Trauma Care, Volume 4, Issue 3 (September 2024) – 6 articles

Background: The effects of adverse childhood experiences on adult psychopathology have received ample attention in empirical studies. Despite the extensive focus on the effects of childhood adversity, research on the protective factors that might mitigate these effects remains limited. The most common measure of childhood adversity is the Adverse Childhood Experiences (ACEs) questionnaire. In 2016, a novel addition, called the ‘Protective and Compensatory Experiences’ (PACEs) questionnaire was created to be administered in tandem with the ACEs measure. Objective: Developing an understanding of PACEs can provide insight into the positive impacts of protective factors and potential ways to build resiliency among those with adversity. The aim of the present review is to provide an overview of the uses and findings of the PACEs measure and its potential contributions in the field. Methods: A literature search was used to identify peer-reviewed publications, dissertations, and conference presentations on empirical data, reporting on the administration of the PACEs measure to a clinical or community population and their findings. Results: A total of 17 studies were identified that used the PACEs. Ten empirical studies were used to explore the impact of PACEs within the realm of child development, including research on pregnant mothers, parenting, and child resilience. Six empirical studies were used to investigate the prevalence of PACEs in various at-risk populations, such as sexual minorities, racial minorities, veterans, individuals with chronic pain, and healthcare providers after the COVID-19 pandemic. One empirical study used PACEs to track attrition in longitudinal research studies. Conclusions: Overall, there appears to be little research on the PACEs, but the empirical studies that we identified suggest that PACEs may increase resiliency among various populations. Future research into positive and negative childhood experiences would benefit from the information assessed with the PACEs measure. Full article

Moral injury is a psychological wound resulting from deep-rooted traumatic experiences that corrode an individual’s sense of humanity, ethical compass, and internal value system. Whether through witnessing a tragic event, inflicting injury on others, or failing to prevent a traumatic injury upon others, moral injury can have severe and detrimental psychological and psychosomatic outcomes that may last a lifetime. Post-traumatic experiences do not have to be a permanent affliction, however. From moral injury can come post-traumatic growth—the recovery from trauma in which personal betterment overshadows moral injury. Moral injury may lead to substantial personal growth, improved capacity and resilience. Based on these observations, it seems that from struggles and darkness, there can be positivity and hope. This review will summarize the current concepts of post-traumatic growth and consider potential mechanisms leading to resilience and recovery through post-traumatic growth. These considerations are gaining more importance in light of a growing number of existential threats, such as violent conflicts, natural disasters and global pandemics. Full article

Existing literature thoroughly reviews the detrimental consequences that adverse childhood experiences (ACEs) have physically, emotionally, neurobiologically, and financially. It is imperative to develop effective treatments that offer a sense of hope to children who have been impacted. The established relationship between high ACE scores and physiological hyperarousal due to emotional dysregulation is clear in the literature. This relationship indicates that taking psychophysiological measures may be an effective method of gauging the effectiveness of trauma treatments. This study measured the heart rate of a child who had experienced multiple ACEs, during 16 child-centered play therapy (CCPT) sessions, using the Empatica (E4) wristband. Bayesian change point analysis was conducted and multiple changes in the heart rate mean were detected and identified within each session’s time series. Additionally, changes in heart rate variability during the 16 sessions were observed and points of interest, e.g., highest and lowest observed heart rates, were noted. Results suggested the number of breakpoints in the heart rate means within each session, as well as the location, i.e., the time of each breakpoint, so that each significantly detectable change in heart rate mean as well as sessions of noted differences in heart rate variability were discussed alongside what was occurring within the video recorded sessions. Full article

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intra-abdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy. Full article