors of accidents and natural or man-made disasters.
• Women experiencing traumatic childbirth; individuals diagnosed with life-threatening illnesses.

Clinical Presentation

• Re-experiencing the traumatic event vividly and distressingly.
• Unwanted flashbacks in which the person feels or behaves as if the event is recurring.
• Frequent nightmares and repetitive, distressing intrusive images or other sensory memories from the event.
• Strong distress and physiological reactions triggered by reminders of the trauma.
• Avoidance of trauma-related reminders is a core symptom of PTSD.
• Co-occurring symptoms: depression, generalized anxiety, shame, guilt, reduced libido.
• Hypervigilance, hyperarousal, and an exaggerated startle response.
• Emotional numbness and detachment from others.
• Impaired sleep and concentration, which can affect work and social functioning.
• Use of alcohol, drugs, caffeine, or nicotine to manage symptoms, potentially leading to dependency.

Investigations

• Usually not indicated; diagnosis is primarily clinical based on symptoms and history.

Management

• GP Assessment: Evaluation of symptom severity and creation of a tailored treatment plan.
• Supportive Care: Empathetic support and management of any secondary injuries.
• Medication: Short-term anxiolytics and SSRIs may be beneficial for symptom relief.
• Cognitive Behavioral Therapy (CBT): Helps the patient process and desensitize trauma, confront survivors' guilt, and develop coping mechanisms.