Multimedia educational decision-making algorithms

Snake envenomation is a marginal topic in developed countries but you can still come across such a cases. On the other hand, in developing countries i this a common injury, which is cause of tens of thousands of deaths per year. It is a question of inadequate infrastructure and limited access to healthcare. A considerable number of patients are exotic snake keepers. This algorithm will take you through two scenarios of snake envenomation and it will help you become familiar with widely spread myths related to treating affected patients

The length of life is not always equal to its quality. When thinking about reviving a severely chronically ill patient, it is appropriate to ask whether life after resuscitation will be sufficiently valuable for him. It is important that the patient can answer this question himself. This is possible thanks to a joint conversation about treatment goals and advance health care planning. This algorithm guides you through the entire process from the diagnosis of a serious chronic patient condition to the moment of his death.

Paediatric polytrauma is a life-threatening condition that can happen in practice to any doctor. In our algorithm we modelled a situation, where we will show step by step how to act in this cases. We will focus on first aid at the scene of an accident, how to proceed with a developed hypovolemic shock and life-threatening bleeding and subsequently we will focus on how damage control surgery in paediatric polytraumas is carried out.

21.6.2022 | MUDr. Jan Hudec, MUDr. Michal Vondráček, Filip Bartoš, Helena Vlčková. Illustration: Eliška Zemanová

In this algorithm we look at the fate of a young runner who suffered from overheating. Hyperthermia is a serious and life-threatening condition that is caused by a combination of high ambient temperature and excessive physical exercise. It can affect both predisposed and completely healthy and young individuals. This condition can result in many organ failures with the need for transplantation and even death. Many cases of hyperthermia are preventable with proper preparation.

Acute adrenal crisis is a condition, which arise from an adrenal cortex insufficiency. It can develop because of untreated Addison disease or abruptly as a result of many other causes. Patients with the adrenal crisis need an intensive health care and adequate treatment, as the condition can be potentially life-threatening. They must be thoroughly informed about their disease and need to precisely follow doctors instructions. In this algorithm, we will look at the patient examination, diagnosis and therapy including complications management.

1.6.2022 | MUDr. Tamara Skříšovská, MUDr. Roman Kula, Gabriela Žabková, Michaela Staňková. Illustration: Bc. Mária Melicherčíková

PIMS, PIMS-TS (Paediatric Inflammatory Multisystem Syndrom Temporally associated with SARS-CoV-2) or MIS-C (Multisystem Inflammatory Syndrom in Children) are abbreviations denoting the same disease. It is a rare but very serious multisystem inflammation caused by an abnormal immune response affecting multiple organs at the same time. PIMS is typical in children who have had COVID-19 infection in the past. Early diagnosis and therapy is most important for the recovery of patients, so there is a need to raise awareness of this relatively new syndrome, the symptoms of which are initially non-specific. The algorithm will guide you through the typical symptoms and specific treatment of a PIMS sufferer.

Pulse ventricular tachycardia is one of the most common complication after mycardial infarction. In this algorithm, we will guide you through management of heamodynamically stable and instable patient. The goal is to implement knowledge from the new ERC Guidelines (2021) a to choose the correct sequence of the pharmacological and non-pharmacological treatment in both cases.

Convulsive states are one of the most common conditions which lead to admission to ICU in children. There is an inexhaustible amount of potential causes of convulsions in pediatric patients, starting with very common febrile spams to extremely rare metabolic or genetic disorders. In any case, every convulsive state always calls for quick termination. This way we can prevent the further brain damage caused by uncoordinated convulsive activity. Follow-up wide differential diagnostics are performed to determine definitive diagnosis.

Cleft defects are the most common congenital malformations. The initial discovery is already possible with prenatal screening examination, and its finding is not an indication to terminate the pregnancy. Nowadays, the treatment possibilities allow us to unsure little-to-no handicap in adulthood. Surgical treatment and anaesthesiological approach for these defects have their own specifics. This algorithm will apprise the solver with course of treatment, will navigate the solver through perioperative management of each of the reconstructive procedures and will acquaint them with multidisciplinary approach.

Regional anesthesia is progressively preferred method in anesthesiology. It provides patients with many advantages in both pre and postoperative period. One of the prerequisites for practicing regional anesthesia is a good knowledge of the area topography, work with ultrasound image, basic indications and contraindications for the specific nerve blocks and recognizing possible complications. The goal of this algorithm is to guide a participant through possibilities for regional anesthesia of the upper extremity and the dealing with possible complications.

Ketoacidosis is an acute, life-threatening condition, which is caused by the presence of ketone bodies in the blood. The treatment has its specifics as well as drawbacks, the knowledge of which is essential for successful therapy. This algorithm is focusing on diabetic ketoacidosis, which occurs mostly in patients with type I diabetes; however, alcoholic ketoacidosis also exists, albeit being less common and having less acute progress. The algorithm introduces typical signs, carries through the therapy with a focus on addressing some of the common setbacks, and provides ways of preventing future similar conditions.

Benign prostatic hyperplasia is one of the most common benign tumors in men. Etiology of this condition is thought to be linked to hormonal imbalance and its prevalence increases with age. If pharmacotherapy fails, a surgical procedure is the next therapeutic step, most often a transurethral resection of the prostate (TURP). TURP syndrome is a serious and life-threatening complication of transurethral resection of the prostate. This algorithm aims to familiarize the solver with the pathophysiology, onset risk factors, clinical signs, diagnosis and treatment of this syndrome. At the end of this algorithm the solver should be aware that TURP syndrome can develop both during and after an uncomplicated TURP procedure.

After a short theoretical introduction you will be able to recognise the basic artifacts and pathological situations on the capnographic waveform in total of 9 clinical cases. Among other you will be explained the significance of this method during the induction to general anaesthesia and cardiopulmonary resuscitation as well. After mastering this algorithm you can rely on this simple but important monitoring method during you clinical practice.

The aim of algorithm is getting to know hemolytic-uremic syndrom, which is one of the most common causes of acute renal failure in childhood. We will look at its clinical manifestations, typical laboratory findings and we will describe two basic forms of this disease. Together we will also clarify the ethiology, pathogenesis, clinical course, treatment and prognosis of hemolytic-uremic syndrom.

In this algorithm you will learn about infections, which affect our most important belongings. Neuroinfections can be life-threatening conditions and despite all therapy can lead to lasting health problems. So how to recognize them on time? How to treat the patient? And can we prevent these infections? Dealing with our algorithm with fluffy patients you will find answers to all these questions and a lot of other interesting information.

Cholangitis (sometimes referred to as cholangoitis) is an inflammation of primarily the intrahepatic bile ducts. It is almost always associated with partial or complete obstruction of the bile ducts. The cause of obstruction may be choledocholithiasis, biliary strictures, primary sclerosing cholangoitis, congenital malformations or tumor obstruction of the bile ducts. Bile that stagnates in the ducts may then be infected with intestinal microorganisms (E. coli) and the process can then proceed intraparenchymatously, leading to multiple microabscesses in the liver and generalized sepsis, which is a life-threatening condition.

Structured passing of information about the patient and correctly doing patient handoff is very often considered marginal. However, the correct execution of these procedures significantly increases patient's safety and leads to better classification and passing on essential information. This algorithm aims to point out the possibilities of structured information pass on and safe patient handoff.

Coronavirus Disease 2019 (COVID-19) is currently a global problem. Patients require specific care from initial treatment in emergency departments. Many patients with extensive bilateral pneumonia require hospitalization in the intensive care unit and are dependent on high-flow oxygen therapy. In some of them, despite all treatment, lung disease progresses to the form of acute respiratory distress syndrome with the need to be connected to mechanical lung ventilation. Adequate blood gas exchange often cannot be achieved by a protective setting of mechanical ventilation. Therefore, the physician must use the prone position and, in the most severe cases, also consider the extracorporeal membrane oxygenation support. The algorithm is divided into two parts, and the participant can decide whether he wants to take care of the patient with COVID-19 during emergency admission or play the role of an intensive care physician.

Acute abdomen refers to a heterogenous group of urgent conditions characterized by the sudden onset of severe abdominal pain. The spectrum of disease encompassed within this term may cause diagnostic difficulty, owing to the considerable diversity in the underlying etiology, which includes, among others, obstructive, inflammatory, vascular, infective, and gynecological processes. Infective intraabdominal processes in particular are a serious cause of mortality and present a unique clinical challenge due to the evolutionarily dynamic nature of the pathogens and the potential for progression of infection beyond the original infectious foci. As a result, diagnosis and management of patients with suspected intraabdominal infections is contingent on obtainment of a comprehensive history, structured evaluation, timely intervention, and prompt initiation of empiric therapy, followed by adjustments in antimicrobial therapy once the causative organism has been identified, if necessary.

Septic shock is a life threatening condition which needs quick intervention. The treatment and differential diagnosis of septic shock might appear to be quite challeging, but is essential for an optimal outcome for the patient. This algorithm will give a insight into the managment of septic shocks, the differential diagnosis, possible error sources in the diagnosis and characteristics of microbes, that cause shock.

Research shows that 40 % to 60 % of children, especially of pre-school and early school age, experience anxiety and stress before a surgery requiring general anaesthesia. Subsequently, some of them show post-traumatic stress symptoms, which continue to affect the child’s overall condition, recovery, and compliance with any other medical care. Children under seven years of age are considered to be the most endangered group. Several preventive measures can be taken that reduce the risk of developing a post-traumatic stress response. This algorithm endeavours to draw healthcare professionals’ attention to the critical points of the entire procedure of preparing a child for the surgery under general anaesthesia in terms of psychology, that can help children better manage medical intervention.

Peripheral nerve block, as part of a multimodal approach to the treatment of pain, is already a standard part of anaesthesiology care not only in adults but also in pediatric patients. The basic condition for the implementation of peripheral blocks is a perfect knowledge of the topographic anatomy of the area, which together with the use of ultrasound methods allows to minimize possible risks. The aim of the algorithm is to approach the specifics of performing peripheral blockades in children. It shows the advantages that allow a small patient to access the stay in the operating room and in the postoperative period, with emphasis on the adequate effect of postoperative pain.

Burns are serious painful injuries. The severity of burn injury depends on the extent, location and the degree of burns. Therapy and subsequent recovery is long. The most common cause of burns in children is heat damage to the skin. This interactive algorithm will comprehensively guide you through all the steps of the treatment of burn injuries in children, from the first aid and pre-hospital care to the anaesthesiology and surgical care of a burnt child.

Childbirth is a common part of human life and it can unfortunately be accompanied by complications of the mother or child. In our algorithm, we will look at the prolonged birth of twins, after which it will be necessary to evaluate the condition and decide on the transport of one of the children. Where to transfer a pathological newborn to be provided with adequate care? How to proceed in securing vital functions along the way? How to react to the deterioration of the condition? If you do not know the answers to these questions, we believe that after mastering our story, you will be prepared for such situations.

2021

Animal bites are a common injury, especially in children. They have a wide scale from small scratches to amputations. Because of the risk of the infections, special care and treatment is needed, different than in any other injury. In our algorithm we focus on dog bites, because that is the most common case. Algorithm has two different branches describing a situation with both rabies vaccinated and non vaccinated dog.

Pericardial tamponade is a serious life-threatening condition whose early recognition is crucial for the patient. Therefore when an unfortunate accident happens, it is possible that even a traditional hunting session becomes a battle for life. Pericardial tamponade is one of the so-called "4T" reversible causes of sudden cardiac arrest, and in this algorithm we will guide you through its differential diagnosis and therapy, from prehospital care to definitive hospital treatment.

Purpose of this algorithm is to understand the significance of the chain of survival, the significance of proper rescue teams activation. In special cases the role of helicopter emergency medical service is crucial. Especially in cases when transport into remote receiving hospital is needed. There is a potential role of early ECMO team activation when indicated.

The times we live in bring with them almost unlimited travel opportunities. It is this fact that can cause the spread of a highly contagious disease in our extremities. Such a situation affects not only doctors and paramedics, but also other units of the Integrated Rescue System. The algorithm offers the opportunity to look under the hood of how to deal with an extraordinary situation with a suspected presence of a highly contagious disease, from emergency calls and pre-hospital care to clean-up operations.

Viscoelastic methods and ROTEM/ClotPro machines examine the coagulation status and mechanical properties of the coagulum in real time during its formation, stabilization and lysis. The examination can be performed immediately after blood collection. They are also referred to as "bedside" tests. The advantage of viscoelastic methods lies in the speed of examination and the possibility of targeted therapy - targeted choice of transfusion products according to the results, reduction of their consumption and reduction of stress for the patient’s organism. They can be used successfully in the treatment of life-threatening bleeding in severe trauma, evaluation of the haemocoagulation status before or during surgery. The interactive algorithm explains the use and interpretation of viscoelastic methods and aims to show various results of the analysis and their solutions.

8.5.2020 | doc. MUDr. Jozef Klučka, Ph.D., Lucienne Michnáčová. Illustration: Priska Liptáková

Respiratory failure is a life-threatening condition in which respiratory system is unable to ensure adequate gas exchange which results in hypercapnia (insufficient elimination of carbon dioxide from the blood), hypoxaemia (insufficient oxygen supply to arterial blood) or both. In acute respiratory failure compensatory mechanisms occur − hyperventilation, tachypnoea and tachycardia. The algorithm presents possibilities of oxygen therapy and ventilatory support in a patient with severe respiratory failure. Regarding patient's clinical condition (vital signs, laboratory, physical examination) you will be able to recognize the (in)effectiveness of therapy and understand ventilation parameters such as PEEP, FiO2 and oxygen flow. Knowledge of individual methods, their limitations and settings is crucial for correct indication in a given patient.

It is very probable that everyone has encountered a mild case of hypothermia at some point in their life. Nevertheless, severe hypothermia is a life threatening condition that can lead to cardiac arrest, metabolic decompensation and multiorgan failure. Therefore, it is necessary to treat it adequately. This algorithm will guide you through the process of treating a hypothermic person, which begins by the first aid in the field, continues by the care of EMS members and doctors in the emergency department and is later completed by the treatment of frostbites.

Whether performing high-altitude work or recreational and sport climbing activities, you may encounter the issue of suspension syndrome. It is a life-threatening situation characterized by syncope as a result of brain hypoperfusion, which can develop due to prolonged passive sitting in a harness. Resolving this algorithm, you will gain the knowledge of suspension syndrome prevention, which can be utilized by anyone in such a situation, as well as the knowledge of necessary steps in mountain rescue of two climbers, one conscious and one unconscious.

Knowledge of hemodynamics is not the only domain of anesthesia. It is an integral part of almost all medical disciplines. In our algorithm, the investigator can try several possibilities of monitoring hemodynamics in anesthetized patient: non-invasive blood pressure measurement, continuous blood pressure measurement by invasive and non-invasive method, but also advanced monitoring by pulse contour analysis. It is necessary to realize that correct evaluation of the patient's physiological functions has a significant effect on his outcome, long-term hypotension increases risk of perioperative perioperative myocardial infarction, stroke and acute kidney injury; in contrast, fluid overload can cause pulmonary edema or heart failure.

The educational algorithm Anesthesia in lung pathologies offers the possibility of solving two cases of different pulmonary diseases. Specifically, it is a patient with COPD and a patient with IPF, ie. a restrictive lung disease. The aim of the algorithm is to emphasize the importance of preoperative patient preparation and at the same time to point out possible complications and their subsequent solution, which may occur in patients with lung disease.

Difficul airway management (DAM) is a life threatening situation, in which anaesthetist experiences difficulty with ventilation by face mask, supraglottic airway or endotracheal intubation. This can be partially avoided by difficult airway assessment (LEMON score, difficult intubation in the past), however, difficult airway can occur in any patient. Difficulty with airway management may result in serious consequences (hypoxic brain injury, death) in a matter of minutes, therefore one needs to recognize the situation early and proceed quickly.

Difficult airway management during pregnancy is a life-threatening situation not only for the mother but also for the fetus. In the third trimester of pregnancy, the risk of difficult airway management is ten times higher compared to the non-pregnant population. Therefore, difficult airway management should be recognised in time, it’s important to proceed quickly and to achieve adequate ventilation, otherwise there are serious consequences such as hypoxic brain injury, fetal or maternal death. This algorithm will give you a chance to deal with two situations of difficult airway management. We use different muscle relaxants in each situation.

Malignant hyperthermia is a rare, life-threatening disease that is charactarized by pathologic hypermetabolic state in muscular tissues that is triggered by specific anaesthetic agents. Firstly, our educational algorithm will lead you step by step through a situation with unexpected case of MH during surgery, show you how to remain calm, assess the situation and save the patient's life. The other part of the algorithm is dedicated to anaesthetic care of a patient who can have genetic predisposition for delevoping MH. It is crucial to prepare your workplace and medical staff for the specifics of anaesthesiological management of this patient and the possibility of further complications. Last but not least, you will learn about means of diagnostics of MH in the Czech Republic.

Trauma accounts for 10 per cent of the world's mortality, about 5 million victims each year. And this trend is expected to increase. Conversely, good organization of care for the injured can reduce this trend, especially in the acute phase. Since 1978, the American College of Surgeons has been trying to systematize and improve this component of care by the Advanced Trauma Life Support protocol. The interactive algorithm approaches the use of the ATLS protocol in pre-hospital care and emergency room to transport to the operating room. It describes the basic scheme of examination, securing and therapy of traumatized patients.

The young athlete Michal was with his friend riding freeride bikes. Michal overestimated his forces and had an accident in which he caused a tension pneumothorax. In this algorithm we will learn how to proceed in such a situation. In the first part we will give first aid in the role of Michal's friend. Then we put ourselfs into position of the EMS physician and show how this situation needs to be solved before the patient is taken to the hospital. Finally, as emergency doctors, we will continue to treat pneumothorax.

8.5.2020 | doc. MUDr. Martina Kosinová, Ph.D., MUDr. Tereza Musilová, Barbora Pitmausová, Kateřina Popková. Illustration: ilustrace - Kateřina Popková, animace - Barbora Pi

Malignant arrhythmias are disorders of a cardiac rhythm, which can lead to a cardiac arrest. They are usually developed in children due to hereditary syndromes like catecholaminergic polymorphic ventricular tachycardia or long QT syndrome. Unfortunately, up to 30 %, the first sign of this disease is a sudden cardiac arrest, which requires immediate intervention. Triggers of these acute states are common situations like higher physical activity, emotional burden, shock or even sleep.

Perioperative pain management and bridging to postoperative period is an important task and has a great impact on chronification of pain in the future. We present you revised algorithm using both paravertebral or epidural block in patient undergoing thoracotomy.

Delirium is a life-threatening and highly underdiagnosed condition. It is a reaction of CNS to damage, manifested by a qualitative impairment of consciousness, decreased attention. Delirium usually starts suddenly in the evening and has a fluctuating course. It can have many causes: organic, toxic (caused by the administration of anticholinergics, dopaminergic antiparkinsonian drugs), and may be caused by withdrawal state as well (D. tremens). According to symptoms we distinguish hypoactive, hyperactive or mixed delirium.

Acetaminophen (Paracetamol) intoxication is a life-threatening condition leading potentially to hepatic failure. Acetaminophen has antipyretic and analgesic effect, it does not have anti-inflammatory effect. It is widely used by the general public in the form of over-the-counter medicines. Due to large number of different types and easy availability of drugs containing acetaminophen on the Czech market, accidental or intentional ingestion of a toxic dose may occur. One of these situations is shown by our algorithm.

Lactic acidosis is serious acid-base balance disorder, that can occur in patients on metformin therapy. Metformin is currently still one of the most used drugs in the treatment of the type 2 diabetes mellitus. Metformin is still one of the most commonly used drug in therapy of Diabettes Mellitus type 2. The aim of this algorithm is to encounter the solver with this condition and its correct therapy.

6.4.2020 | MUDr. Deana Slovjaková, MUDr. Eva Klabusayová. Illustration: Eva Klabusayová

Number of patients infected with COVID-19 worldwide is still growing. The risk of transfer of infection to the medical personnel is high, especially when aerosol generating procedures are done, for example intubation. Anaesthesia of COVID-19 positive patients has it's specifics, which must be taken into account, due to safety of the patient and due to safety of the medical personnel as well. Algorithm will guide you through the basic steps of preparing anaesthesia team and workplace, correct use of personal protective equipment and uncomplicated airway management of COVID-19 positive patient undergoing surgery in general anaesthesia.

The general director of the World Health Organization (WHO) declared the COVID-19 infection a world pandemic situation on the 11 th March 2020. At the time, there is neither specific treatment nor vaccination available against COVID-19 infection. Everyone in the population is considered to be susceptible to this infection. The clinical features of COVID-19 infection vary from asymptomatic presentation to severe pneumonia and in the gravest cases can lead to death. In most of the cases (80%), the clinical presentation would correlate to mild respiratory infection and pneumonia. The severe cases with the high risk of death are connected with the elderly patients with comorbidities and chronic medical impairment. This algorithm aims to guide you through the essential safety precautions and deviations from the standard CPR approach, taking into account the risk of spreading the COVID-19 infection from the patient to the medical staff.

Carotid arterial atherosclerosis is a common cause of stroke. The internal carotid artery and the carotid bifurcation are the locations most frequently affected by carotid atherosclerosis. Carotid endarterectomy (CEA) is an established revascularization intervention that removes atherosclerotic plaque. In this algorithm, we will review the anaesthetic management of an elderly patient undergoing CEA, utilizing two possible options.

Decompression sickness (also known as caisson disease) affects mainly divers, but may also affect airmen or astronauts. It is a very dangerous condition that can easily kill the person. In our algorithm, we focused on highlighting the various symptoms of decompression sickness, the importance of pre-hospital care, and the hyperbaric chamber. Furthermore, we want to familiarize the investigator with the indications and contraindications of therapy in the hyperbaric chamber. Although this is not a common disease in our country, anything can happen and you will find yourself in a situation where you will have to deal with decompression sickness.

The aim of this algorithm is to offer 2 difficult intubation situations in a paediatric patient. In the first case  it is possible to try a protocol for the unexpected difficult intubation. The second one in an expected difficult intubation. Step by step and you can go throught the procedure for these clinicaly truly important situations.

Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary, evidence-based approach to perioperative care. The purpose of the ERAS concept is to minimize complications related to the surgical procedure and early recovery of physiological functions, which results in reduced rates of morbidity, faster recovery and shorter length of stay in hospital. Interdisciplinary collaboration, especially anaesthesiologist, surgeon, nurse and physiotherapist, is essential.