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Case 16: Wazza Wainright

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please review the scenario below and take a focused history from Wazza. No further examination is required. Please discuss the issues raised and outline your management plan to Wazza. The Austroads Assessing Fitness to Drive1 standards will be available in the consultation room in either hard or electronic copy.

Scenario

Wazza Wainright, aged 48, drives road trains for a living. He has booked in to see you for his commercial driving licence renewal. Wazza attends your practice but this is the first time that you have seen him. He has completed part of his driving assessment with your practice nurse, and relevant sections of this are available below.

The following information is on his summary sheet:

  • Past medical history

  • Nil significant

  • Medication

  • Nil

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Road train driver

  • Married

  • Non-smoker

  • Alcohol intake—two standard drinks weekly

The below assessments have been handed to you by your practice nurse.

Epworth Sleepiness Scale

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How likely are you to doze off in the following situations, in contrast to just feeling tired? Would never doze off (0) Slight chance of dozing (1) Moderate chance of dozing (2) High chance of dozing (3)
a) Sitting and reading image image image image
b) Watching TV image image image image
c) Sitting inactive in a public place (e.g. a theatre or a meeting) image image image image
d) As a passenger in a car for an hour without a break image image image image
e) Lying down to rest in the afternoon when circumstances permit image image image image
f) Sitting and talking to someone image image image image
g) Sitting quietly after a lunch without alcohol image image image image
h) In a car, while stopped for a few minutes in the traffic image image image image

Observations

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Blood pressure
Pulse		 136/82 mmHg
76, regular
Height
Weight
BMI		 180 cm
149 kg
46 kg/m2

The rest of Wazza’s fitness to drive health assessment is unremarkable.

INSTRUCTIONS FOR THE PATIENT, WAZZA WAINRIGHT

You are a 48-year-old road train driver. You enjoy the freedom of the open road but staying awake on long stretches has become more difficult. You keep yourself going with energy drinks, such as Red Bull, and strong coffee. Some of the younger drivers have tried to sell you amphetamines but you’ve resisted. Your diet is dependent on what you can buy at roadhouses, and you do little exercise.

You look forward to your days off at home but recently all you seem to do is fall asleep during the day when you try to relax. You get to sleep OK but your partner seems to spend half the night telling you to stop snoring or shouting at you to start ...

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