In 1987 I returned to McLure’s Beach and climbed the rock I fell on. I was utterly alone. There was no one in the parking lot, and thus no one for miles. I had gone thru the New Hope Program and had a year of sobriety. I had been in hypnotherapy. I had to do this.

I had not climbed but thirty feet, and was heading for the bridge, when I came upon a plaque nailed into the rock.

“6 KNOWN DEATHS”

This plaque was not there in 1967, and the thought that six people who came after me, met their death, was otherworldly. I was entering The Land of the Known Dead. I thought about the collective grief of their families. Their tears had come here. I closed my eyes, took some deep breaths, told myself I can do this, and proceeded.

I do not think Keith and James knew I was going into shock, because they were in shock at seeing me wounded. The powerful dose was incapacitating. We could not walk. Like a heavy gravity we were pinned to the sand. We could only watch and wait until the inital impact subsided.

After James tried to wash my wound, and after I got soaking wet, I told him to leave me be. He went and sat with Keith about fifty feet away. I sat at the edge of the water listening to the strange sound that the gravel made as each wave receded. It sounded like many engines. All of a sudden landing craft were coming out of the ocean, and I was in the a middle of horrendous battle. A young man fell next to me, mortally wounded. When he died, and with his last breath, he uttered his last word;

“Mother!”

I believe I was that soldier.

I watch that scene from Saving Private Ryan where the captain goes into a tunnel of silence. The engine of war is grating up and down my backbone. My teeth are chattering. I can not make it stop.

Jon

http://wrybread.com/gametone/leftcoast/mcclures.shtml

Acute stress reaction (also called acute stress disorder, psychological shock, mental shock, or simply shock) is a psychological condition arising in response to a terrifying or traumatic event. It should not be confused with the unrelated circulatory condition of shock, or the concept of shock value.

Circulatory shock, commonly known simply as shock, is a life-threatening medical condition that occurs due to inadequate substrate for aerobic cellular respiration.[1] In the early stages this is generally an inadequate tissue level of oxygen.[2]
The typical signs of shock are low blood pressure, a rapid heartbeat and signs of poor end-organ perfusion or “decompensation/peripheral shut down” (such as low urine output, confusion or loss of consciousness). There are times that a person’s blood pressure may remain stable, but may still be in circulatory shock, so it is not always a sign.[3]
Circulatory shock is not related to the emotional state of shock. Circulatory shock is a life-threatening medical emergency and one of the most common causes of death for critically ill people. Shock can have a variety of effects, all with similar outcomes, but all relate to a problem with the body’s circulatory system. For example, shock may lead to hypoxemia (a lack of oxygen in arterial blood) or cardiac arrest.[4]
One of the key dangers of shock is that it progresses by a positive feedback mechanism. Once shock begins, it tends to make itself worse, so immediate treatment of shock is critical to the survival of the sufferer.[3]

At this stage, the vital organs have failed and the shock can no longer be reversed. Brain damage and cell death are occurring, and death will occur imminently. One of the primary reasons that shock is irreversible at this point is that much cellular ATP has been degraded into adenosine in the absence of oxygen as an electron receptor in the mitochondrial matrix. Adenosine easily perfuses out of cellular membranes into extracellular fluid, furthering capillary vasodilation, and then is transformed into uric acid. Because cells can only produce adenosine at a rate of about 2% of the cell’s total need per hour, even restoring oxygen is futile at this point because there is no adenosine to phosphorylate into ATP.[3]

Post-traumatic stress disorder symptoms typically start within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not appear until years after the event.

Post-traumatic stress disorder symptoms are generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

Symptoms of intrusive memories may include:
Flashbacks, or reliving the traumatic event for minutes or even days at a time
Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:
Trying to avoid thinking or talking about the traumatic event
Feeling emotionally numb
Avoiding activities you once enjoyed
Hopelessness about the future
Memory problems
Trouble concentrating
Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:
Irritability or anger
Overwhelming guilt or shame
Self-destructive behavior, such as drinking too much
Trouble sleeping
Being easily startled or frightened
Hearing or seeing things that aren’t there

Post-traumatic stress disorder symptoms can come and go. You may have more post-traumatic stress disorder symptoms when things are stressful in general, or when you run into reminders of what you went through. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape and feel overcome by memories of your own assault.

When to see a doctor
It’s normal to have a wide range of feelings and emotions after a traumatic event. You might experience fear and anxiety, a lack of focus, sadness, changes in how well you sleep or how much you eat, or crying spells that catch you off guard. You may have nightmares or be unable to stop thinking about the event. This doesn’t mean you have post-traumatic stress disorder.

But if you have these disturbing thoughts and feelings for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your health care professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.

In some cases, post-traumatic stress disorder symptoms may be so severe that you need emergency help, especially if you’re thinking about harming yourself or someone else. If this happens, call 911 or other emergency medical service, or ask a supportive family member or friend for help.

“Acute stress response” was first described by Walter Cannon in the 1920s as a theory that animals react to threats with a general discharge of the sympathetic nervous system. The response was later recognized as the first stage of a general adaptation syndrome that regulates stress responses among vertebrates and other organisms.

The onset of a stress response is associated with specific physiological actions in the sympathetic nervous system, both directly and indirectly through the release of adrenaline and to a lesser extent noradrenaline from the medulla of the adrenal glands. These catecholamine hormones facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviors often related to combat or escape.

Normally, when a person is in a serene, unstimulated state, the “firing” of neurons in the locus ceruleus is minimal. A novel stimulus, once perceived, is relayed from the sensory cortex of the brain through the thalamus to the brain stem. That route of signaling increases the rate of noradrenergic activity in the locus ceruleus, and the person becomes alert and attentive to the environment.

If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system (Thase & Howland, 1995). The activation of the sympathetic nervous system leads to the release of noradrenaline from nerve endings acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis.

Contents
[hide] 1 Causes
2 Symptoms of acute stress reaction
3 Symptoms of acute stress disorder
4 Diagnostic guidelines
5 Treatment
6 See also
7 References

Causes[edit source]

By definition, acute stress disorder (abbreviated ASD) is the result of a traumatic event in which the person experiences or witnesses an event that causes the victim/witness to experience extreme, disturbing or unexpected fear, stress or pain, and that involves or threatens serious injury, perceived serious injury or death to themselves or someone else. Acute stress reaction is a variation of Post-Traumatic Stress Disorder (PTSD) and is the mind’s and body’s response to feelings (both perceived and real) of intense helplessness.

Symptoms of acute stress reaction[edit source]

The symptoms show great variation but typically include an initial state of “daze”, with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation.

This state may be quickly followed by either further withdrawal from the surrounding situation (to the extent of a dissociative stupor), or by agitation and over-activity, anxiety, impaired judgement, confusion, detachment, and depression. Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are also commonly present.

The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within 2–3 days (often within hours). Partial or complete amnesia for the episode may be present.

Symptoms of acute stress disorder[edit source]

Common symptoms that sufferers of acute stress disorder experience are: numbing; detachment; derealization; depersonalization or dissociative amnesia; continued re-experiencing of the event by such ways as thoughts, dreams, and flashbacks; and avoidance of any stimulation that reminds them of the event. During this time, they must have symptoms of anxiety, and significant impairment in at least one essential area of functioning. Symptoms last for a minimum of 2 days, and a maximum of 4 weeks, and occur within 4 weeks of the event.[1]

Diagnostic guidelines[edit source]

There must be an immediate and clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes, if not immediate. In addition, the symptoms show a mixed and usually changing picture; in addition to the initial state of “daze,” depression, anxiety, anger, despair, overactivity, and withdrawal may all be seen, but no one type of symptom predominates for long; the symptoms resolve rapidly (within a few hours at the most) in those cases where removal from the stressful environment is possible; in cases where the stress continues or cannot by its nature be reversed, the symptoms usually begin to diminish after 24–48 hours and are usually minimal after about 3 days.[1]

If symptoms last for more than a month, then the patient might be instead diagnosed with PTSD.

Treatment[edit source]

This disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. However, results of Creamer, O’Donnell, and Pattison’s (2004) study of 363 patients suggests that a diagnoses of Acute Stress Disorder had only limited predictive validity for PTSD. Creamer et al. did however find that re-experiences of the traumatic event and arousal were better predictors of PTSD.[2] Medication can be used for a very short duration (up to four weeks)[citation needed].

A number of studies have been conducted to assess the efficacy of counselling and psychotherapy for people with ASD. Cognitive behavioral therapy which included exposure and cognitive restructuring was found to be effective in preventing PTSD in patients diagnosed with ASD with clinically significant results at 6 months follow-up. A combination of relaxation, cognitive restructuring, imaginal exposure, and in vivo exposure was superior to supportive counseling.[3]