History. An 85-year-old white gentleman was admitted to the inpatient psychiatry service to "dry out" following a drinking binge. At morning report, the addiction treatment team said that the patient was "sleeping it off."
Physical Examination. At the bedside, I observed the patient to have a pulse of 120 beats per minute, a respiratory rate of 40 breaths per minute, and to be in a semi-coma, from which he could not be awakened.
Emergency Consultation. The medical intensive care team was called. With correction of his fluid and electrolyte imbalance and stabilization of his pulmonary status, the patient woke from his semi-coma and was returned to our inpatient psychiatry unit, where he remained comfortable and stable until our social work service could provide comfortable alcohol(Drug information on alcohol)-free housing for him. He verbalized his appreciation of our timely diagnostics, treatment and care and also for our human services liaison. Twelve-step work with sponsorship was recommended and documented for him to develop and use his Tools of Recovery.
Critique. In a review of how this patient came to be hospitalized on our detoxification unit, it became apparent that his first medical physical examination was performed on the morning after he arrived on our detoxification unit. Records documented previous detoxification unit hospitalizations; at this repeat hospitalization the patient appeared in a reasonable disposition. The only glitch was that in the middle of the night the patient was minimally examined, if at all; and, in the absence of a complete medical physical examination, was simply labeled as a patient who was "sleeping it off." Once the pulse rate, respiration rate and level of consciousness were determined on the detoxification unit, then an accurate diagnosis of semi-coma became much more clear. It is probably a good and reasonable diagnostic rule-of-thumb that the majority of hospital inpatients, whether chemically dependent or not, need a thorough medical, physical examination by their health care providers on morning rounds.
These two case studies are representative of the many reasons why health care providers need to put aside typical stereotypes and tunnel vision and provide our chemically-dependent patients with the same care as our non-chemically dependent patients.
(c) CME LLC