NEW Algorithms of the year 2017

We are happy to present you nine brand new interactive algorithms created by students of Faculty of Medicine together with doctors from educational portal AKUTNE.CZ, reviewed by specialists from all over the Czech Republic.

Czech version  

The term 'mass-casualty incident' indicates any situation in which the number and severity of casualties exceed accessible medical resources. To ensure the best efficiency it is essential to quickly distinguish life-threatening injuries and determine the priority of treatment and transport of the wounded as well as to differentiate patients who cannot be saved. To facilitate the process, we can use one of several triage models (e.g. Triage and identification tags which evaluate victim's respiration, circulation and state of consciousness). In this algorithm, one can try to treat basic types of injuries caused in a multiple-vehicle collision.

25. 5. 2017 | Martin Polášek, MD, Veronika Sochorová, Michaela Spoustová

Clinical syndrome of thyrotoxicosis is the manifestation of tissue exposure to high levels of circulating thyroid hormones, which is accompanied by characteristic changes in their function. The most common form of thyrotoxicosis, which is caused by excessive thyroid gland, is hyperthyroidism. Shift from thyreotoxicosis of any type to a life-threatening state of a thyrotoxic crisis can caused by stress (emotional stress, intercurrent illness, surgery), destruction of functional tissue (radioiodine treatment), stable iodine (contrast medium administration) or abrupt withdrawal of thyrostatic agents. The failure of all compensatory mechanisms exacerbates the symptoms of toxicosis: agitation to delusional states, profuse sweating in hyperthermia, vomiting, diarrhea, hyperventilation, rhythm disorders and systolic dysfunction will accelerate the development of circulatory and metabolic failure. If treatment is not promptly initiated, mortality is high.
This algorithm will guide you through the issue of thyreotoxicosis with a focus on its diagnosis and treatment.

25. 5. 2017 | Hana Harazim, MD, PhD, Denisa Ölveczká, Tereza Tesaříková

Usually, the work of a young anaesthetist in perioperative care is vital. Therefore, much attention should be paid to it. Preoperative evaluation is commonly made before all surgical procedures. Nevertheless, its extent differs whether it is elective or emergency surgery and at the same time age and other comorbidities must be considered as well. Because it would be impossible to cover all the variations on one patient the algorithm includes more patients with various perioperative status. These patients should be prepared for different types of surgery (acute vs. elective). While solving the algorithm you can meet the same patient more than once, therefore, it is necessary to stay concentrated.

25. 5. 2017 | Ivo Křikava, MD, PhD, Martin Kovář, Radovan Lamoš

The return of spontaneous circulation is just the first step towards recovery after cardiac arrest. Based on prolonged hypoperfusion or even organ ischaemia and following reperfusion, a patophysiological phenomenons develop. We call this post resuscitation syndrome. This algorithm will guide you through the current recommendations in post-resuscitation care, from securing the patient’s airways in the ambulance through treatment in ICU to post cardiac arrest rehabilitation.

25. 5. 2017 | Olga Smékalová, MD, Veronika Machalová, Tereza Novotná

Burns are still one of the most serious injuries. Despite the progress in surgery, intensive care, pharmacotherapy and nutritional therapy we still have to keep in mind that burns are associated with high mortality and lifelong impairment of the patient. 
This alghorithm explains the principles of basic life support, urgent medical care and anaesthetic care for burnt pacients.

25. 5. 2017 | Monika Zamborská, MD, Václav Vafek, Igor Ferenčák

Ocular trauma is the one cause of the acute visual loss. Even a slight defect of the globe integrity can have negative consequences. We can distinguish two types of mechanical ocular trauma: closed (contusion, lamellar laceration) and open (penetration, perforation). In the case of the penetrating ocular trauma is the corneoscleral wall damaged in its whole thickness. The anaesthesia in eye surgery has its very own specifics, that anaesthetist need to care about. This interactive algorithm describes principles of the care for the eye trauma, beggining from the first aid up to the eye surgery.

25. 5. 2017 | Jitka Chlupová, MD, Adam Lužák, Lukáš Majerčák

Abnormal heart rhythms (arrhythmias, also dysrhythmias) are one of the most common heart diseases. According to heart rate they can be divided into two groups - bradycardias and tachycardias. The main cause of arrhythmias is a disorder in impulse formation and conduction in myocardial muscle. Generally, the presence of so-called arrhythmogenic substrate is the underlying cause of cardiac arrhythmias. This substrate can be a scar after myocardial infarction, source of ectopic automatism or degenerative changes of the myocardium.
Algorithm Cardiac Pacing provides insight into management of acute arrhythmias. It is also focused on perioperative treatment of sinus bradycardia that leads to cardiac asystole. 

25. 5. 2017 | Jan Hudec, MD, Daniela Charwátová, Roman Kula

Ileus is one of many forms of acute abdomen. It is characterized as a disruption of the normal propulsive ability of the gastrointestinal tract with distension of bowel and then perforation followed by peritonitis and sepsis. This algorithm allows you to diagnose and treat this condition. You will also learn about complications that can occur.

Other version of this algorithm: Acute abdomen from a anesthesiological viewpoint
25. 5. 2017 | Kateřina Gajdošíková, MD, Michal Sochor, Vendula Svobodová

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.

25. 5. 2017 | Prof. Petr Štourač, MD, PhD, Pavla Miřátská, Petr Zámečník

Who is considered as an “eldery patient” nowadays? Statisticaly it is age of 65 years. There were 1 760 000 citizens of this age group in the Czech republic at the 31th December 2012, which is nearly 17 % of our population. The pensionable age is 66.5 years. It is claimed that 22 % of all surgeries are among the eldery patients regarding the same date and this number is rising. Higher risk of perioperative morbidity is connected with higher age and so there are important specifics of anesthesia in eldery patients. What kind of specifics? 

25. 5. 2017 | Marek Kovář, MD, Hana Gottwaldová, Jiří Valenta

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. 

25. 5. 2017 | Martina Klincová, MD, Kristýna Dvořáková, Marie Bartošíková

When injuries occur, life-threatening bleeding may develop with no obvious external signs, which could warn you. Our algorithm is based on the  actual case history about the patient who suffered from a serious car accident.

Other version of this algorithm: Invasive venous catheterization of critical patient - 2019, Serious head injuries - invasive monitoring
27. 4. 2016 | Jana Kubalová, MD, Kateřina Vaníčková, MD, Ľudmila Floreková, Michal Hrubý

Every year, more than 150 people die in snow avalanches in Europe and Northern America. Most of them are climbers, skiers and skialpinists. Many of these deaths can be prevented by preventive measures, or by fast extrication of the buried people, appropriate first aid, on-scene triage, and subsequent highly specialized treatment in a suitable healthcare facility. Using this algorithm, you will learn how to proceed during a mountain rescue for a victim completely buried by an avalanche, which has these parameters: the width of the riving 200 m, height breakaway from 0.2 to 1.8 m, length 600 m avalanches, deposition height of 6 m, the estimated weight of 9.960 tons of snow. 
Firstly, you will play a role of a member of a group of skialpinists surprised by an avalanche while staying in the Krkonoše mountains. Then, you are going to become a prehospital physician responsible for the on-scene treatment given to people extricated by the mountain rescue service.

15. 4. 2016 | Prof. Petr Štourač, MD, PhD, Tereza Hanzelková, Magdaléna Hartová

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.

13. 4. 2016 | Martina Kosinová, MD, PhD, Patrícia Bartolenová, Michaela Cipovová