Please select the eligibility criteria that correspond to the clinical trial below.
Title: Administration of Prazosin to Prevent PTSD After Sexual Assault
Brief Summary: This study plans to learn more about whether taking the medication, Prazosin, immediately and during the weeks immediately following a traumatic event can help to reduce the risk of developing posttraumatic stress disorder (PTSD). Early post traumatic event sleep disturbance predicts the later development of PTSD. Prazosin has shown some effectiveness in reducing trauma related nightmares and sleep disturbance. We hypothesize that regulating sleep immediately after a sexual assault will reduce PTSD and diminish symptoms.


Options:
A: Inclusion Criteria:

* Any patient who has been exposed to a traumatic event that could cause an acute PTSD (accident or aggression that causes intense fear, helplessness or horror)
* a PDI (Peri-traumatic Distress Inventory) score and / or PDEQ (Traumatic Traumatic Dissociation Experience Questionnaire - Evaluative Form)
* and / or (Appendix 1, 2 and 3) calculated between J1 and J3 and estimated moderate or high with a score\> 15.

Exclusion Criteria:

* Any serious traumatized patient who needed treatment in intensive care.
* Any patient with psychiatric illness or psychotropic medication prior to randomization.
* Non-cooperating patient (unable to answer the assessment test).
* Non consenting patient.
B: Inclusion Criteria:

* Female patients between the ages of 18 years and 50 years
* Victim of sexual assault/rape
* Able to understand consent procedure
* Discharged to home

Exclusion Criteria:

* Admitted to inpatient unit
* Previous diagnosis of PTSD
* Contra-indications to prazosin: orthostatic hypotension, right heart failure, use of anti-hypertensive medication, 5-phosphodiesterase inhibitors (sildenafil) or diuretic, history of syncope or severe unexplained faintness, known hypersensitivity to quinazolines
* Hemodynamically unstable
* Current use of over the counter, prescribed, or use of other drugs for insomnia
* Dependence on alcohol, opiates or other illegal drugs
* History of psychotic disorder
* Suicidal risk defined by a positive response on the 3-item assessment, standard protocol in the ED
* Current use of morphine or methadone
* Pregnant or breastfeeding
* Known hepatic dysfunction
* Cardiac or vascular history including coronary artery disease
* Narcolepsy
* History of sleep apnea
* Returning to chronic domestic abuse situation
C: Adult males with acute traumatic pain that are eligible to receive pain medication prior to hospital arrival under current practice will be screened for enrollment in the primary trial. The inclusion and exclusion criteria mirror this existing protocol (Appendix 1: Prehospital Protocols).

Inclusion Criteria of Primary Trial

* Subjects must be experiencing pain due to acute trauma (i.e. extremity deformity, tourniquet placement, or severe burns).
* A Verbal Numerical Rating Scale pain score ≥7 prior to any pain medication administration.
* Age: ≥18 through 65 years (i.e. subjects must have had their 18th birthday, but not had their 66th birthday).
* Systolic blood pressure ≥100mmHg and \<180mmHg.
* Transported directly from the scene of injury to the Emergency Department at University of Cincinnati Medical Center by a participating EMS agency.
* English-speaking.
* Male sex.
* Receiving fentanyl IV/IM/IN as part of standard care. Exclusion Criteria of Primary Trial
* Subject reported allergy to morphine, fentanyl, or ketamine.
* EMS treatment with ketamine (any), morphine (any), or more than one dose of fentanyl prior to enrollment.
* Inter-facility transfers.
* Prisoners or those in police custody.
* Female sex.
* Paramedic clinical concern of acute agitation or psychosis.
* Pain medication not needed in judgment of prehospital provider.
* Altered level of consciousness, mental status change, or suspected head injury.
* Paramedic clinical concern of circulatory shock.
* Inability to provide Verbal Numerical Rating Scale.
* Facial injury or suspicion of nasal bone fracture.
* Paramedic judgment that subject cannot consent due to underlying cognitive impairment.
* Systolic blood pressure ≥180mmHg

Justification for Exclusions Medications are generally withheld if there is a reported drug allergy. This is a study of acute pain management, and pretreatment with additional medications may bias results. EMS does not routinely provide inter-facility (between hospital) transfers, and these subjects will likely be transferred several hours after injury and should have received pain medications from the original hospital. Prisoners or those in police custody represent a protected population. Ketamine is pregnancy class N (unknown); while frequently used in developing countries for analgesia/sedation for Cesarean sections, 73-75 obtaining a serum or urine pregnancy test is not possible in the prehospital setting. Breast feeding women and women of childbearing age will be excluded. To avoid introducing bias from a partially included population, all women will be excluded. Ketamine may cause psychomotor agitation in some subjects (even though ketamine is frequently used as treatment of excited delirium76). Pre-existing agitation or mental status changes and inability to provide VNRS prevent outcomes assessments. Current prehospital protocols do not allow pain medications for patients with circulatory shock. Nasal trauma may interfere with medication delivery or absorption. Previous trials have excluded patients with a systolic blood pressure ≥180mmHg.6,38,49

Inclusion Criteria for Secondary Trial Subjects enrolled in the primary trial will be approached for participation in the secondary trial. Enrollment in the secondary trial will involve a second and separate consent process (further described below). Participation in the secondary trial is not required to participate in the primary trial.
D: Inclusion Criteria:

* victims of motor vehicle accidents
* signed informed consent

Exclusion Criteria:

* pregnancy
* traumatic brain injury
* psychiatry disorders
* active cancerous conditions
* adrenal diseases
* medical treatment by estrogens, anti-depressants, melatonin, pain control.
* substance abuse
* hospitalization due to the trauma
* contra indication to hydrocortisone treatment
* over 6 hours from time of injury

Answer: B