Trauma definition

Adverse event. Unwanted effects that occur and are detected in populations. The term is used whether there is or is not any attribution to a medicine or other cause. Adverse events may be known parts of a disease that are observed to occur within a period of observation, and they may be analyzed to test for their frequency in a given population or trial. This is done to determine if there is an unexpectedly increased frequency resulting from nondisease factors such as medicine treatment. The term adverse event or adverse experience is used to encompass adverse reactions plus any injury, toxicity, or hypersensitivity that may be medicine-related, as well as any medical events that are apparently unrelated to medicine that occur during the study (e.g., surgery, illness, and trauma). See definition of Adverse reaction. 

Synonyms of adverse reactions generally include adverse medical effects, untoward effects, side effects, adverse drug experiences, and adverse drug reactions. Specific distinctions among some of these terms may be defined operationally. For example, the term adverse reaction is used to denote those signs and symptoms at least possibly related to a medicine, whereas the term adverse experience is used to include nonmedicine-related medical problems in a trial such as those emanating from trauma or concurrent illness. Distinctions among side effects, adverse events, and adverse reactions are illustrated in the definitions of the two former terms. 

In the event of a terrorist attack, people will suffer physical and psychological trauma. Physical effects will include the effects of exposure to any explosion—broken bones, burns, shock, lacerations, and so forth. These may be compounded by the presence of radioactive contamination and, in some cases, radiation illness. In addition, any terrorist attack will, by definition, inflict psychological trauma, and medical personnel must be prepared to receive many patients who are worried, panicked, or suffering psychosomatically in spite of being physically well. In the aftermath of a terrorist attack, even a simple headache or anxiety attack may be seen as evidence of radiation sickness. 

Stabilize the patient, medically and surgically, and provide definitive treatment of serious injuries, including major trauma, bums and respiratory injury if evident. Patients should receive necessary surgical interventions within 36 h and no later than 48 h after exposure surgery after that time is contraindicated for 6 weeks or until evidence appears that the patient is immunocompetent and that incised tissue is capable of revascularizing (10). 

Besides the paucity of historic data, another difficnlty associated with mental health studies of disaster victims is the lack of standardization of criteria used for case definitions of mental health disorders following mass trauma, such as post-traumatic stress disorder (PTSD) (6,7). Diagnostic criteria for PTSD, as noted in the fourth edition of the diagnostic and statistical manual (DSM-IV), should go beyond specified combinations of symptoms to include requirements for symptom duration and the patient s ability to function (6,7). Specifically, for a PTSD diagnosis, the patient must have symptoms for more than 1 month, and the symptoms must cause clinically significant distress or impair the patient s ability to function (6,7). In addition, the symptoms must occur after the traumatic event and could not have existed before the event. Unfortunately, many studies have used questionnaires that fail to distinguish new symptoms following traumatic events from previous prevalent symptoms such as sleeplessness that many people have at various times (6). The consequence is that many studies tend to inflate the prevalence of PTSD. 

In addition to problems with study design and study instruments, the DSM-IV diagnostic criteria themselves lack specificity, making case definitions difficult in epidemiologic studies of mass trauma victims. For example, the DSM-IV criteria for PTSD define exposure vaguely as the person experienced, witnessed, or was confronted with the event (6,7). Fortunately, the accompanying explanatory text... 

Although the basic pathophysiology is similar for the various causes of hypovolemic shock, there are unique considerations relative to each. For example, whereas isolated head injuries associated with trauma typically do not result in substantial blood loss or shock, pelvic fractures may sequester several liters of blood as hematoma formation. Patients with traumatic or thermal injuries, as well as postoperative patients, may have substantial fluid accumulation in sites where it cannot be readily transferred back into blood vessels (i.e., third-spaced fluid) for maintaining pressure. With these types of injuries, prompt control of compressible bleeding sources with rapid patient transfer to the hospital for definitive treatment may preclude the cascade of events leading to shock. Indeed, with trauma patients, a scoop and run approach is used in most urban hospitals that places a priority on rapid transport to a hospital. ... 

Exposure to a traumatic event is required for a diagnosis of PTSD. The person must have witnessed, experienced, or have been confronted with a situation that involved definite or threatened death or serious injury, or possible harm to themselves or others. The patient s response to the trauma must include intense fear, helplessness, or horror. Some examples of traumatic events include motor vehicle accidents, natural disasters, rape, being held hostage, child sexual abuse, and witnessing a murder or injury of another. 

The skull and vertebrae protect the CNS from blunt or penetrating trauma (Fig. 105-1). The brain is suspended in these structures by cerebrospinal fluid (CSF) and is surroimded by the meninges. The meninges are made up of three separate membranes dura mater, arachnoid, and pia mater. Dura mater, or pachymeninges, lies directly beneath and is adherent to the skuU. The other two membranes are referred to collectively as leptomeninges. Pia mater lies directly over brain tissue. Arachnoid, the middle layer, lies between the dura mater and the pia mater. The subarachnoid space, located between the arachnoid and the pia mater, is the conduit for CSF. By definition, meningitis refers to inflammation of the subarachnoid space or spinal fluid, whereas encephalitis is an inflammation of the brain... 

Considerable caution must still be exercised in allotting a definite role to the RE system in the defense of the body against physical trauma though there is some evidence which strongly suggests that the greater... 

Any injury, wound, or shock whether physically or emotionally inflicted. Trauma has both a medical and a psychiatric definition. Medically, trauma refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry, trauma has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects. 

Posterior urethra can be injured in patients with pelvic traumas. Precise definition of pelvic fracture location may enable prediction of which subjects are at risk for posterior urethral injury (Basta et al. 2007). 

---