Algorithms of the year 2018

We are happy to present you eight 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  

Acute coronary syndrome (ACM) is one of the most frequent causes of death in our population. Common risk factors such as bad eating habits, obesity, hypertension, diabetes mellitus and smoking are responsible for its development. This algorithm aims at right diagnostics of ACM as well as STEMI and non-STEMI differentiation which is necessary for the right choice of treatment.

1. 6. 2018 | Marie Miklíková, MD, Daniela Kočí, Martina Kořínková

Myotonia congenita Becker is an autosomal recessive disease, non-dystrophic myotonia. The worldwide prevalence of myotonia congenita is about 1:100,000. It is linked to mutations in CLCN1, the gene encoding the skeletal muscle chloride channel. The mutation in Becker’s disease leads to reduced flow of chloride ions during repolarisation leading to sustained muscle contraction. The reduced chloride conductance of the mutated chloride channels in Becker’s myotonia causes hyper-excitability of the muscle fibre membrane leading to bursts of aberrant action potentials. The algorithm will lead you through the anesthesia in patient suffering from this disease from preoperating examination to his awakening. 

1. 6. 2018 | Martina Kosinová, MD, PhD, Lucia Hrušková, Tereza Janoušová

Total hip arthroplasty is one of the most frequent operations in hospitals of all types, which is performed predominantly in elderly people and has its own specifics. The algorithm focuses on the choice and method of anaesthesia. It points to a potentially fatal complication of the operation using cement implantation, the cement syndrome (BCIS) and offers a solution to this complication. Next it deals with the problem of perioperative blood loss, which needs to be quantified and subsequently rationally covered. The last part suggests the methods of post-operative pain treatment.

1. 7. 2018 | Monika Zamborská, MD, Kamil Vrbica, MD, Zuzana Čuloková, Daniel Kosztúr

There is an increasing prevalence of diabetic patients undergoing surgery with the high number of complications associated with comorbidities. And even shorter surgical procedures without prior adequate diabetes compensation can pose a significant risk to them.
This algorithm aims to emphasize the importance of preoperative preparation of the patient with DM, choice of anaesthesia and perioperative monitoring.

1. 7. 2018 | Jitka Chlupová, MD, Vojtěch Nekvapil, Ielyzaveta Panchenko

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.

1. 6. 2018 | Peter Kľúčovský, MD, Michal Návoj, Matúš Šaffo

Palliative care in nursing reflects the view of a dying patient as a entire whole person. The provision of palliative care depends primarily on the non-medical health care staff, which provides, for the majority of the time, the dying patients comprehensive care during hospitalisation in an acute bed. Primarily the nurse is a direct participant in all of the events and comes in to contact with dying and death more often than any other medical staff. Therefore, it is essential that non-medical healthcare professionals have considerable interpersonal skills but, above all, clinical knowledge in relation to observation, response and initiation of symptom therapy. The aim of nursing in palliative care is to provide integrated comprehensive care that prevents and alleviates all aspects that are associated with any form of suffering of the dying patient. The aim is therefore to provide care that guarantees the highest quality of life until the last days of a dying patient in the department of acute and intensive care.

1. 7. 2018 | Michaela Březovská, MSN, Hana Harazim, MD, PhD

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.

1. 7. 2018 | Martina Klincová, MD, Lucie Moťková, MD, Anna Juhásová, Juliána Šimová. Illustrations: Juhásová Anna

Life-threatening bleeding can be defined in many aspects: by extent of blood loss, by the presence of clinical and laboratory signs of tissue hypoperfusion or signs of organ functions failure. Sometimes bleeding is not associated with major blood loss, but it threatens the life by localization of bleeding to the regions important for maintaining vital functions (eg. brain). In our algorithm we pursue bleeding from esophageal varices, which are frequent complication of hepatic cirrhosis. The goal of this algorithm is to show you the right steps and resolution of the therapy of life-threatening bleeding.  

Other version of this algorithm: Life-threatening haemorrhage - 2014
3. 7. 2018 | Olga Smékalová, MD, Michaela Brázdilová, Jan Sapák

Mushroom picking is one of the favorite ways of spending free time in the Czech Republic. Unfortunately, since not everyone in this country happens to be a mycologist there are many cases of fungal poisoning every year. Poisoning can occur in a variety of ways, ranging from banal nausea requiring medical treatment through excessive vomiting and diarrhea to severe organ failure. This condition, without timely and intensive care might lead to patient's death.
In this algorithm you will diagnose and then adequately treat poisoning with different types of fungi. We have three scenarios prepared, how many you go through depends on you.

3. 7. 2018 | Marek Kovář, MD, Jan Filip Sýkora, MD, Kateřina Bochníčková, Eva Urbánková

Neuromuscular blocking agents (NMBA) are drugs with potentially life threatening effects for the patient. Therefore the monitoring of neuromuscular transmission during the operation is done according to the Czech Society of Anaesthesia, Resuscitation and Intensive Care and it is considered to be a standard procedure in patients care. The objective evaluation of the depth of relaxation gives the anaesthesiologist a valuable information that aids in his decision making about the immediate care. The main goal of this algorithm is to introduce the audience to the basic informations and options about neuromuscular monitoring and furthemore, to point to its importance in bringing the best possible care to the patient.

1. 6. 2018 | Hana Harazim, MD, PhD, Tereza Musilová, Adam Predáč

Peripartum life-threatening hemorrhage is defined as quickly increasing blood loss, which is clinically estimated at 1500 ml and more and which is connected with development of clinical and/or laboratory signs of tissue hypoperfusion.

1. 6. 2018 | Prof. Petr Štourač, MD, PhD, Eliška Moráňová, Ivo Štrýgl

Pulmonary embolism is one of the most frequent life threatening diseases and according to statistics it is the third most common cause of cardiovascular mortality (after myocardial infarction and stroke).
The goal of this algorithm is to show that pulmonary embolism is not a rare disease and that one should keep it in mind during a diagnostic process. This algorithm also points out the fact that pulmonary embolism occurs moreover in younger population because of very widespread risk factors which are for example smoking, a use of oral contraceptive pills or long flights by airplane.

Other version of this algorithm: Pulmonary embolism
3. 7. 2018 | Olga Smékalová, MD, Kateřina Matoušková, MD, Klára Fabiánková, Dalibor Zimek

The airways are most often affected by infectious inflammatory diseases and these are usually not serious. A more severe course may be expected mostly in children, the elderly and patients with a compromised immune system. In this algorithm we encounter a severe course of infectious disease of the airways in a child and learn the therapy options.

1. 6. 2018 | Prof. Petr Štourač, MD, PhD, Vladislav Nezval, MD, Pavel Brančík, Sylvia Šefčíková

The syndrome of inapropriate secrection of the ADH – antidiuretic hormone develops after injuries, operations or brain infections. Secretions of the ADH in organism results in water retention and also decreasing of plasma sodium level. However there are also other causes of hyponatremia, which differ significantly in their clinical solution. That is why it’s so important for the doctor to find the cause of hyponatremia as soon as possible and suggest correct therapy. This algorithm guides you in differential diagnosis of hyponatremia and folowing possibilities of the therapy.

1. 7. 2018 | Jan Hudec, MD, Miriam Šipošová, Kristýna Chudjáková

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.

3. 7. 2018 | Ivo Křikava, MD, PhD, Vít Bönisch, Petra Křemečková. Illustrations: Bakošová Mária

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.

Other version of this algorithm: Water rescue I, Water rescue II
1. 6. 2018 | Michal Vondráček, MD, Lenka Šrahulková, MD, Zbyněk Šimek, Lujza Jandurová, Simona Tuhrinská. Illustrations: Šimek Zbyněk