1. Step 4
1.1. Hypothesis organization (tentative solution)
1.1.1. acute renal failure
1.1.2. volume depletion
1.1.2.1. internal bleeding
1.1.2.2. dehydration
1.2. 20 minutes
2. Step 1
2.1. Identify terms and cues
2.2. New terms
2.2.1. Pensioner
2.2.2. coherently
2.3. cues
2.3.1. 66 y/o male widowed pensioner
2.3.2. brought to local hospital
2.3.3. found by daughter lying on bathroom floor
2.3.3.1. stayed for 48 hrs and had fallen
2.3.4. found confused
2.3.5. he couldn't move the whole time, and there was immediate pain in right hip
2.3.6. daughter called a Dr. to administer IV saline
2.3.7. couldn't coherently explain what had happen
2.3.8. swelling in right leg
2.3.9. BP was low on admission
2.3.10. On cathetrization and little urine drain
2.4. 10 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. Kidney filtration physiology
3.1.1.1. trauma and muscle injury? how does it compensate
3.1.2. acute renal failure
3.1.2.1. Pathophysiology
3.1.2.2. Types
3.1.2.2.1. Tubular necrosis
3.1.2.3. clinical features
3.1.2.4. diagnosis
3.1.2.5. complications
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. 66 year old man was addmitted to ER on IV drip confused with low BP and swelling and pain on his right leg after he was found by his daughter laying in the bathroom for 48 hrs after he had fall. On cathetrization very little urine was drained
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. Confusion
5.1.1.1. low perfusion to brain
5.1.1.2. volume depletion
5.1.1.2.1. dehydration
5.1.1.3. uremia
5.1.1.4. medication side effects
5.1.2. Low BP
5.1.2.1. RAAS system dysfunction
5.1.3. little urine drained
5.1.3.1. urinary incontinence
5.1.3.2. water imbalance
5.1.4. Pain and swelling on right leg
5.1.5. Chronic kidney disease
5.1.5.1. comorbidity
5.1.6. ureter injury