Urgent Management Research Articles

Ileostomy: Early and Late Complications

Abstract Introduction Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases. Materials and Methods We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review. Results/Discussion Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation. Conclusion Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor.

Lessons learned from eDNA adoption in the management of bigheaded carps in Chicago IL USA Area Waterways

AbstractThe Chicago Area Waterway System (CAWS) connects the Great Lakes watershed with the Mississippi watershed via canals that withdraw water from Lake Michigan. From 2009 through 2011, collaborators and I provided research, development, and application of eDNA to invasive species management in the CAWS in cooperation with the US Army Corps of Engineers (USACE). The research team's approach was a high‐stakes test of a novel combination of proven technologies (field sampling techniques and laboratory genetics). In the first application of eDNA to a large scale, urgent management goal, we quickly discovered eDNA of two species of bigheaded carps in parts of the waterway where traditional tools had not captured fish. The central research question was whether the sensitivity (probability of detecting a fish when it was present) of eDNA was higher than that of traditional fish sampling tools (e.g., nets, electrofishing). The effort was part of what became a very large, complex, on‐going initiative to reduce access by invasive species to Lake Michigan. This immediately garnered much attention, initiating a dialog about the reliability of eDNA, public discussion about the benefits and costs of the CAWS, and skepticism from industries that use the CAWS. Government agencies formed the Asian Carp Rapid Response Workgroup, which eventually became the Invasive Carp Regional Coordinating Committee (ICRCC). The ICRCC continues its coordinating role on the use of eDNA and other management responses in the CAWS. With the benefit of hindsight, I draw several lessons from the experience that may help in other settings where eDNA is now being deployed with increasing confidence and acceptance; evaluate the on‐going CAWS surveillance and management effort; and recommend strengthening the current approach by broadening and deepening participation in a collaborative governance approach. Stronger public‐private partnerships would accelerate research, development, commercialization, and application of eDNA analysis to the benefit of society.

An integrated ecosystem service-based approach for the sustainable management of forested islands in South Korea

Implementing sustainable island forest management policies requires categorizing the islands into groups based on key indicators and establishing a consistent management system. This study proposes a novel framework to support an ecosystem service-based approach to managing forested islands in South Korea. First, a typology of six forested island categories is established based on varying extents of natural vegetation cover (as a percentage of forest cover) and connectivity to the mainland. An analytic hierarchy process (AHP) analysis was conducted with island forest experts to identify priority ecosystem services (ESs) for the sustainable management of each island type. On connected islands, provisioning services (natural resources and natural medicines) are more important than regulatory (erosion control) or supporting services (genetic diversity). On unconnected islands, particularly those with a small proportion of natural vegetation, regulatory services (erosion control) require a greater emphasis on management. Since Type 3 islands require urgent management as connectivity to the mainland makes natural vegetation=sparse island forest ecosystems vulnerable to anthropogenic activities, the land-use scoring method was performed on Jin-do. Comparisons between the AHP-derived expert demand for key island ESs and the spatial distribution of ES supply potential revealed mismatches between supply and demand for erosion control, freshwater supply and habitat provision. The framework developed in this study can help guide policy and decision-making processes and indicate where interventions should be focused to achieve sustainable island management.

Comparative study of the vulnerability to groundwater pollution by the DRASTIC and SINTACS methods on the Amizour plain (Béjaia, North Algeria)

The present study deals with the vulnerability and the risks of pollution on the Amizour plain aquifer (north Algeria), already threatened by several sources of pollution (e.g., industries, agriculture, illegal dumping, etc.) that collapsed this region, without any planned environmental protection measures. In the aim to study the sensitivity of the Amizour plain against pollution two methods (DRASTIC and SINTACS models) were used and the results were compared and evaluated. The maps showed a similarity in the degrees of vulnerability ranged from high to medium. Most of the plain is affected by a high degree of vulnerability of 76% and 67% as estimated by DRASTIC and SINTACS, respectively. In fact, such remarkable degree is justified by the shallow position of the groundwater and the type of aquifer. The degree of groundwater vulnerability was 18% and 33% in the northern and southern part of the studied zone as estimated by DRASTIC and SINTACS methods, respectively. According to the DRASTIC approach, an area with a very high vulnerability (6%) was observed amidst the Amizour plain. Superimposing both maps of vulnerability and the pollution source sites allowed us through the risk map to frame the areas at high risk of groundwater contamination. This investigation will facilitate to make decisions in implementing of an accurate and urgent management project for safeguarding the studied zone. The applicability of these findings has been discussed and suggestions for attenuating the risk of contamination have been given.

Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

BackgroundEmergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH).MethodsA Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model.ResultsFindings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies.ConclusionsThe cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.

Ileal prolapse through patent omphalomesenteric duct in a two year-old boy: a case report

BackgroundPatent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13–0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology.Case presentation2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day.ConclusionProlapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered.

Abstract TP119: Predicting Posterior Circulation Stroke During Emergency Triage: Dizzy-7 Project

Introduction: “Stroke code” activation is a uniform process to summon healthcare stakeholders to orchestrate the rapid sequential steps for urgent management in patients with possible stroke. Acute dizziness, a common emergency department (ED) presentation, frequently leads to stroke code activation; however, cancellation rates remain high and process improvement strategies are warranted. Methods: We analyzed stroke identification accuracy, cancellation rates, and clinical characteristics in patients presenting with an acute vestibular syndrome to inform process improvement strategies for stroke code activation. We developed an ED triage diagnostic algorithm termed, “Dizzy-7”, based on evidence incorporating key history and physical examination elements derived in patients with acute posterior circulation ischemia. Subsequent analyses were performed on algorithmic utilization and its ability to predict stroke. Results: 1599 patients presented with acute dizziness over a 4-month period (2022-2023). Stroke code activation occurred in nearly one in four (366/1599) these presentations. 20% (319/1599) were ultimately diagnosed with stroke and of these, 49% (319/366) were identified following stroke code activation. The Dizzy-7 algorithm was used infrequently (4%) among all acute dizziness presentations. Of the 65 cases that incorporated the algorithm, 16 resultant stroke code activations occurred with 1 confirmed diagnosis (6%). We analyzed stroke alert cancellation and found an increased frequency in cancellation for those without use of the protocol at 22% (77/350) compared to those who did use it at 6% (1/16). Discussion: Accurate and reliable identification of acute ischemic stroke among patients presenting with acute dizziness remains complex. Implementation of a triage diagnostic algorithm based on contemporary evidence was infrequently implemented. Process improvement efforts targeted at greater algorithmic use, interprofessional collaboration, and education may improve stroke code utilization efficiency. Although based on limited sample size, a trend towards reduced stroke code cancellation rates were seen throughout the pilot Dizzy-7 algorithm use.

Fish community structure and functional guild composition in an anthropogenically impacted, temporarily closed sandbar estuary.

This study investigates the fish assemblage in a temporarily-closed sandbar estuary along India's west coast, across different zones and seasons. Moderate species diversity (54 species), low species abundance, varying fish diversity from lower to upper estuarine gradient (higher counts in lower zones, and decreasing from middle to upper zones), and higher prevalence of marine migrants (estuarine use) and piscivorous species (feeding mode) were the significant characteristics of the estuary. Distinct spatial, seasonal, and estuarine mouth state-based variations were recorded in the estuary, based on diversity indices and count of taxa. Peak diversity and abundance were noted during thepre-monsoon, and during the open mouth state of the estuary. The entire estuarine gradient is anthropogenically impacted by a multitude of stressors, except at the estuarine mouth region, which is favored by marine connectivity. The fish assemblage structure in Poonthura estuary (PE) has thus far remained unaffected by anthropogenic disturbances. Nevertheless, growth and nursery function of the estuary have been significantly compromised. The predominance of juvenile fish in the ecosystem, and prevailing anthropogenic stressors from point and non-point sources underscore the necessity for long-term maintenance of the population of coastal species, as well as a need for developing and implementing urgent management strategies for this fragile ecosystem.

Genome-centric analyses of 165 metagenomes show that mobile genetic elements are crucial for the transmission of antimicrobial resistance genes to pathogens in activated sludge and wastewater.

Antimicrobial resistance (AMR) threatens the health of humans, animals, and natural ecosystems. In our study, an analysis of 165 metagenomes from wastewater revealed antibiotic-targeted alteration, efflux, and inactivation as the most prevalent AMR mechanisms. We identified several genera correlated with multiple ARGs, including Klebsiella, Escherichia, Acinetobacter, Nitrospira, Ottowia, Pseudomonas, and Thauera, which could have significant implications for AMR transmission. The abundance of bacA, mexL, and aph(3")-I in the genomes calls for their urgent management in wastewater. Our approach could be applied to different ecosystems to assess the risk of potential pathogens containing ARGs. Our findings highlight the importance of managing AMR in wastewater and can help design measures to reduce the transmission and evolution of AMR in these systems.

Snakebite envenomation: A comprehensive evaluation of severity, treatment, and outcomes in 100 patients correlating timing of ASV administration with complications

This study, conducted at the New Civil Hospital in Surat from June 2004 to November 2006, explored the clinical dynamics, complications, and outcomes of 100 cases of poisonous snakebites. The age group most affected was 21–40 years (58%), reflective of heightened outdoor activities. Males, often primary earners, exhibited a higher incidence, while rural areas dominated (75%) due to favorable snake habitats. Notable patterns emerged, such as a significant occurrence of bites between 6:00 p.m. and 5:59 a.m. attributed to nocturnal snake activity and rural sleeping habits. The monsoon season experienced a peak in snakebites (79%) as snakes sought refuge in human habitats. Intriguingly, 45% of patients lacked visible fang marks, challenging their reliability for identifying venomous bites. Neurotoxicity prevailed (54%), with local pain and swelling prominent. Effective treatment resulted in a 90% cure rate, highlighting the significance of early diagnosis. Respiratory failure, hypotension, and combined manifestations indicated poor prognosis, underscoring the critical need for early recognition. Mechanical ventilation notably reduced mortality in neurotoxic cases. Delayed admission correlated with heightened severity, complications, and poorer outcomes, emphasizing the urgency of early intervention. Severity grades 3 and 4 exhibited elevated mortality rates, calling for urgent and meticulous management. The duration of venom in the bloodstream before antivenom administration directly impacted severity and outcomes. Future research avenues include species-specific considerations, antivenom advancements, community education, remote healthcare solutions, and long-term follow-up. Limitations encompass single-center data, incomplete records, temporal constraints, limited species identification, and a need to delve into social and cultural factors influencing snakebites.

Traumatic Renal Artery Injuries: A Comprehensive Case Study Analysis

Post-traumatic renal artery injury is a rare yet critical complication following trauma, potentially leading to severe renal damage and functional loss. We present three cases of post-traumatic renal artery injury resulting in renal ischemia due to late diagnosis. Of particular note is that the interval between the first patient and the third is only three months, occurring at a time when such lesions are rarely observed. These cases, all involving young male individuals, highlight the challenges of prompt identification and timely intervention in such injuries. Delayed diagnosis hampered attempts at surgical revascularization in all cases, and our hospital lacked resources for percutaneous revascularization procedures. Despite efforts to manage these injuries conservatively, the success rates of surgical revascularization have been limited, leading to recurrent thrombosis. This has prompted the medical community to reconsider the approach to managing these injuries, with emphasis on non-operative methods and less invasive alternatives, particularly in the presence of a functioning contralateral kidney. However, determining the optimal management strategy remains elusive due to insufficient evidence regarding the efficacy of various approaches. Urgent management of renal artery injuries aims to preserve kidney function and mitigate secondary complications, such as renovascular hypertension. Long-term follow-up revealed varying outcomes among these patients, emphasizing the complex nature of managing post-traumatic renal artery injuries

Understanding Hydrologic, Human, and Climate System Feedback Loops: Results of a Participatory Modeling Workshop

Groundwater depletion threatens global freshwater resources, necessitating urgent water management and policies to meet current and future needs. However, existing data-intensive approaches to assessments do not fully account for the complex human, climate, and water interactions within transboundary groundwater systems. Here, we present the design of and findings from a pilot participatory modeling workshop aiming to advance understanding of the hydrologic–human–climate feedback loops underpinning groundwater systems. Using participatory modeling tools and methods from the system dynamics tradition, we captured the mental models of researchers from water, social, data, and systems sciences. A total of 54 feedback loops were identified, demonstrating the potential of this methodology to adequately capture the complexity of groundwater systems. Based on the workshop outcomes, as an illustrative example, we discuss the value of participatory system modeling as a conceptualization tool, bridging perspectives across disciplinary silos. We further discuss how outcomes may inform future research on existing knowledge gaps around groundwater issues, and in doing so, advance interdisciplinary, use-inspired research for water decision-making more broadly.

Awareness of eclampsia among rural tribal women of reproductive age.

Globally, eclampsia is the leading cause of maternal and neonatal morbidity and mortality. The present community-based study was conducted among rural tribal women of reproductive age in remote villages of central India to determine their awareness of eclampsia and its likely impact. This cross-sectional analytic study included randomly selected 4500 tribal women, between 15 and 45 years of age, residing in 140 villages in the proximity of one village with a health facility (study center), and who were willing to undergo a personal interview. In-depth face-to-face interviews (each lasting 15-30 min) of study subjects regarding awareness, knowledge, practices, and perceptions about eclampsia were conducted using a predesigned tool completed by research assistants (not the subjects). Of the 4500 women interviewed, the majority (62.4%) were 20-29 years old, minimally educated (40.6%), laborers (41.3%), and of a low socioeconomic class (40.8%). Of all the participants, only 35.9% were aware of eclampsia, associated events during pregnancy, labor, and the immediate post-delivery period; 81.7% of those who were aware understood about symptoms and signs like headache, blurring of vision, dizziness, swelling over the body, ad high blood pressure. Of all the women who knew about eclampsia, 73.9% were aware that the occurrence of convulsions during antenatal and postnatal periods was an emergency and required urgent management, whereas 88.4% were not aware that severe convulsions affected maternal and neonatal health seriously, only 38.2% knew that eclampsia was a preventable condition. There was lack of awareness about eclampsia in many women and, of those who knew, some were not aware that it was dangerous. There is a need for awareness among women and their families of the disorder, its impact, and what action is needed in case it occurs.

Contemporary Review of Idiopathic Sudden Sensorineural Hearing Loss: Management and Prognosis.

Sudden sensorineural hearing loss (SSNHL) is a rapid decline in auditory function that needs urgent medical management. Although etiologic factors, including viral infections, autoimmune diseases, and vascular issues, contribute to the understanding of SSNHL, the condition remains unclear in most cases. Systemic steroids are often used as the first-line treatment because they reduce inner ear inflammation; however, there remains numerous discussions about the effectiveness of alternative treatments. To predict hearing recovery is crucial in patients' counseling with factors, including delayed treatment, vertigo, and other health conditions, which indicate poor prognosis. Herein, we review contemporary research on the treatment approaches and outcome predictions of SSNHL to establish important guidelines for physicians in evaluating and treating patients with SSNHL.

Microsatellite analysis reveals genetic variation of Hipposideros pratti in its northernmost distribution

Hipposideros pratti, a bat species found in caves across Southeast Asia to the Qinling-Funiu Mountain area in China. To understand the dynamic changes in its distribution and evaluate the current population status of the species, we reviewed 48 caves in the northernmost tip of the distribution, however, only three caves contained H. pratti. In this study, microsatellite markers enabled us to analyze genetic diversity among species in this region, and several noteworthy findings were uncovered. 1) The average number of observed alleles (Na) of H. pratti in the region was 3.94, and the average observed heterozygosity (Ho) was 0.529. Additionally, all three populations were in Hardy–Weinberg equilibrium. 2) Intra-population was the predominant genetic variation of the H. pratti population. 3) H. pratti in the region experienced a bottleneck effect. Alarmingly, our investigation revealed varying degrees of human interference in the three caves where H. pratti are currently distributed, thereby putting the populations at risk. It is of utmost importance for urgent management strategies to be implemented, including the adoption of appropriate measures to decrease human disruption within caves.

Diagnostic Accuracy of Bedside Lung Ultrasound in Detecting Traumatic Pneumothorax by Novice Physicians in the Emergency Department of a Tertiary Care Hospital of Nepal.

Traumatic pneumothorax is a life-threatening condition requiring vigilant clinical assessment and urgent management. Lung ultrasound (LUS) is considered to be a safer, rapid, and accurate modality for the early diagnosis of traumatic pneumothorax. The principle objective of this study was to evaluate the diagnostic accuracy of bedside LUS performed by trained novice physicians in the diagnosis of traumatic pneumothorax as compared to supine chest X-rays (CXRs) and/or computed tomography (CT) scans and/or air leak during needle/tube thoracostomy as composite standard. It is a prospective, cross-sectional, single-blinded study using a nonprobability quota sampling technique. A total of 96 patients presenting to the emergency department (ED) with polytrauma and chest injuries within a period of twelve months were included. The diagnostic accuracy of bedside LUS performed by trained novice physicians was calculated in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared with the composite standard. The sensitivity of LUS in diagnosing traumatic pneumothorax as compared to the composite standard was 100% (95% confidence interval (CI): 59.05%-100.00%), whereas its specificity was 97.75% (95% CI: 92.12%-99.73%). Similarly, the PPV and NPV of LUS were 77.7% (95% CI: 39.99%-97.19%) and 100% (95% CI: 95.85%-100.00%), respectively. The results of the study showed that the application of LUS in detecting traumatic pneumothorax had similar diagnostic accuracy as supine CXR. Bedside LUS is widely available, portable, and inexpensive. It also has the capability of real-time imaging and can be repeated as necessary with less risk of radiation exposure. Therefore, physicians working in tertiary and rural health institutions must be trained adequately in order to uplift the clinical utility of LUS for the timely and cost-effective detection of traumatic pneumothorax.

Management of a Young Patient With High-risk Multiple Myeloma Complicated by Acquired von Willebrand Syndrome: A Diagnostic and Therapeutic Emergency

Multiple myeloma associated with bleeding events secondary to von Willebrand syndrome is underdiagnosed. The management of this entity is highly complex, and aims to control the hemorrhagic syndrome and reduce plasma viscosity with plasmapheresis and multiple myeloma-specific treatment. The authors report the rare case of a young patient with high-risk multiple myeloma complicated by hyperviscosity syndrome and presenting an acquired von Willebrand syndrome with hemorrhagic manifestations, requiring urgent therapeutic management to save the patient's life.

A Comparative Exploration of Video Laryngoscopes (King Vision and Airtraq) as the Future of Intubation during General Anesthesia

Abstract Background: In the dynamic medical landscape, anesthesiology plays a pivotal role in ensuring patient safety and comfort during surgeries. Central to this is endotracheal intubation, a critical procedure for securing the airway under anesthesia. Innovations such as King Vision and Airtraq video laryngoscopes offer enhanced glottis visualization and Cormack Lehane scores compared to direct laryngoscopy, with a shorter learning curve. This study aims to assess King Vision and Airtraq’s efficiency in terms of laryngoscopy time, Cormack and Lehane grading, and single-attempt success rate, the number of intubation attempts and endotracheal intubation duration. Methodology: We conducted a study involving 90 patients, aged 20–40 years, undergoing elective surgeries in Departments of General Surgery, ENT, and Gynecology under General Anesthesia. They were divided into two groups, Group K (King Vision) and Group A (Airtraq). Anesthesiologists with at least 40 prior intubations using both devices performed intubations. Preoperative assessments included Alprazolam and Ranitidine, fasting for 8 h, and vital sign monitoring. Anesthesia induction comprised fentanyl, propofol, and succinylcholine, with Macintosh laryngoscopy as a backup. Anesthesia maintenance included nitrous oxide, oxygen, isoflurane, and rocuronium, while parameters were diligently recorded. Results: Our results indicate comparable age and gender distributions between Airtraq and King Vision groups, as well as no differences in Mallampati grading. Kings Vision showed significantly faster laryngoscopy and quicker intubation. Most patients required only one intubation attempt in both groups. Cormack and Lehane grading was unaffected by device choice. Conclusion: Our study shows that both Airtraq and King Vision perform similarly across patient characteristics, but King Vision offers faster laryngoscopy and intubation times, ideal for urgent airway management.

Aortic Limited Intimal Tear in a 16-Year-Old Boy.

Teaching point: While demanding urgent management, limited intimal tear (LIT), a rare subtype of acute aortic syndrome (AAS), poses challenges in terms of accurate and timely diagnosis.

Shock Simulation Day: Medical Decision-Making and Communication Skills for Managing a Hypotensive Adult in a Rapid Response.

Shock is a life-threatening condition amongst hospitalized patients and requires urgent management to avoid mortality. Early exposure is vital for educational and patient safety purposes. We developed a 90-minute shock day session that provided internal medicine interns with a cognitive framework for the initial diagnosis and management of shock, which they applied to two simulations. The first simulation involved a patient with septic shock, and the second involved a patient with cardiogenic shock. Critical action checklists were used to assess learners and guide structured debriefs after each simulation. Medical decision-making and communication frameworks were presented through a presession video and a chalk talk. The curriculum was evaluated using pre- and postintervention surveys to assess knowledge and confidence. Forty-eight interns participated in the session in 2022 and 2023. We observed an increase in the percentage of learners correctly answering a knowledge-based question regarding the amount of fluid administered to a patient in septic shock (pre: 33%, post: 62%, p < .01), as well as increases in learner-reported confidence in leading a rapid response (pre: 9%, post: 62%) and in managing undifferentiated shock (pre: 13%, post: 56%), septic shock (pre: 20%, post: 83%), cardiogenic shock (pre: 2%, post: 54%), hemorrhagic shock (pre: 20%, post: 73%), and anaphylactic shock (pre: 22%, post: 54%, all ps < .01). Employing a variety of pedagogical methods, we demonstrated that intern knowledge and confidence regarding the management of a hypotensive patient during a rapid response can be increased through participation in our curriculum.