SDL_Pulm

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Mercy College *

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198A

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Medicine

Date

Dec 6, 2023

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docx

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3

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Tulane University School of Medicine Self-Directed Learning (SDL) Directing Your Own Learning in Order to be a Life-Long Learner Upon being presented with a problem or case that requires self-directed learning: STEP 1: Self- assessment of learning needs Create a list of topics/areas that you know/learned already about the problem or case. Add a list of topics/areas that you will need to learn in order to address the problem or case. Sepsis and other causes of ARDS, ARDS, respiratory failure, respiratory distress, pulmonary edema due to microthrombi, PAO2/FiO2 ratio, PEEP, tidal volume, What questions do you have in order to propose a solution for the clinical case/problem? Is the sepsis the precipitating factor for the development of ARDS? STEP 2: Independent Identification What resources will you consult to come up with the answers to your questions? (See Student Guide for details) Consult the Ankiking Deck for answers, and UptoDate STEP 3: Analysis What initial information did you identify after consulting the resources? I found that sepsis is the precipitating factor for the ARDS. Sepsis is defined as having a change in mental status, having a BP less than 100 and having a RR greater than 22. The patient has all these signs of sepsis. ARDS leads to neutrophils that release cytokines and proteases on type I and type II pneumocytes, leading to a pathology of thickened interalveolar fibrinous membranes with thickened hyaline membranes that collapsed alveoli due to too much surface tension. The patient is undergoing respiratory failure. The PaO2/FIO2 is not good. The positive- end PEEP is there to pull the alveoli open for ventilation, and the mechanical ventilation is required with low tidal volumes of 4-6 mL/kg to keep the patient alive after intubation. The patient may suffer from secondary pulmonary hypertension as a result of microthrombi blocking the alveoli as well as possible interstitial alveolar fibrosis due to loss of type II pneumocytes as well as possible DIC. Are the topics you have identified sufficient, or will you need to learn additional areas to solve the problem? The topics I have identified are sufficient.
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