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A 38-year-old female emergency medical technician presents 10 days after witnessing a fatal multi-vehicle accident in which she performed CPR on a child who died. She reports recurrent intrusive images of the child's face, nightmares about the event every night, avoidance of driving, hypervigilance, an exaggerated startle response, emotional numbness, and a persistent inability to experience positive emotions. She also describes episodes of feeling detached from her body, as though she is watching herself from outside. She is unable to return to work.
Explanation
When evaluating trauma-related symptoms, the timeline is the first consideration. Under 3 days: too early to diagnose. Days 3-30: acute stress disorder. Beyond 30 days: PTSD. The symptom count must then be confirmed. ASD requires 9 or more symptoms from any of the five categories. The nine symptoms can come from any combination of the five categories, the patient does not need to have symptoms in every category to meet criteria.
Key Takeaway
Acute stress disorder is diagnosed from 3 days to 1 month post-trauma; PTSD cannot be diagnosed until symptoms persist beyond 30 days.