Responses seen in the emergency room Clinical features

By the time that patients reach the emergency room, they may have already started working through the accident, the injury, and its implications. (4)

They may experience intrusive images and memories of the accident.(5) While intrusive symptoms are related to the severity of the accident, avoidance is more strongly related to the pre-accident psychological state of the subject. Avoidance symptoms include trying not to talk about the accident and not engaging in cognitive or behavioural activities which remind the victim about the accident.

In general, intrusive thoughts and avoidance are more frequent than hyperarousal during the first few hours and days, except for difficulty in sleeping, which is reported by about 40 per cent of non-injured subjects in the first few nights after the accident. Symptoms of hyperarousal include exaggerated startle response, poor sleep, increased heart rate, shivering and trembling, irritability, difficulty in concentrating, and hypervigilance. They occur in less than 10 per cent of accidentally injured subjects, and less often in those who have not been injured. Hyperousal is associated with later post-traumatic distress problems. (i6)

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