Chief Physician of the Perinatological centre, Hospital Most, Most, Czech Republic
This interactive algorithm takes student fully into the real situation. Convulsions in children are one of the most common diagnoses which can be seen in prehospital care and also in children hospital wards. Prolonged convulsions with loss of consciousness belong to one of the most stressful events for all personnel involved. This algorithm is focused on basic stabilisation of a child until ambulance arrives, rational use of adequate dose of anticonvulsive agent and quick use of ABCDE approach in postictal and pharmacological sedation. Differential diagnosis of seizure condition is vital – metabolic causes, neuroinfection, intracranial processes that could lead to intracranial hypertension and also fever induced seizures especially in children with positive family history. In algorithm you can also find later counselling process after prolonged seizures, including preventive management for relapse paroxysms. In each point of decision making the student has a chance to learn from his inaccurate answer and then choose again, which cannot be accomplished in real life.
The algorithm describes a completely real situation of childbirth in the neonatal unit I, type. Childbirth is risky for gemini, but already in a favorable gestational week. While the adaptation of twin A is completely physiological, in twin B, after a prolonged pelvic delivery, a disorder of postpartum adaptation and subsequent further complications occur. The algorithm didactically emphasizes the solution of the current clinical condition and values of vital functions, which leads to further steps. The first is the treatment of hypoxia and then the indication of the transfer of the newborn to a neonatological workplace of a higher type using equipment to ensure a thermoneutral environment according to the gestational week of the child with the possibility of both oxygen therapy and respiratory support. An integral part of transport to a higher workplace is the form of passing on all information about the patient. The steps in the algorithm follow each other logically and the team is able to anticipate and react immediately to changes in the newborn's health. As a result, the student realizes how quickly the clinical condition of the newborn can deteriorate. Each decision is sufficiently reasoned in the explanatory text.