An Evidence-Based Approach to Emergency Department Patients at Risk for Posttraumatic Stress Disorder Symptoms (Trauma CME and Behavioral Health CME) -

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Delivery Method:	Online
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Publication Date: January 2023 (Volume 25, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 01/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Trauma CME credits and 4 Behavioral Health CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Approximately one-quarter of emergency department patients who are injured or experience medical emergencies will develop clinically significant posttraumatic stress disorder (PTSD) symptoms, which can evolve into PTSD. Emergency clinicians and rapid response teams (eg, trauma, cardiac, stroke) can play a critical role in recognizing symptoms of posttraumatic stress and providing early distress management techniques, screening, and referral to services that may mitigate the development of PTSD. This review summarizes the existing literature on psychological distress related to events that trigger the need for emergency care and synthesizes cutting-edge approaches that may impact patient outcomes.

Case Presentations

A 21-year-old woman with a stab wound to the arm is anxious, upset, and having difficulty focusing and answering questions…

• The patient recalls a similar violent injury from her past and appears to struggle to answer general questions from the treating team. There is a record of antidepressant medication in her chart.
• Her injuries are mild, and she is stable. After being evaluated by emergency clinicians and the surgical consult team, she remains anxious-appearing and tearful.
• You suspect that her recovery may be complicated, given her emotional state.
• You wonder whether a mental health consultation is indicated, and whether you can even get one on an emergent basis...

A 55-year-old man presents with chest pain and shortness of breath…

• The man is previously healthy with no history of cardiac problems.
• He is found to have a non-ST segment myocardial infarction (NSTEMI) following workup in the ED. He is started on antiplatelet therapy in addition to anticoagulation, and is admitted to the medical service for telemetry and possible catheterization.
• He is anxious during the ED evaluation and becomes tearful when told he is having a heart attack. “This is going to completely change my life. I’m so afraid I’m going to have another bigger heart attack.”
• You wonder whether there is any acute intervention that might mitigate his mental distress...

A 33-year-old woman presents to the ED following a motor vehicle crash involving a motorcycle…

• She struck her head during the accident, has slight photophobia, and is shaken up about the incident. She says she was afraid for her life and expresses concern for the other individuals involved in the crash.
• During the historical examination, she reports having experienced childhood adversity but appears to have adapted successfully with no prior intervention. Her wounds are primarily superficial, and following her secondary trauma survey, a CT scan of the head reveals negative findings. She is otherwise neurologically intact, and her plan includes discharge directly from the ED.
• When told of her results, she tells you, “I don’t think I can ever drive again…it’s just too frightening…I could have died.” While relieved that her trauma evaluation was reassuring, you wonder about some of the longer-term psychological effects of this event and whether there is anything that should be initiated in the ED . . .

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.