Duodenal Atresia / Hypovolemic Shock: A Case for High-Fidelity Simulation in Emergency Medicine

Abstract

Abstract This high-fidelity patient simulation case involves a 3-day-old child with a diagnosis of duodenal atresia. Evaluation in the emergency department demonstrates a severely dehydrated neonate with a history of greenish/yellow emesis. Appropriate treatment with IV fluids allows stabilization of the patient. Residents also have to discuss the patient's disposition with an attending pediatric surgeon. Debriefing materials are provided to illustrate and stimulate discussion of the important concepts for diagnosing and treating patients' duodenal atresia and bilious emesis. This scenario has been presented for small groups of three to four participants and has been field-tested approximately 12 times over the past 2 years. All participants were fourth-year medical students. Our experience to date has been that the medical students were able to successfully negotiate this case. Several students successfully diagnosed hypovolemic shock and related this to vomiting. Most others successfully went through the majority of the possible causes of an ill neonate. Although many students are unfamiliar with how to do a complete workup of a neonate, after the discussion and with repetition the majority of participants felt more comfortable completing such a workup.

Keywords

• Duodenal Atresia
• Newborn Infant
• Duodenal Obstruction
• Hypovolemic Shock
• Intestinal Volvulus