1. Step 1
1.1. Identify terms and cues
1.2. New terms
1.2.1. retrenchment
1.2.2. sort went stiff
1.2.3. flushed in apperience
1.2.4. intermittently
1.3. cues
1.3.1. 35yo male
1.3.2. unemployed (6 months)
1.3.3. seen fallen by his girlfriend while having breakfast in the morning
1.3.4. presented to the ER
1.3.4.1. flushed in appearance
1.3.4.2. drank heavly the night before presentation 4L
1.3.4.3. last drink 11.45 pm
1.3.4.4. he was confused
1.3.5. rigid body and violent rhythmic contractions
1.3.6. heavy drinker usually 1L
1.3.6.1. doubled in the last six months 2L
1.3.7. drugs to stop worrying
1.3.7.1. serapax
1.3.7.2. benziodiazepine
1.3.7.3. drugs have been taking intermittently
1.3.8. excessive worrying
1.4. 10 minutes
2. Step 4
2.1. Hypothesis organization (tentative solution)
2.1.1. metabolic
2.1.1.1. CNS depressant drugs might cause muscle contraction
2.1.1.1.1. like benzodiazpine
2.1.1.2. alcohol (long exposure) cause reduced liver function
2.1.1.2.1. multi-factorial
2.1.1.3. Combination of drugs and alcohol
2.1.1.3.1. recently took drugs (3 weeks ago)
2.1.1.4. contraindications to alcohol
2.1.2. trauma
2.1.2.1. head injury (might be from alcoholism or vertigo)
2.1.2.1.1. internal bleeding
2.2. 20 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. how alcohol and drugs (serapax, benzodiazepine) affect the body in the syptoms that was presented?
3.1.2. What causes rhythmatic contractions and body rigidity?
3.1.2.1. could it be head injury?
3.1.3. what causes flushing?
3.2. 10 minutes
4. Step 3
4.1. Hypothesis generation (brainstorming)
4.1.1. vascular
4.1.1.1. Flushed in appearance caused by vasodialation
4.1.2. infections
4.1.2.1. food poisoning
4.1.3. trauma
4.1.3.1. accident while he was drunk (head injury)
4.1.3.2. falling because vertigo
4.1.3.3. internal bleeding
4.1.4. autoimmune
4.1.4.1. myasthena gravis
4.1.4.1.1. receptor blocking cause muscle contraction
4.1.5. metabolic
4.1.5.1. toxins
4.1.5.2. CNS depressant drugs might cause depression and muscle contraction
4.1.5.2.1. benzodiazpine
4.1.5.3. alcohol toxicity (long exposure) cause reduced liver function
4.1.5.4. Combination of drugs and alcohol
4.1.5.4.1. recently took drugs (3 weeks ago)
4.1.5.5. contraindications to alcohol
4.1.6. idiopathic
4.1.7. neoplastic
4.1.7.1. brain tumor
4.1.7.2. liver tumor
4.1.7.2.1. affecting the function of the liver
4.1.8. conginital
4.1.8.1. dormant disease
4.1.8.2. genes
4.2. 40 minutes
5. Step 2
5.1. Problem formulation (put it in a senates)
5.1.1. A 35yo alcoholic male presented to the ER in the morning confused and flushed in appearance. He had rigid body followed by violent rhythmic contractions while having breakfast.