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

Publication ID Published Volume
8505 June 20, 2011 7


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 will allow stabilization of the patient. Residents will 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.

Pilot testing:

  • Number of participants – This scenario has been presented for small groups of 3-4 participants, and has been field tested approximately 12 times over the past 2 years. All participants have been 4th year medical students.
  • Performance expectations – Our experience to date has been medical students are able to successfully negotiate this case. Several students have successfully diagnosed hypovolemic shock and related this to vomiting. Most others have successfully gone through the majority of the possible causes of an ill neonate. While 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 with the workup of a sick neonate.


O'Neill J, Fitch M. Duodenal atresia / hypovolemic shock: a case for high-fidelity simulation in emergency medicine. MedEdPORTAL Publications. 2011;7:8505. http://dx.doi.org/10.15766/mep_2374-8265.8505

Educational Objectives

A. Primary Learning Objectives:

  1. To demonstrate an appropriate initial approach for a patient with hypovolemic shock and duodenal atresia.
  2. To identify and treat hypovolemic shock.
  3. To recognize a “double bubble” sign on radiograph.
  4. To list the diagnostic features of duodenal atresia.
  5. To understand the treatment of duodenal atresia with possible malrotation.

B. Secondary Goals:

  1. To differentiate between different causes of vomiting in a neonate.
  2. To understand the pathophysiology of duodenal atresia.
  3. To illustrate the emergency department disposition for a neonate with bilious emesis.


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

Prior Scholarly Dissemination

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ISSN 2374-8265