LO1 mass flashcards

what does it mean to be trauma informed

• understand how common trauma is

• understand how people are effected by trauma

four key elements of trauma informed care

1. realizing the impact of trauma and how to recover

2. recognizing common reactions to trauma

3. responding by integrating knowledge of trauma

4. resisting re-traumatization via principles

overwhelming stress or trauma can cause

• substance use disorders

• mental health problems

• relationship problems

• employment issues

• physical health problems

core aspects of all trauma informed care

• therapeutic relationship

• first do no harm

principals

• awareness

• looking at trauma from eyes of others: consider specifics, attributes, culture

• create safety and trust

• choice and collaboration: reinforce persons sense of control

• focus on strengths: helps identify coping mechanisms and skills

• recovery is possible

trauma definition

requires the presence of actual or threatened death, serious injury, or sexual violence

three components of trauma

1. potentially traumatic event

2. individual experience of the event: SDOH

3. physical, mental, social, emotional, spiritual distress symptoms

social determinants of health SDOH

• biology and genetics

• gender

• culture

• health practices

• social support networks

• social status

• social and physical environment

• child development

• education and literacy

• employment and working conditions

• living conditions

acute trauma

single incident of relative short duration (motor accident)

chronic trauma

multiple events which are repeated over an extended period (domestic violence)

complex trauma

began or took place before the age of 5, perpetrated by trust figures

system oriented trauma

• services meant to help cause trauma

developmental trauma

• trauma that happened during developmental stages

intergenerational trauma

• effects of trauma are passed down from one generation to another

post traumatic stress disorder PTSD

lasts longer than four months

• flashbacks, avoidance, etc.

adverse childhood experiences ACEs

• abuse

• neglect

• household dysfunction

cumulative grief

• losses that occur simultaneously or over a short period of time where there is no space, time or energy to grieve each loss

stressor

stimulus that triggers stress response

Hans Selye rats

• rats were injected with a hormone thought to cause stress

• stress was really caused by the handling and injecting, not the hormone

critical incident

• an incident that overwhelms the ability of a paramedic to cope with it

• unable to cope at the scene or after

critical incident stress debriefings CISDs

• held within 24-72 hours of incident

• debriefing with personnel who experienced a critical incident or other serious incident

• no evidence they are effective

• normal people having normal reactions to abnormal situations

• 7 steps

incidents that require CISDs

• serious injury or death of fellow worker

• suicide of fellow worker

• MCI

• serious injury or death of a child

• intense media attention to an incident

signs of PTSD

• trouble getting incident out of thoughts

• flashbacks of incident

• apetite changes

• nightmares or sleep disturbances

• laughing or crying for no reason

• withdrawal from people around you

• guilt or shame

• memory loss

• chronic pain

eustress

• positive stress

• beneficial

• motivation, performance, etc.

• usually short term

distress

• negative stress

• detrimental

• causes anxiety, concern, etc.

• can be long term

acute stress

• most common form of stress

• demands and pressures of the recent past

• short term

symptoms of acute stress

• emotional distress

• muscular problems

• gastrointestinal problems

• elevation in blood pressure, rapid heart rate, sweating, headaches, etc.

episodic acute stress

• suffering from acute stress frequently

• extended over arousal

• ceaseless worry

symptoms of episodic acute stress

• persistent tension

• headaches

• migraines

• hypertension

• chest pain

• heart disease

chronic stress

• unrelenting stress

• long term

• feels like there is no way out

• people get used to it

• wears people down to a final breakdown

chronic stress dangers

chronic stress can kill through:

• suicide

• violence

• heart attack

• stroke

• cancer

sudden stimulation of the sympathetic nervous system causes

• increased heart rate

• widened bronchial passages

• constricted blood vessels

• dilated pupils

• goosebumps

• rise in blood pressure

• diaphoresis

• decreased motility of large intestines

• increased peristalsis in the esophagus

general reaction to a sudden threat

• alarm reaction

• sudden stimulation of the sympathetic nervous system

stimulation of the CNS causes

• increased heart rate

• widened bronchial passages

• constricted blood vessels

• dilated pupils

• goosebumps

• rise in blood pressure

• diaphoresis

• decreased motility of large intestines

• increased peristalsis in the esophagus

common paramedic stressors

• constant unknowns

• unpredictability

• poor or dangerous working conditions

• shift work

• long hours

• confrontation with death

• daily confrontation of injury or sick people

• demanding care

• undervalued role by other team members

• high self expectations

• support system may not be working

three primary interventions to manage stress

1. decrease stressor

2. increase stress resistance

3. reduce response to stress

Miller’s stress minimizing techniques

1. investment: identify goals before responding, monitor while in field and after, avoid critical judgement

2. empathetic engagement and identification: seek empathy, find what makes negative feelings, identify personal triggers

3. supervision and support: buddy system, regular supervision, team meetings

4. the basics: food, water, sleep

5. physical activity: develop routines before response, do activities while in field

6. recreational activities: journaling, mindfulness, etc.

7. connection with others

8. help when wounded: seek help and help others

symptoms of burnout

• chronic fatigue

• irritability

• negative attitudes

• lack of desire to work

• changes in sleep patterns

• emotional instability

• feeling hopeless

• loss of interest

• chronic pain

• anxious

• panicky

• demanding

three main characteristics of crisis

1. usual balance between thinking and emotions is disturbed

2. failure of usual coping mechanisms

3. evidence of distress, impairment, or dysfunction

critical incident stress

• state of cognitive, physical, emotional, and behavioural arousal accompanying the crisis reaction

• may lead to acute distress disorder, PTSD, etc.

critical incident stress management CISM

• comprehensive, systematic multi tactic crisis intervention

• coordinated program of tactics to alleviate reactions to traumatic experiences

Sask Poly critical incident stress policy

If critical stress reaction from practicum occurs

• report to coordinator ASAP

• in house critical incident debriefing may be necessary

• saskpolytech counselling services

• coordinator will follow up to determine when student can return to practicum

EC working time directive

• no more that 48 hours a week over 17 week period

• minimum daily rest period of 11 consecutive hours

• weekly rest period of 24 or 48 consecutive hours over 14 days

• min 20 minutes rest after 6 hour work period

• free health assessments for night workers

• pained annual leave of at least 4 weeks

when does highest level of alertness and best coordination occur

between 10:00 - 14:30

how can effects of shift work on circadian rhythm be minimized

• avoid caffeine

• healthy meals

• regular sleep pattern

• rest while required

coping

• problem focused (actively addressing the event)

• emotion focused (regulation of emotions caused by stress)

• emotion focused is better when events are uncontrollable

control and self efficacy (protecting health)

• having the belief you are in control of a situation

• perceived control benefits immune system functioning

• feeling in control can change stress hormone levels

• self efficacy: believe in yourself

type A behaviour

• competitive, impatient, hostile, time urgent

• doubled risk of heart disease

type B behaviour

• relaxed, easygoing, flexible, even tempered

• health protective

biofeedback

• individual is shown bodily info that they wouldn’t normally have (heart rate)

• proven to reduce the effects of stress

Dunbar cognitive limit

we can maintain social relationships with about 150 people

emotional construct

• expression of empathy, love, trust, and caring

instrumental construct

• tangible aid and service

• husband working from home to relieve some of the stress of taking care of children

informational construct

• advice, suggestions, and information

appraisal construct

• information that is useful for self-evaluation

• reminder to encourage accurate assessment of current situation

basal metabolic rate BMR

• the energy that is required while you are at rest

• breathing, circulation, body temperature

resting energy expenditure REE

• energy required for simple activity

• digestion of food

• accounts for ¾ of daily energy requirements (including BMR)

carbohydrates

• recommended main source of energy

• obtained mostly via plants

• simple (sugars) or complex (starch, glycogen)

• ranked according to glycemic index

glycemic index GI

• effect food has on blood glucose levels and insulin release

• higher the GI, greater the release of sugar into bloodstream

  • lower GI foods are safer

proteins

• needed for tissue growth, repair, maintenance

• essential (cannot be synthesized)

• nonessential (synthesized by body)

• transport other nutrients in bloodstream

• only source of nitrogen (tissue repair and growth)

• can be used as energy source

fats

• most calorie dense nutrient

• energy source

• cushions organs, lubricates body tissues

• insulates and protects cell membranes

• saturated or unsaturated

• trans fatty acids result in diabetes, heart disease, infertility, prostate cancer

water

• critical component because cells depend on fluid environment

• regulates body temperature

• moves waste and nutrients through body

• cannot survive more than a few days without water

vitamins

• organic substance essential for metabolism

• highest in fresh foods

• fat soluble (can be stored in body, A,D,E,K)

• water soluble (cannot be stored, B, C)

minerals

• inorganic element essential in biochemical reactions

• macro (more than 100mg needed daily)

• trace elements (less than 100mg)

Canada food guide suggests

• half of portions should be fruits and vegetables

• about a quarter should be proteins

• about a quarter should be whole grains

minimum amount of physical activity per week

• minimum of 2 ½ hours

• recommended strengthening activities 2 days a week

• children between 5-17 minimum 60 minutes a day and strength building 3 times a week

normal sleep requirements

varies per person, anything between 6-10 hours is recommended

4 basic dimensions of mental health

• thoughts

• body reactions

• emotions

• behaviours