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Problem-Based Learning (PBL): Sepsis Medical Challenge

Problem Based Learning

Problem based learning (PBL) is a popular method of learning, currently used by most health professional courses in the UK.

The aim of PBL is for you to read through a complex and broad series of information, to identify areas of interest and areas you would like to explore further, in order to further your knowledge of specific topics, through self-directed learning. 

If you have a passion for Problem-Based Learning (PBL) and are intrigued by witnessing how doctors navigate critical decision-making moments, we invite you to enrol in our Free Virtual Work Experience programme!

Managing Infections

Mr Bloggs is a 40-year-old man living in Bristol who presents to hospital with a short 1-day history of fever and breathlessness.

On arrival, his blood pressure is 65/50, his heart rate is 110 bpm and his respiratory rate is 30. The doctors took some blood tests and listened to his heart. There was an audible murmur, and his blood tests showed raised inflammatory markers, raised lactate levels and acidaemia.

The doctor taking a history found that Mr Bloggs is an ex-smoker, an intravenous drug user, and has a family history of lung cancer. They did an echocardiogram, which found abnormal vegetations on the tricuspid valve.

A diagnosis was made of sepsis secondary to endocarditis. 

Problem Based Learning Challenge Questions:

  1. What are signs that a person might have an infection (localised and systemic)?
  2. What is endocarditis? 
  3. What are the possible complications of endocarditis? 
  4. Given the history, what is the most likely cause of Mr Bloggs’ infection? 
  5. What is sepsis?
  6. What are the sepsis six and why are they important?
  7. What do the numbers mean in a blood pressure reading? 
  8. What causes the heart sounds that you can hear with a stethoscope and what might a murmur mean?
  9. Challenge: It is unusual for the tricuspid valve to be affected in endocarditis. Thinking about the route that blood takes through the body, why might intravenous drug users have a higher risk of tricuspid valve involvement? 
  10. Challenge: What is the relationship between sepsis, low blood pressure, raised lactate and acidaemia?

For aspiring medical students just starting to delve into Problem-Based Learning scenarios, here are some guidance hints to help give you a starting point of where to research:

1. Signs of Infection:

– Localised infection signs: Redness, swelling, warmth, and pain at the site.
– Systemic infection signs: Fever, increased heart rate, and increased respiratory rate.

2. Endocarditis:

– Research the inflammation of the inner lining of the heart chambers and valves.
– Explore how it may result from an infection, often bacterial.

3. Complications of Endocarditis:

– Investigate potential complications such as valve damage, embolism, and heart failure.

4. Likely Cause of Mr. Bloggs’ Infection:

– Focus on the history provided: ex-smoker, intravenous drug user, family history of lung cancer.
– Research common pathogens associated with intravenous drug use.

5. Sepsis:

– Understand sepsis as a severe, life-threatening response to infection affecting the whole body.
– Explore the systemic inflammatory response and its consequences.

6. Sepsis Six:

– Identify and research the six key interventions for managing sepsis promptly.

7. Blood Pressure Reading:

– Understand the two numbers (systolic and diastolic) and their significance.
– Explore what is considered normal and abnormal blood pressure.

8. Heart Sounds and Murmurs:

– Learn about normal and abnormal heart sounds.
– Explore the causes of murmurs and how they are classified.

9. Tricuspid Valve Involvement in Endocarditis:

– Investigate the anatomy of blood circulation in the body.
– Explore why intravenous drug users might be at a higher risk for tricuspid valve involvement.

10. Relationship Between Sepsis, Low Blood Pressure, Raised Lactate, and Acidaemia:

– Understand the physiological responses to sepsis.
– Explore how sepsis can lead to low blood pressure, increased lactate levels, and acidaemia.

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