Please select the eligibility criteria that correspond to the clinical trial below.
Title: N/A
Brief Summary: Assessing the efficacy of escitalopram in preventing the development of PTSD, or or reducing its severeness, after exposure to a traumatic event.


Options:
A: Inclusion Criteria:

* Age 18-64
* ISS \>15
* Infusion can be started within 24 hrs of arrival to FMLH (time of injury irrelevant)
* Admitted to Inpatient hospital trauma service (not Ortho/Plastics/Neurosurgery etc)

Exclusion Criteria:

* Age \<18 or \>64
* History of adverse reaction to ketamine therapy
* Chronic opioid therapy defined as \> 3 weeks of \>30mg oral morphine equivalents per day
* Current substance abuse with opioids including prescription and/or heroin
* Intubation on arrival or need for urgent intubation on arrival
* GCS \<13, significant traumatic brain injury, or suspicion of elevated intracranial pressure resulting in the patient's inability to communicate
* History of psychosis
* Active delirium
* Glaucoma
* Ischemic heart disease defined as active acute coronary syndrome
* Severe, poorly controlled hypertension (SBP \>200) on more than two readings
* Aortic Injury requiring HR and BP control
* Concurrent use of monoamine oxidase inhibitors (MAOIs)
* Pregnancy
* Prisoners
* Inability to start investigational drug infusion within 24 hours of arrival
B: Inclusion Criteria:

* Level 2 trauma patients admitted to the trauma floors or trauma ICU at Westchester Medical Center
* Experienced fear at the time of the trauma

Exclusion Criteria:

* Vulnerable populations, such as pregnant women, prisoners, persons with decisional incapacity.
* History of coronary artery disease, heart failure, prior stroke, heart surgery
* Bood pressure \>160/90
* Acutely psychotic
* Current diagnosis of anorexia nervosa, bulimia
* Current diagnosis of cancer
* Drug abuse or dependence in the preceding 3 months,
* Any unstable medical condition
* Active suicidal/homicidal ideation
* Cannot speak, read, write and understand English at least at 8th grade level.
C: Inclusion Criteria:

1. The patient is able to read and understand the Patient Informed Consent.
2. The patient has signed the Patient Informed Consent.
3. The patient has sufficient knowledge of Hebrew in order to understand the study procedure and instruments
4. The patient is male or female aged between 18 and 65 years (extremes included).
5. The patient underwent a traumatic event, such as vehicle or other accident, terror attack, physical or sexual assault within the last 3 weeks, and no more than 4 weeks ago.
6. The patient meets either of the following criteria:

1. Full DSM-IV criteria for ASD 2. Intrusion and hyperarousal criteria only

Exclusion Criteria:

1. The patient refuses having any medication therapy. This patient will be referred to another treatment outside the study frame.
2. The patient has a serious physical injury at inclusion, in which his Abbreviated Injury Scale (AIS) score, for at least one of his body regions, is 3 or more, or that according to the judgment of the clinician his injury sequelae would interfere with the study treatment.
3. The patient uses concomitant medications not allowed in the study:

   1. Antidepressants, including MAOI, RIMA within the last 3 weeks prior to screening.
   2. Mood stabilizers within the last 3 weeks prior to screening.
   3. Antipsychotic medications within the last 3 weeks prior to screening.
   4. Anxiolytics 2 weeks in a row before randomization. Patient can participate in the study if did not take the medications for 3 days over the two weeks before randomization. Except for oxazepam 10-20 mg/day no more than 7 days in a raw.
   5. Serotonergic agonists (e.g. triptans) within the last 2 weeks prior to screening.
   6. Prophylactic treatment with any anticonvulsant drug.
   7. Herbal remedies that are psychoactive (e.g. St John's Wort, Kava kava, valerian, gingko biloba) within the last 3 weeks prior to screening.
4. The patient meets lifetime DSM-IV-TR criteria for:

   1. Mania or Bipolar disorder
   2. Schizophrenia
   3. Any personality disorder judged by the investigator to jeopardize the evaluation of the treatment.
   4. Mental retardation or pervasive disorder
   5. Cognitive disorder (inc. dementia)
5. The patient has or has had alcohol or drug abuse related disorders in the last year prior to the screening visit.
6. The patient has, in the investigator's opinion, significant suicide risk and/or a score of ≥ 5 on question 10 in the MADRS scale.
7. The patient has a history of severe suicide attempt.
8. The patient requires ElectroConvulsive Therapy (ECT) or has received ECT within the last year prior to the screening visit.
9. The patient is currently serving in the Israeli security forces.
10. The patient has a history of drug allergy or hypersensitivity, or known hypersensitivity to escitalopram or citalopram.
11. The patient has an illness and/or serious sequelae thereof, severe enough according to the clinician judgment, to prevent his participation in the study, including liver or renal insufficiency; cardiovascular, pulmonary, gastrointestinal, endocrine (inc. uncontrolled thyroid), neurological (inc. epilepsy), infectious, neoplastic, or metabolic disturbances
12. The patient is pregnant or breast-feeding.
13. The patient, if woman of childbearing potential, is not using adequate contraception (adequate contraception is defined as sexual abstinence, oral/systemic contraception, surgical sterilisation, intrauterine device, diaphragm in combination with spermicide, or condom for male partner in combination with spermicide).
14. The patient, in the opinion of the investigator, is unlikely to comply with the clinical study protocol.
15. The patient has previously participated in the current study or in any other study within the last 30 days.
16. The patient has familial relationships with the investigator.
D: Inclusion Criteria:

* Adult patients admitted to an intensive care unit requiring mechanical ventilation and anticipated to require mechanical ventilation \>48h
* Patient has a sedation target (e.g. using the Richmond Agitation Sedation Scale or Sedation Agitation Scale) that is anticipated to be stable \>48h
* Minimum sedative infusion doses (any one of):

  * Propofol \>/=1.5 mg/kg/h \>24h
  * Midazolam \>/=3.0 mg/h \>24h

Exclusion Criteria:

* Sedation for paralysis
* Use of neuromuscular blocking agents (patients may be eligible once these are discontinued)
* Asthma or known reactive airways disease
* 1st, 2nd or 3rd-degree heart block (with no permanent pacemaker) at the time of screening
* Known history of congestive heart failure with ejection fraction \<20%
* HR\<60 bpm at baseline
* Hypotension requiring vasopressor support above the following levels

  * Norepinephrine dose \>0.15mcg/kg/min or equivalent (\>0.15mcg/kg/min epinephrine; \>22.5 mcg/kg/min dopamine; \>0.06 U/min vasopressin)
  * Phenylephrine \>2.0 mcg/kg/min
  * Receiving 3 or more vasopressors, regardless of dose
* Pregnancy or lactation
* Allergy to propranolol
* Patients for whom an enteral route of drug administration is not available
* Patients who are on digoxin, diltiazem, or verapamil
* Patients on chronic betablockers are eligible for enrolment. Patients allocated to the intervention arm will have their betablocker replaced with propranolol. Once propranolol is discontinued, the treating team may resume their usual betablocker. Control patients may continue their usual betablocker (unless it is propranolol) at the treating team's discretion.

Answer: C