Treatment of the underlying condition can quickly resolve the shock. For tension pneumothorax, needle decompression should be done immediately. A chest tube is also inserted. Cardiac tamponade is treated through needle or surgical decompression. Needle pericardiocentesis can be done at the bedside. This is often the preferred therapy. A catheter may be placed for continued drainage. If these methods are not effective, surgery may be needed. Pericardial window is a surgery that is particularly in cases of cancer.Massive pulmonary embolism requires thrombolysis or embolectomy. Thrombolysis can be systemic via IV alteplase (tPA) or catheter-directed. tPA works to break up the clot. A major risk of tPA is bleeding. Thus, patients must be assessed for their risk of bleeding and contraindications. Catheter-directed therapy involves giving tPA locally in the pulmonary artery. It can also fragment and remove the clot itself (embolectomy). This local therapy has a lower risk of bleeding. Surgical embolectomy is a more invasive treatment, associated with 10-20% surgical mortality risk. == References ==
Medications like prazosin are sometimes used to treat nightmares in people with PTSD. Therapy usually helps to deal with the frightening themes of the nightmares and alleviate the recurrence of the dreams. The persistent nightmares will usually improve as the patient gets older. Therapy is usually efficient to treat chronic nightmares in PTSD disorder or in other population. Medication has shown efficacy to treat chronic nightmares among a PTSD population but the impact of pharmacological treatments on other populations, such as drug-related nightmares, are unknown. Furthermore, patients usually take more than one medication at a time, whatever the cause related to nightmares, leading to possible interactive effects.Eye Movement Desensitization and Reprocessing (EMDR) has demonstrated a significant nightmares reduction, especially for the treatment of PTSD. Silver, Brooks and Obenchain have found a decrease of the nightmares with Vietnam War veterans after 90 days of EMDR. Jayatunge has found significant results with people who have survived to a tsunami. Greenwald has successfully used the EMDR with children. There wasnt any negative consequence due to the EMDR sessions. Imagery rehearsal therapy has been shown as efficient to treat nightmare disorder in PTSD as well as in non PTSD populations. In this treatment, the person has to write a new scenario of the nightmare with positive images that will be rehearsed during 10 to 20 minutes per day, in order to change the negative content of the nightmare. Cognitive behavioral therapy for insomnia (CBT-I) is also efficient to treat nightmares in the PTSD population.