If a trauma patient is tachycardic, should we call for a counsellor?

BACKGROUND: It has been suggested in the literature that raised heart rate in the early period after trauma is associated with the development of post-traumatic psychopathology, but little account has been taken of the potential confounding effect of injury severity.

MATERIALS AND METHODS: A cohort of 154 patients, studied as part of a wider investigation of trauma outcomes, was included. Initial heart rate in the accident & emergency department, and injury severity score and new injury severity scores were recorded. Patients completed the General Health Questionnaire (GHQ-28) as a measure of psychopathology at presentation and again at two- and six-month follow-up.

RESULTS: There was no relationship between psychopathology at presentation and initial heart rate or injury severity. Raised heart rate was associated with post-traumatic psychopathology at two months but not at six months. When the potential confounding effect of injury severity was controlled for, there was no independent correlation between heart rate and post-traumatic psychopathology. Injury severity score and new injury severity scores were strongly associated with GHQ-28 caseness.

CONCLUSION: Post-traumatic tachycardia is not associated with development of psychopathology, but injury severity is. Previous studies that have suggested a link between tachycardia and development of psychopathology are flawed because they have not considered the confounding effect of severity of injury.

Clinicians’ perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma

Objective: The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma.Methods: A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews.Results: Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients’ requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer.Conclusions: The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making.

Memory, image, matter: Trauma and acts of un-forgetting

How might we conceive of the role of memory as a non-representational mode of commemoration that reconstitutes and transforms lived experience? In this paper I will draw on aspects on Indigenous epistemology and apply conceptions of memory outlines in works of Edward Casey, Henri Bergson and others to consider how social and psychological effects of trauma are manifested through generations. An understanding of the relationship between images, memory and matter and of memory as a primarily eidetic and material process may also help to suggest how some people may be able to avoid or overcome trauma. As image production, art-making generates images that like memory, perform acts of "unforgetting" through which the past is returned as a presence that is materially apprehended. This process can both sustain and transform individual and collective histories. Central to this idea is the notion that, the structure of mind and of memory are co-extensive with the external world an that the articulation of consciousness is crucially dependent on space and place.

Theorising irony and trauma in magical realism: Junot Díaz’s the brief wondrous life of Oscar Wao and Alexis Wright’s the swan book

Magical realism has been commonly theorized in terms of a postcolonial strategy of cultural renewal, according to which such fiction is understood as embodying a racialized epistemology allegedly inclusive of magic. The inherent exoticism of this idea has drawn criticism. Critics have recently begun to re-envision magical realism in terms of trauma theory. However, trauma readings of magical realism tend to unselfconsciously reinvigorate an authenticating rhetoric: magical realism is represented not as the organic expression of a precolonial or hybrid consciousness, but of colonial or other kinds of trauma. Through case studies of Junot Díaz’s The Brief Wondrous Life of Oscar Wao and Alexis Wright’s The Swan Book, this essay intervenes in trauma studies readings of magical realist literature to emphasize the fundamentally ironic nature of the iconic narrative strategy of representing the ostentatiously fantastical as real. It also argues that these texts, while invested in representing the traumas of colonialism, are less interested in authenticating magic as part of a postcolonial or traumatic epistemology than in transforming fantasy into history and empowered futurity.

An investigation of trauma responses to intimate partner violence

This research identified a high prevalence of posttraumatic stress, and complex trauma symptoms among victims of intimate partner violence; trauma symptoms may result from even moderate levels of violence. Exploration of the relationship between trauma symptoms and risk suggests that specific mental health treatment is indicated for this population.

Trauma in critically ill children : transfusion and osmotherapy practices

Les accidents sont la cause la plus fréquente de décès chez l’enfant, la plupart du temps à cause d’un traumatisme cranio-cérébrale (TCC) sévère ou d’un choc hémorragique. Malgré cela, la prise en charge de ces patients est souvent basée sur la littérature adulte. Le mannitol et le salin hypertonique (3%) sont des traitements standards dans la gestion de l’hypertension intracrânienne, mais il existe très peu d’évidence sur leur utilité en pédiatrie. Nous avons entrepris une revue rétrospective des traumatismes crâniens sévères admis dans les sept dernières années, pour décrire l’utilisation de ces agents hyperosmolaires et leurs effets sur la pression intracrânienne. Nous avons établi que le salin hypertonique est plus fréquemment utilisé que le mannitol, qu’il ne semble pas y avoir de facteurs associés à l’utilisation de l’un ou l’autre, et que l’effet sur la pression intracrânienne est difficile à évaluer en raison de multiples co-interventions. Il faudra mettre en place un protocole de gestion du patient avec TCC sévère avant d’entreprendre des études prospectives. La transfusion sanguine est employée de façon courante dans la prise en charge du patient traumatisé. De nombreuses études soulignent les effets néfastes des transfusions sanguines suggérant des seuils transfusionnels plus restrictifs. Malgré cela, il n’y a pas de données sur les transfusions chez l’enfant atteint de traumatismes graves. Nous avons donc entrepris une analyse post-hoc d’une grosse étude prospective multicentrique sur les pratiques transfusionnelles des enfants traumatisés. Nous avons conclu que les enfants traumatisés sont transfusés de manière importante avant et après l’admission aux soins intensifs. Un jeune âge, un PELOD élevé et le recours à la ventilation mécanique sont des facteurs associés à recevoir une transfusion sanguine aux soins intensifs. Le facteur le plus prédicteur, demeure le fait de recevoir une transfusion avant l’admission aux soins, élément qui suggère probablement un saignement continu. Il demeure qu’une étude prospective spécifique des patients traumatisés doit être effectuée pour évaluer si une prise en charge basée sur un seuil transfusionnel restrictif serait sécuritaire dans cette population.

Exploration of Ground Penetrating Radar and Time Domain Reflectometry Methods for the Determination of Pavement Dielectric Constant

Traditionally, densities of newly built roadways are checked by direct sampling (cores) or by nuclear density gauge measurements. For roadway engineers, density of asphalt pavement surfaces is essential to determine pavement quality. Unfortunately, field measurements of density by direct sampling or by nuclear measurement are slow processes. Therefore, I have explored the use of rapidly-deployed ground penetrating radar (GPR) as an alternative means of determining pavement quality. The dielectric constant of pavement surface may be a substructure parameter that correlates with pavement density, and can be used as a proxy when density of asphalt is not known from nuclear or destructive methods. The dielectric constant of the asphalt can be determined using ground penetrating radar (GPR). In order to use GPR for evaluation of road surface quality, the relationship between dielectric constants of asphalt and their densities must be established. Field measurements of GPR were taken at four highway sites in Houghton and Keweenaw Counties, Michigan, where density values were also obtained using nuclear methods in the field. Laboratory studies involved asphalt samples taken from the field sites and samples created in the laboratory. These were tested in various ways, including, density, thickness, and time domain reflectometry (TDR). In the field, GPR data was acquired using a 1000 MHz air-launched unit and a ground-coupled unit at 200 and 500 MHz. The equipment used was owned and operated by the Michigan Department of Transportation (MDOT) and available for this study for a total of four days during summer 2005 and spring 2006. The analysis of the reflected waveforms included “routine” processing for velocity using commercial software and direct evaluation of reflection coefficients to determine a dielectric constant. The dielectric constants computed from velocities do not agree well with those obtained from reflection coefficients. Perhaps due to the limited range of asphalt types studied, no correlation between density and dielectric constant was evident. Laboratory measurements were taken with samples removed from the field and samples created for this study. Samples from the field were studied using TDR, in order to obtain dielectric constant directly, and these correlated well with the estimates made from reflection coefficients. Samples created in the laboratory were measured using 1000 MHz air-launched GPR, and 400 MHz ground-coupled GPR, each under both wet and dry conditions. On the basis of these observations, I conclude that dielectric constant of asphalt can be reliably measured from waveform amplitude analysis of GJPR data, based on the consistent agreement with that obtained in the laboratory using TDR. Because of the uniformity of asphalts studied here, any correlation between dielectric constant and density is not yet apparent.

Il sistema Trauma Tracker - individuazione e analisi di parametri vitali acquisiti da monitor multiparametrico.

Lo scopo della presente tesi è lo studio e la progettazione di un sistema Hands-Free applicato in ambito Healthcare, volto ad aiutare il personale sanitario nello svolgimento delle mansioni lavorative. Il progetto, denominato Trauma Tracker, ha avuto origine grazie alla collaborazione con medici ed infermieri dell'ospedale Maurizio Bufalini di Cesena. In particolare, il sistema in prodotto si prende carico della compilazione del report finale contenente tutte le operazioni svolte sui pazienti nell'ambito del Pronto Soccorso, riducendo così notevolmente le possibilità di errori dovuti a fattori umani. Durante le fasi di sviluppo e progettazione sono state aggiunte ulteriori funzionalità al sistema, fino a farlo diventare vero e proprio oggetto incantato, in grado di esibire proprietà finora inimmaginabili in questo campo di applicazione. Trauma Tracker, almeno in queste prime fasi, non si propone come uno strumento immediatamente utilizzabile sul campo e pronto ad affiancare i medici, poiché necessiterebbe subito di qualità come robustezza ed affidabilità a livelli estremamente elevati. Per questo motivo il progetto è stato trattato come un "Proof of Concept", ossia un prototipo che ha lo scopo di dimostrare la fattibilità di tale sistema nella realtà, e di verificarne l'utilità una volta applicato in uno scenario concreto. L'argomento trattato ha quindi una grande importanza, poiché getta le basi di una tecnologia che un giorno potrà aiutare medici ed infermieri a svolgere al meglio l'impegnativo compito di salvare vite. In questa tesi, è stato approfondito in particolare il sottosistema utilizzato per il riconoscimento dei parametri vitali dal monitor multi-parametrico posto nei diversi reparti ospedalieri. Esso ha richiesto lunghe fasi di implementazione e collaudo per ottenere dei risultati soddisfacenti, che alla fine sono stati raggiunti.

Trauma in critically ill children : transfusion and osmotherapy practices

Les accidents sont la cause la plus fréquente de décès chez l’enfant, la plupart du temps à cause d’un traumatisme cranio-cérébrale (TCC) sévère ou d’un choc hémorragique. Malgré cela, la prise en charge de ces patients est souvent basée sur la littérature adulte. Le mannitol et le salin hypertonique (3%) sont des traitements standards dans la gestion de l’hypertension intracrânienne, mais il existe très peu d’évidence sur leur utilité en pédiatrie. Nous avons entrepris une revue rétrospective des traumatismes crâniens sévères admis dans les sept dernières années, pour décrire l’utilisation de ces agents hyperosmolaires et leurs effets sur la pression intracrânienne. Nous avons établi que le salin hypertonique est plus fréquemment utilisé que le mannitol, qu’il ne semble pas y avoir de facteurs associés à l’utilisation de l’un ou l’autre, et que l’effet sur la pression intracrânienne est difficile à évaluer en raison de multiples co-interventions. Il faudra mettre en place un protocole de gestion du patient avec TCC sévère avant d’entreprendre des études prospectives. La transfusion sanguine est employée de façon courante dans la prise en charge du patient traumatisé. De nombreuses études soulignent les effets néfastes des transfusions sanguines suggérant des seuils transfusionnels plus restrictifs. Malgré cela, il n’y a pas de données sur les transfusions chez l’enfant atteint de traumatismes graves. Nous avons donc entrepris une analyse post-hoc d’une grosse étude prospective multicentrique sur les pratiques transfusionnelles des enfants traumatisés. Nous avons conclu que les enfants traumatisés sont transfusés de manière importante avant et après l’admission aux soins intensifs. Un jeune âge, un PELOD élevé et le recours à la ventilation mécanique sont des facteurs associés à recevoir une transfusion sanguine aux soins intensifs. Le facteur le plus prédicteur, demeure le fait de recevoir une transfusion avant l’admission aux soins, élément qui suggère probablement un saignement continu. Il demeure qu’une étude prospective spécifique des patients traumatisés doit être effectuée pour évaluer si une prise en charge basée sur un seuil transfusionnel restrictif serait sécuritaire dans cette population.

The Ultimate Secrecy: Feminist Readings of Masculine Trauma in Vietnam War Literature

It is a widely acknowledged and often unquestioned fact that patriarchy and its modes of behaviour and social organization favour the appearance of trauma on the weakest (and defenceless) members of society: women. In the last decades, trauma seems to have taken the baton of typically female maladies such as 19th c. hysteria or 20th c. madness. Feminists in the 20th c. have long worked to prove the connection between the latter affections (and their reflection in literary texts) and patriarchal oppression or expectations of feminine behaviour and accordance to roles and rules. With Trauma Studies on the rise, the approach to the idea of the untold as related to femininity is manifold: on the one hand, is not trauma, which precludes telling about one’s own experience and keeps it locked not only from the others, but also from ourselves, the ultimate secrecy? On the other hand, when analyzing works that reflect trauma, one is astounded by the high number of them with a female protagonist and an almost all-female cast: in this sense, a ‘feminist’ reading is almost compulsory, in the sense that it is usually the author’s assumption that patriarchal systems of exploitation and expectations favour traumatic events and their outcome (silence and secrets) on the powerless, usually women. Often, traumatic texts combine feminism with other analytical discourses (one of the topics proposed for this panel): Toni Morrison’s study of traumatic responses in The Bluest Eye and Beloved cannot be untangled from her critique of slavery; just as much of Chicana feminism and its representations of rape and abuse (two main agents of trauma) analyze the nexus of patriarchy, new forms of post-colonialism, and the dynamics of power and powerlessness in ethnic contexts. Within this tradition that establishes the secrecies of trauma as an almost exclusively feminine characteristic, one is however faced with texts which have traumatized males as protagonists: curiously enough, most of these characters have suffered trauma through a typically masculine experience: that of war and its aftermath. By analyzing novels dealing with war veterans from Vietnam or the Second World War, the astounding findings are the frequent mixture of masculine or even ‘macho’ values and the denial of any kind of ‘feminine’ characteristics, combined with a very strict set of rules of power and hierarchy that clearly establish who is empowered and who is powerless. It is our argument that this replication of patriarchal modes of domination, which place the lowest ranks of the army in a ‘feminine’ situation, blended with the compulsory ‘macho’ stance soldiers are forced to adopt as army men (as seen, for example, in Philip Caputo’s Indian Country, Larry Heinemann’s Paco’s Story or Ed Dodge’s DAU: A Novel of Vietnam) furthers the onset and seriousness of ulterior trauma. In this sense, we can also analyze this kind of writing from a ‘feminist’ point of view, since the dynamics of über-patriarchal power established at the front at war-time deny any display of elements traditionally viewed as ‘feminine’ (such as grief, guilt or emotions) in soldiers. If trauma is the result of a game of patriarchal empowerment, how can feminist works, not only theoretical, but also fictional, overthrow it? Are ‘feminine’ characteristics necessary to escape trauma, even in male victims? How can feminist readings of trauma enhance our understanding of its dynamics and help produce new modes of interaction that transcend power and gender division as the basis for the organization of society?

Valoración del dolor en el paciente con trauma grave y ventilación mecánica no comunicativo

Pain is defined since 1979 by the International Association for the Study of Pain (IASP) as "unpleasant subjective, sensory and emotional experience associated with actual or potential damage of tissue", with the concept more acceptable in our days. The Intensive Care Unit (ICU) is a complex environment to assess pain, where the difficulty in communication with the patient is the biggest barrier to getting your "selfreport", which is considered the gold standard in pain assessment. Many factors alter communication with critically ill patients, as the low level of consciousness, mechanical ventilation, sedation, and the patient's own pathology, besides, there are other limitations such as excessive technology or devices that can divert professional attention to the patient's pain behavior, and lack of training and guidance for management. The multicenter study SUPPORT, it showed that 50-65% of critical patients included suffered pain, and 15% of them reported moderate to severe intensity for more than half the period of hospitalization. Critically ill patients experience pain due to high volume of potentially painful techniques applied to them during their ICU admission, emphasizing nursing care and tracheal suctioning, mobilization, wound healing and channeling of catheters and others. The underestimation of pain involves physiological and hemodynamic effects such as increased blood pressure and/or heart rate, altered breathing pattern, and psychological and anxiety. Also an increase of sedation and mechanical ventilation time and ICU stay of increasing the morbidity and mortality of critically ill patients...

"... the credentials that would rescue me": Trauma and the fraudulent survivor

The author of the present study juxtaposes accounts by " postmemory" individuals with the fraudulent works of Binjamin Wilkomirski (Bruno Dössekker) and Jerzy Kosinski. Analyzing both phenomena as representative of the dynamics at work in memory of the Holocaust and of other "traumatic events," the author arrives at a formulation, via Giorgio Agamben, of the aporia (contradiction) that lies behind both the legitimized and illegitimated. © Oxford University Press 2010; all rights reserved.

Shifting the "vantage point" to women: re-conceptualizing magical realism and trauma

Magical realist literature and trauma are often understood in terms of nationalist and historical paradigms in ways that expose a phallocentric bias. With the convergence of magical realist scholarship and trauma studies—in response to the centrality of trauma to magical realist fiction—this phallocentric bias has in many cases been consolidated. This article attends to magical realist trauma narratives by women, undertaking case studies of the UK writer Ali Smith’s Hotel World and the Filipino-Australian writer Merlinda Bobis’s Fish-Hair Woman. Following the groundbreaking work of the feminist historian Joan Kelly, who demonstrated that adopting a woman’s “vantage point” revolutionizes our understanding of history, this article argues that investigating magical realism and trauma from the “vantage point” of women writers leads to a reconceptualization of what constitutes trauma and a redefinition of magical realist fiction.

What reading and writing trauma fiction illuminates about post-traumatic growth.

Angelina Mirabito's PhD in Creative Writing investigated the therapeutic value of reading and writing trauma fiction. Her findings show that it is possible for adult survivors of complex trauma to experience post-traumatic growth from writing an adult survivor of childhood trauma coming of age story.

When continuity of care breaks down: a systems failure in identification of osteoporosis risk in older patients treated for minimal trauma fractures

OBJECTIVE: Minimal trauma fractures may be the first indication of osteoporosis. Our aim was to determine the proportion of patients who underwent bone density testing for osteoporosis of those with a minimal trauma wrist fracture treated in the emergency department (ED).

DESIGN: This observational retrospective cohort study used explicit medical record review and scripted telephone interviews.

SETTING: EDs of three metropolitan hospitals in Melbourne in 2006.

PARTICIPANTS: Patients aged 50 years and over who were treated for wrist fracture due to minimal trauma. Data collected included demographic details, fracture details, causes of injury, any bone density testing and any osteoporosis-related medication change.

MAIN OUTCOME MEASURE: The proportion of patients who underwent bone density testing in the follow-up period.

RESULTS: 131 patients were studied; 83% were female, and the median age was 71 years. No patient was referred by an ED or fracture clinic for bone density testing (95% CI, 0-3.5%). Telephone follow-up data were obtained from 91 patients. Of these, 28 reported having bone density testing after their fracture, of whom 14 (50%; 95% CI, 32%-67%) were found to have osteoporosis. Seven were treated with a bisphosphonate and one with a selective oestrogen-receptor modulator.

CONCLUSION: Follow-up of patients suffering minimal trauma wrist fractures treated in the ED is poor. Systems to improve the identification and treatment of osteoporosis in this group are needed if future osteoporotic fractures and their consequences are to be avoided.