1. Step 1
1.1. Identify terms and cues
1.2. New terms
1.2.1. swerved
1.2.1.1. avoid
1.2.2. knocked
1.2.2.1. hit someone
1.2.3. stretcher
1.2.3.1. at which the patient carreid on
1.3. cues
1.3.1. male cycling
1.3.2. hit in the chest by a car wing mirror
1.3.3. shortness of breath
1.3.4. counchious
1.3.5. uncooperative
1.3.5.1. didn't want to go to the hospital
1.3.5.2. he tried to remove the mask
1.3.6. chest pain
1.3.7. talked with short words
1.3.8. bruising in the chest
1.3.9. arrived after 40 min
1.3.10. on oxygen mask
1.3.11. his mother and younger brother were aggressive
1.4. 10 minutes
2. Step 4
2.1. Hypothesis organization (tentative solution)
2.1.1. CVS problem
2.1.1.1. hypotension
2.1.1.2. cardiac temponad
2.1.2. fracture
2.1.2.1. rib fracture
2.1.2.1.1. muscle tear
2.1.3. neurogenic shock
2.1.3.1. aggresive behaviour
2.1.3.1.1. previous bad experience
2.1.3.1.2. post-trauma stress syndrome
2.1.3.1.3. under drug effect
2.1.3.2. uncooperative behaviour
2.1.3.2.1. psychological disease
2.1.3.2.2. legal troubles
2.1.3.2.3. phobia
2.1.4. pleura puncture
2.1.4.1. pneumothorax
2.1.4.1.1. shortness of breath
2.1.4.1.2. pain
2.1.5. internal bleeding
2.1.5.1. hemothorax
2.2. 20 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. brief anatomy of thorax region
3.1.2. How to deal with traumatic difficult patient?
3.1.2.1. post-trauma stress syndrome
3.1.3. rib fracture and consequences
3.1.3.1. internal bleeding
3.1.3.1.1. hemothorax
3.1.3.2. muscle teat
3.1.3.3. pneumothorax
3.1.4. what causes shortness of breath, bruising, and pain after trauma?
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. a male cyclist hit in the chest by a car wing mirror, presented to the ER with shortness of breath, right chest bruising, and chest pain. He was conscious, uncooperative, and resisting.
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. fliud accumolation
5.1.2. rib fracture
5.1.3. muscle tear
5.1.4. internal bleeding
5.1.5. pneumothorax
5.1.5.1. shortness of breath
5.1.5.2. pain
5.1.6. tracheal dislocation
5.1.7. pleura puncture
5.1.8. CNS injury
5.1.9. brain injury
5.1.9.1. caused by hypoxia
5.1.10. neurogenic shock
5.1.10.1. aggresive behaviour
5.1.10.1.1. previous bad experience
5.1.10.1.2. post-trauma stress syndrome
5.1.10.1.3. under drug effect
5.1.10.2. uncooperative behaviour
5.1.10.2.1. psychological disease
5.1.10.2.2. legal troubles
5.1.10.2.3. phobia
5.1.11. injury to the cervical nerves
5.1.12. right clavicle fracture
5.1.13. CVS injury
5.1.13.1. hypotension
5.1.14. hyperventilation
5.1.14.1. depresses the CNS