Location: You are an FY1 working in the emergency department. You have been asked by the nurse in charge to talk to a patient admitted with hematemesis.
Patient: Matthew is a 35 year old man who has had multiple attendance in A&E with alcohol related problems.
– Take a focused history from the patient to determine if he has an alcohol dependence problem, focusing on the symptoms of dependency
– You are NOT expected to take a medical history, the patient has been determined as medically fit by the consultant
– Assess the patients mental state and determine if there is an underlying mental health problem
– After 6 minutes you will be asked a series of questions by the examiner.
– You are anxious, your hands are shaking, you can’t keep them still. You are on edge. You become emotional when talking about personal topics and struggle to talk about them. You answer questions but only when specifically asked
– Started drinking at 15 years old, vodka in the park most weekends
– At 18 years old you joined the army and started drinking after work socially
– Currently you drink alone. Typical day: breakfast 3 cans of lager to get you up, you’ll go to the park and have a bottle of vodka in a plastic bottle, evening you’ll go home put the TV on and have a bottle of whisky and pass out in front of the TV
– You have been drinking like this for the past 5 years
– Drinking in the morning to stop the shaking and sweating
– You have noticed you now have to drink much more to get tipsy
– You have not tried to have a day without alcohol in a while, it is the most important thing in your life at the moment and you have no idea what to do about it
– Only if specifically asked what might have caused your drinking
– You were in the army, all of your unit were killed whilst out on exercise including all your best friends. You were the only one to survive
– You keep having flashbacks, the thoughts are so vivid it’s like reliving the experience. You become very emotional when this happens. You cannot control these thoughts and use alcohol to stop this from happening. Triggered when you hear a loud noise like a door slamming or a car back firing
– When you got back home after this happened you struggled to adjust back to civilian life and were discharged from the army on medical grounds but was lost to follow up with regards to problems. You couldn’t leave the house, had an inner restlessness
– Your sleep is awful, 4 hours a night. You have to pass out drunk in order to do it. You eat 1 meal a day, a ready meal. You struggle to do anything but drink. You don’t enjoy anything and only leave the house to buy more alcohol and drink
– Forensic: never been involved with the police
– Risk to self and others: no thoughts of suicide or harm to others