We introduce you algorithms that have gained recognition and admiration among their creators and users. Every year, a vote is announced on Algorithm of the Year, attended by all algorithms published in that year. The voices of past and present creators of interactive algorithms will decide who will receive a unique glass trophy and undying fame. In addition, in 2017 there was a large open competition for the best Algorithm of the decade, and resulted in 5 interactive algorithms that excelled among others by a significant lead and won the signature of Annivesary collection-10 years.
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.
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.
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.
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.
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.
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.
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.
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.
Sepsis is a life-threatening dysregulated response of the organism to an infectious stimulus that persists even after removal of this stimulus. Sepsis can occur very quickly and severely, under the picture of septic shock with multiorgan failure and the need for organ function support. Therefore, early recognition of this critical condition and early initiation of treatment should be considered. In treatment, emphasis is placed on initiating it within the first hour of suspected sepsis to maximize the patient's chances of recovery.
Food or other foreign body aspiration represents a frequent life threatening condition, mainly in children under the age of 3, who already possess the ability of independent movement and use it to discover their surroundings. The management of these situations has a number of significant characteristics, from active expectoration support and eventual resuscitation to often necessary invasive intervention. How to perform the first aid and remove the foreigner body from the airway? With this algorithm, we invite you to experience a model situation that each of us can go through.
In certain situations the use of balanced anaesthesia is not indicated (e.g. malignant hyperthermia). If we cannot use balanced anaesthesia nor regional anaesthesia (due to the characteristics of the surgery) – a TIVA (Total Intravenous Anaesthesia) should come to our minds. And TCI (Target Controlled Infusion) is a way how TIVA can be performed. The advantages of TCI in comparison to manually performed TIVA are for example – easier titration of the anaesthetic agent, it leads to fewer interventions by anaesthesiologist and helps us anticipate the wake up time. The purpose of this algorithm is to introduce the TCI syringe pump, to demonstrate how it works, what the indications are, what parameters are needed and how the complications can be solved with the use of TCI.
Traffic accidents often lead to wide spectre of different injuries that can greatly endanger the life of a crew. Even at first glance minor injuries can cause extensive internal bleeding with large blood loss. In such cases, inevitable immediate intervention is necessary, mostly with a blood transfusion products/blood derivatives. But what if a patient belongs to a group of so-called blood transfusion rejectors? Do you know when you can replace your patient's blood loss with these products and when will you try to find another way of replacing? Our algorithm offers you the opportunity to solve the model of a traffic accident involving Jehovah's Witnesses who are known to belong to a group of people rejecting blood transfusions. There are nearly 16,000 Jehovas Whittnesses in the Czech Republic, so the chance occuring this kind of situation is not negligible.
The laws mentioned in the algorithm are valid for the Czech Republic, therefore situation in the English-speaking countries may differ.
Brain death is an irreversible extinction of all brain functions including brainstem functions despite of the working cardiovascular system or other organs. The organ donor can be living human or the organ can be taken from the body of dead one. The condition is free and voluntary donor decision. The dead donor is in most cases a person, whose brain damage leads to its death, which has to be medicaly very precisely examinated and confirmed by objective screening procedure.
In the Czech Republic, swimming is very popular and frequent sport. Warm weather and summer days sprout the swimmers from the pools to the open waters. Swimming in open waters carries not only the joy, but also risks, and a lot of experienced swimmers can end up drowning for the first time. This algorithm will guide you through the water rescue technique from the beginning until the end.
HELLP syndrome (Haemolysis, Elevated Liver Enzymes, Low Platelet Count) is a rather rare, nonetheless a very serious complication of pregnancy. It often occurs in the setting of preeclampsia but can occur independently, too. One third of cases manifests in the immediate postpartum period. This condition cannot be predicted, the final diagnosis can only be determined based on the laboratory test results, medical signs and patient-reported symptoms. This interactive case takes you on a tour from the recognition of the first signs of HELLP syndrome, its diagnosis and therapy to its possible complications and their consequences.
The newborn is not a small adult, there are many anatomical and physiological differences. If itꞌs possible, we postpone the operation until later age. However, exceptions exist, such as a congenital malformation, an acute case etc. and we are forced to perform operation as soon as possible. In these situations, the specialized departments take action. In our algorithm youꞌll encounter pylorostenosis which is the congenital malformation (2-5/1000 newborns) causing disorder of the passage.
The procedures and techniques commonly encountered in anaesthesia are different when carried out on obese patients. The obesity makes some of them more difficult, or even impossible to perform. Airway management and drug dosage are also specific. The aim of this algorithm is to show you the entire process of anaesthesia in order to realize the important moments when considering patient’s body size is necessary.
Crush syndrome also called compression syndrome, is a condition caused by massive compression of soft tissues, especially muscles, resulting in rhabdomyolysis (destruction of muscles), edemas and a risk of hyperkalemia. Myoglobin is released from the injured muscles and causes a severe kidney damage and acute renal failure. This algorithm describes treatment of a patient suffering from crush syndrome, step by step, beginning from the lay first aid up to the final care in hospital.
Carbon monoxide poisoning is one of the most common accidental poisoning. CO has very strong binding to hemoproteins and blocks their function. It causes severe tissue hypoxia. Poisoning can result in severe neurological disability, worstly can lead to patient’s death. CO binding is reversible, well-timed and adequate therapy is necessary.
Although cardiac arrest in pregnancy is rare, it can be really unpleasant situation for every doctor. There are a lot of causes, e.g. cardiac failure, bleeding, coagulation disorder or trauma. In this algoritm you can go through basic and advanced life support of mother with emphasis on specifics in resuscitation in pregnancy according to the quidelines.
Acute mountain sickness (AMS) can affect all of us already at an altitude of 2500 MASL as a result of the reduced amount of oxygen in air. Initial symptoms may progress to life-threatening diseases such as high altitude cerebral or pulmonary edema. Although we can effectively prevent AMS due to proper acclimatization, sometimes AMS can also affect the professional and experienced climbers.
Act as a member of the alpine expedition in our algorithm and try to solve this case at different stages of this disease.
Epilepsy is a disease characterized by recurring seizures of uncontrolled brain neuron excitatory activity, resulting in a cerebral dysfunction. The seizures can be caused as the result of a head trauma, brain tumor or inflammation, brain stroke or due to different metabolic changes. They can also be idiopathic. Most of the seizures end spontaneously, but some continue for a long time or the patient remains unconscious. This situation is called the status epilepticus and it is considered to be a life threatening situation.
Labour pain appearing during uterine contractions is a reaction of a pregnant woman’s organism preparing for labour. Intensity of labour pain is individual, because perception of pain is affected by somatic, mental and social factors. Therefore, approach to analgesia must be individual as well. Currently, any of many farmacological and non-farmacological means can be used. Epidural analgesia is one of the most commonly used means, lately accompanied by remifentanil. Correctly indicated and administered labour analgesia may help to reduce incidence of labour complications at both mother and child.
The Mountain Rescue Service in Czech Republic provides more than 6000 rescue operations every year. About a half of the accidents occures in ski slope skiing. The most common injuries are joint injuries, contusions and fractures. Our algorithm introduces you to the management of the ski slope injury from the layman´s first aid to the professional prehospital and hospital care.
To think about the most serious complication of Abdominal aortic aneurysm - the rupture is very important because even banal difficulties such as backache, epigastric pain or vomiting could be a harbinger of a lethal end. After asymptomatic period, condition can lead to hemorrhagic shock in few hours. Due to risk factors which are widely distributed in our population (smoking, hypertension, atherosclerosis, age) and the prevalence of aneurysm which is not negligible (2.5 – 5 %), the risk of rupture is very high. It depends on size – the risk of rupture 6 cm aneurysm in 5 years is 33 %, in case of aneurysm with diameter above 7 cm is up to 95 %.
Laryngospasm is an acute life-threatening condition caused by reflex closure of the rima glotidis by the vocal cords. Presence of saliva, blood, stomach contents, supraglottic airway device and manipulation with laryngoscope in the hypopharynx in state of partial consciousness may contribute to the development of this condition. Laryngospasm occurs more often in children, young adults or in obese people during extubation procedure when the patient is not yet fully recovered from general anaesthesia. The following algorithm introduces a recommended management of severe laryngospasm.
The Caesarean section is an operation, when the baby is delivered by a surgical way. There are many indications for this medical help. Our algorithm follows three types of anaesthesiology (general, epidural and spinal), which can be used, and the complications, which can come during the operation. Unpreparedness and insufficient help could be dangerous not just for the baby, but also for the patient.
Not every gravidity would end up with labor at term. During pregnancy there could be many complications, either with mother or child, that result in premature birth. One of these complications can be hypoxia of baby. In that case premature birth ends with delivering hypoxic baby with very low Apgar score. In Algorithm „Newborn resuscitation“ you can try what to do in such a situation.
Acute abdomen is one of the classic cases of acute medicine. Due to the threat of serious complications it is necessary to recognize it early and treat appropriately. In the case of surgical intervention, the patient is at high risk of aspiration of gastric contents during induction of general anesthesia. Our algorithm focuses on the topic from the perspective of anesthesiologist, especially on the correct rapid induction of anesthesia (Rapid Sequence Induction-RSI, flash introduction, crush introduction).
Peripartal life-threatening haemorrhage is defined as sudden and uncontrolled blood loss, which is clinically estimated at 1500 ml and more, and which is associated with the onset of clinical and/or laboratory signs of tissue hypoperfusion.
The Diabetes mellitus algorithm describes step-by-step prehospital and subsequently hospital process of treatment of the hyperglycaemic coma. The algorithm is processed in the prehospital phase from the perspective of a non-medical professional and a medical professional at the scene of an incident to make sure to emphasize basic life functions.
Childbirth in the field is situation which can confront every one of us. For this case an algorithm was created, where you find yourself in the position of emergency doctor called to assist the progressing childbirth. Here is your chance to get familiar with the proper medical guidance of the childbirth in the field.
Myocardial infarction (heart attack) is one of the most common causes of death in our population. Many risk factors contributing to its genesis are spread widely such as smoking, obesity, junk food, lack of exercise, high blood pressure and diabetes mellitus. Our algorithm presents you the right way to diagnose and treat heart attack as so as the most frequent mistakes that can endanger the patient.
Acute postoperative pain management is a multidisciplinary task in which they are responsible both anesthesiologist, surgeon, attending physicians and nurses of postoperative department. For this reason, there is often a transfer of responsibilities between the involved medical staff, and often a poor care of the patient's pain. Early postoperative pain treatment can prevent its chronification. Therefore, we present here the algorithm for the treatment of postoperative pain after pulmonary surgery.