Opening Ceremony
The dean of the Faculty of Medicine of Masaryk University, prof Martin Repko, inaugurated the CZ Conference on Saturday morning welcomed all present guests and participants. The co-founder of the AKUTNĚ.CZ portal, Prof. Štourač, and other esteemed guests, including Prof. Gál (Brno), Dr Klincová (Brno), Prof. Beneš (Plzeň), Dr Mrozek (Olomouc), assoc.Prof. Schwarze, assoc. Prof. Máca (Ostrava), Dr Kuly (Ostrava), and the patron of NF AKUTNĚ.CZ, Pavel Tomeš were present.
The dean emphasized that the contribution of the AKUTNĚ.CZ portal is not only for the education of physicians but also for students who understand what to expect in their professional lives furthermore, the progress of AKUTNĚ.CZ over the 15 years was highlighted by Dr. Mrozek. This was followed by the awarding of the Jiří Mach Award for the best publication by an author under 35 for the year 2022 to Dr. Klincová, Dr. Prokopová, and Dr. Hudcova. Dr. Štoudek (Brno) was named the Celebrity of AKUTNĚ.CZ.
Finally, three books were produced in collaboration with the AKUTNĚ. CZ team were baptized: Acute Conditions in Initial Contact, AKUTNĚ Under the Lid, and a book titled 13!. The guests expressed their support for the entire portal through their speeches, thus ceremonially initiating another meeting of supporters of acute medicine.
Conference Highlights AKUTNĚ.CZ I.
Following the introductory session, Dr. Máca (Ostrava) introduced the audience to Czech Antarctic research taking place on James Ross Island at one of the largest stations in Antarctica, owned by Masaryk University, the Mendel Polar Station. Through his presentation, Dr. Máca provided insight into how the research was conducted, including transportation challenges, limited medical care options, and the impressive flora and fauna. Dr. Klučka (Brno) then shared the top publications from Article Monitoring with the audience. Most interest was devoted to addressing misinformation about the COVID pandemic and vaccination. He emphasized the importance of evidence-based medicine and critical thinking for physicians. Subsequently, the results of scientific publications in intensive care, including new recommendations for managing acute conditions, were summarized. In the final session, Dr. Kula (Ostrava) presented on autophagy in critically ill patients, particularly in the context of sepsis.
According to Dr. Kula, the patient should be given enough time for their body to "clean up" after inflammation through the housekeeping mechanism - autophagy. Following an insult (including autophagy), the patient's condition can be monitored using a commonly measured parameter, CRP (C-reactive protein). Dr. Kula addressed the question of whether elevated CRP is indeed a marker of inflammation. The first section concluded with an invitation to the 26th annual January festival of intensive medicine, Colors of Sepsis.
AKUTNĚ.CZ United
The section titled "AKUTNĚ.CZ Unites" was initiated by Dr. Beneš (Plzeň) with his lecture on 30 years of the Velvet Revolution, 15 years of AKUTNĚ.CZ, and is still at the beginning in some aspects. He focused on the development of medicine over the past 30 years, particularly on the transformation from evidence-based medicine to evidence-based medicine. He also emphasized the significance of lifelong learning. Dr. Truhlář (Hradec Králové) continued with his topic, "Is there an ideal pre-hospital anesthesia for severe trauma?" He illustrated this with a case study of Princess Diana's accident. The audience then voted on pre-hospital care management and mentioned the principles of best practice advice as a means of choosing the most proven approach. Responding to the question of whether to intubate or not intubate a patient in pre-hospital care, he presented data showing that patients intubated in the hospital have a better prognosis. He then listed 5 indications when it is desirable to intubate a patient early, but always performed by experienced personnel. In conclusion, he summarized that the safest anesthesia is the one that never occurs. The section concluded with Dr. Stern (Prague) pondering whether CPR should be practiced in the ICU. In his opinion, it is definitely necessary. He began by acquainting us with the situation at FNKV, where there are approximately 70 CPR cases per year. He mentioned the existence of the mandatory simulation course CPR for all doctors and the NLZP. He outlined the most common errors in simulations, such as failure to adhere to algorithmic procedures, errors in compression depth and frequency, and failure to adhere to the principles of proper defibrillation. He also addressed the significant psychological burden of simulations for staff in higher positions who have been in practice longer compared to younger colleagues. Finally, he discussed a case study of a young man, demonstrating the necessity of knowledge and adherence to recommended procedures and subsequent staff learning from this event.
Rising Stars
The afternoon session of the main program was initiated by Dr. Durila (Prague) with the topic "Hemostasis Differently.". He began by emphasizing the role of platelets in in vivo coagulation, which is not accounted for in the classical model of hemostasis. He then focused on diagnosis using ROTEM and PFA 200, mentioning their advantages, disadvantages, and particularly their use in acute conditions. He also presented studies indicating that in septic patients, the absence of plasma administration in cases of normal ROTEM findings but elevated aPTT and PT values did not lead to an increased occurrence of bleeding complications. During the discussion, Dr. Durila was asked whether ROTEM should be performed as part of preoperative examinations - he stated that, besides high-risk patient groups, it probably does not make sense to perform it universally. Dr. Dvořák (Hradec Králové) followed with the lecture "Emergency Medicine and Social Networks.". He initially presented examples of IZS components, hospitals, and healthcare workers' presentations, emphasizing that the right approach to content creation can contribute to positive public perception. He mentioned the main advantages of institutional activities on networks, such as communication control, education, or awareness of job opportunities; risks may include unprofessional presentation and less privacy protection. Regarding public profiles of healthcare workers, he highlighted issues of responsibility and access by followers who may ask specific questions about their health status. However, he demonstrated the positive impact of social networks with examples of people who decided to work in healthcare or were able to provide first aid because of their content. Finally, in this block, Dr. Bakalář (Prague) presented the topic "New Opportunities for Prevention and Treatment of Polyneuromyopathy." He began by mentioning that despite advances in intensive care and organ system support, rehabilitation is given insufficient importance. Insufficient activity at synapses leads to reduced BDNF formation, resulting in overall neuronal network degradation. Dr. Bakalář listed benzodiazepines and propofol as pharmacological agents with the greatest impact on BDNF, as they increase the inhibitory activity of GABA receptors. From his workplace, he presented experience with sedation using isoflurane, which appears to be less harmful in this regard. In terms of physical rehabilitation, he mentioned the benefits of a verticalized bed or the concept of illusory movements, utilizing stimulation of tendon insertions through vibrations, thus preserving proprioception.
AKUTNĚ.CZ Classics II.
The final block commenced with a lecture by Dr. Stibor (Baden bei Wien, Austria) titled "Patient Data Management System (PDMS) and Its Significance and Necessity in Contemporary ICU". Dr. Stibor initially emphasized the importance of PDMS and provided a brief excursion into the history of PDMS, explaining the problems and shortcomings of the old paper-based system. He further emphasized how a proper PDMS should function in practice and introduced its potential benefits, such as the automatic collection of all digital data. He presented specific examples of organ-specific PDMS. He highlighted system security options, such as fingerprint scanning on computer mice. Finally, Dr. Stibor explained how PDMS is specifically used in his workplace and the obstacles encountered during the implementation of this system.
Dr. Nalos (Ústí nad Labem) continued with the topic "Consequences of Embryonic Development on Approaches in Regional Anesthesia". He first emphasized the most significant events in embryonic development for this topic: alar lines, through which he explained the principles of somatic skin innervation of different body areas and highlighted the specifics of regional anesthesia administration. He then introduced the migration of the neuromuscular apparatus and the development of fascial compartments. He pointed out various myths prevalent in regional anesthesia, such as the blockade of the phrenic nerve or erector spinae. Additionally, he mentioned the formation of paraneurias and explained why they are the target site for the application of local anesthetics. He provided examples of fluid spread in the lumbar and brachial plexus areas. Finally, he discussed acute visceral pain and its specifics compared to somatic pain.
Workshops
From the early hours, workshops were running in parallel with the lectures for physicians, nursing staff, and medical students. This year, 929 participant slots were prepared for 25 workshops.
UPV Basics: The workshop led by Dr. Kratochvíl proceeded in a very pleasant atmosphere in an interactive format. Participants had the opportunity to try out various basic types of ventilation modes. Dr. Kratochvíl answered many curious questions and explained which basic parameters must be appropriately set on the UPV monitor.
Coagulation Disorders and Thrombelastography Basics In the workshop with Dr Kateřina Vaníčková (Brno), the principle and potential uses of thrombelastographic methods in acute conditions were first explained. The advantages include the possibility of examination at the patient's bedside, simplicity, speed, and monitoring all phases of hemostasis. This was followed by a practical part where participants could work together on 20 real-life case studies. At the end of the workshop, participants were shown a demonstration of operating the ROTEM device, including evaluating a specific sample. The workshop provided participants with a comprehensive insight into thrombelastography issues and practical skills for applying these methods in a clinical setting.
Coagulation Disorders and Thrombelastography: Advanced – In the afternoon workshop, focusing on coagulation disorders and thromboelastography methods, Dr. Zýková (Liberec) followed up with a workshop for (slightly) advanced participants. After a brief theoretical introduction focusing on the interpretation of individual parameters, she introduced less common conditions that can be encountered in clinical practice using examples of thromboelastographic curves. As part of their interaction with participants, she focused on topics such as differential diagnosis of gastrointestinal bleeding and postoperative bleeding states in heparinized patients or the differentiation between dabigatran intoxication and hyperfibrinolysis in the early phase of patient management. Finally, she discussed some specifics in patients with hepatopathy.
Automatic Pupillometry: A New Method in Monitoring and Prognostication of Brain Injury and Post-Cardiac Arrest – The workshop led by Dr. Lavička and Mgr. Vodňanský focused on introducing innovative pupilometry technology and its practical use in the neurosurgical ICU in Plzeň. Case studies accompanied this presentation. The technology enables the measurement of NPi (neurological pupil index) using two cameras and estimating the patient's outcome, which can alert to increasing ICP. This technology is helpful in conditions such as SAH, TBI, and encephalopathy. It has also proven effective in cardiac arrest and subsequent ROSC. Participants had the opportunity to try out this method practically, and case studies of patients with brain injury and post-cardiac arrest were presented to demonstrate the application of this method in practice.
Essential Pain Management: The interactive workshop was led traditionally by Dr. Kubricht and Dr. Mátlová. Participants also had the opportunity to complete an online course. Among the participants were physicians from various faculties in the Czech Republic, healthcare professionals, and even hypnosis experts. In the beginning, all participants completed a short test to verify their knowledge of pain management pharmacology. The key element also familiarised participants with the RZP algorithm for pain management and emphasised non-pharmacological treatment methods. Significant contributions included case studies of patients of all age groups and sharing personal practice experiences.
An Anesthesiologist is a Medicine – The workshop led by Dr. Škutchanová focused on a discussion about communication in anesthesiology, an area where significant communication skills are not initially expected. Dr. Škutchanová likened an anesthesiologist to a goalkeeper, from whom a "zero performance" is expected, i.e., performance without complications. Proper dialogue and non-verbal communication with the patient can facilitate work and make the procedure more enjoyable. The discussion also revolved around the influence of emotions and intuition in the work of an anesthesiologist. Finally, it was mentioned that knowledge of this information before starting work can serve as prevention against burnout syndrome.
TIVA/TCI - How to Set it Up Properly (Before You Go for Coffee) – In collaboration with Braun, Dr. Lipš and Dr. Bartošová (Prague) introduced participants to the TIVA/TCI method. This is a combined method of intravenously administered anesthesia using a targeted infusion pump. It serves to maintain the desired concentration of the anesthetic in the plasma or other compartment. They presented the advantages of TIVA compared to volatile anesthetics, such as a lower incidence of postoperative nausea and vomiting, a lower risk of complications during awakening, and better cognitive function of patients after anesthesia. The main disadvantages of this method include higher costs and the need for venous access. They also dispelled myths associated with the TIVA method. The risk of wakefulness during the procedure is still highest after the administration of muscle relaxants, regardless of the method of anesthesia administration itself. Other opioids than remifentanil can be used in combination with TIVA. Propofol can be used even in Rapid Sequence Induction (RSI). The workshop aimed to practice setting the application of propofol with the pump using case studies according to the Marsh, Schneider, and ELEVED models, which take into account the synergistic effect of opioids.
Life-Saving Measures – HOW TO? – The practical workshop, which followed the lecture of the same name, was led by Dr. Horejsek and colleagues. Participants had the opportunity to try out various ways of securing airways such as orotracheal or nasotracheal video-assisted intubation, the use of laryngeal masks, or intubation of children of different ages in 5-member groups. Training in coniotomy as a method of infraglottic airway securing was also included, along with a less common method in practice: intraosseous access.
Radiological Tips and Tricks in the Field of AIM – Dr. Gerstberger presented a lecture on the basics of radiology. The presentation focused on the use and evaluation of X-rays, ultrasound, and CT scans. Dr. Gerstberger provided a radiologist's perspective and together with the participants, we had the opportunity to describe images using an interactive quiz. The focus was mainly on chest X-rays + lungs and the evaluation of both physiological and pathological findings such as pneumothorax, fluidothorax, atelectasis, and pulmonary infiltrates. We also looked at the evaluation of X-rays in ileus conditions. Finally, a description of a CT scan of the brain in epidural and subdural hematoma was summarized. It was a clear summary of radiology for physicians in any field.
Utilization of the Sedaconda System in the Prevention and Treatment of Polyneuromyopathy, Including Practical Demonstration – The workshop provided a detailed presentation of the Sedaconda system from Medizintechnik, developed as an affordable alternative to expensive anesthesia devices. It allows for simple and effective administration of isoflurane and sevoflurane. Indications for using this device include pulmonary diseases such as ARDS and COPD, where it exhibits antibacterial effects. It is also used in status epilepticus.
Closing Ceremony
The block concluded with Dr. Ševčík (Ostrava) presenting on the topic "Gluttony, the Seventh Sin, or a Glaring Epidemic?" He explained the relevance of obesity for anesthesiological and intensive care. He cited data on the increase in obesity and diabetes mellitus in adults in the Czech Republic. He supplemented his lecture with images of obese patients and explanations of the specific challenges posed by caring for these patients. He then divided the degrees of obesity according to BMI. He presented possible causes of obesity such as lack of sleep, family influence, easy access to food, and less physical activity. He continued by listing the consequences of obesity on the patient's overall health and introducing the concept of a food revolution. He concluded his lecture by discussing the impact of our diet on the planet Earth and proposing possible steps leading to obesity prevention. He highlighted data showing the increase in obesity in the coming decades and its financial consequences.
The conference day flew by like water, and we are now facing the ceremonial conclusion of the jubilee XV. Conference of AKUTNĚ.CZ. Dr. Štourač thanked all participants for their enthusiasm and warmly expressed gratitude to all organizers for their meticulously performed several-month-long work. An enjoyable duty was the announcement of the results of the Poster Competition. This year, 5 authors submitted their poster to the medical section, and once again, it was difficult to select the winner. The poster by Dr. Lečbychová K. on the topic "Management of life-threatening non-traumatic abdominal bleeding using REBOA" impressed the evaluating committee consisting of Dr. Smékalová, Dr. Straková, and Dr. Beneš.
Once again, we cannot deny diligent readers their favorite final statistical report. The XV. AKUTNĚ.CZ Conference was prepared by 83 organizers of the medical section. There were 60 lectures heard by 1168 participants. It is worth noting that, thanks to all involved, a record attendance was achieved. For the participants, not only was there "mental nourishment" in the form of professional presentations and workshops, but also 1200 sandwiches, 1200 slices of cake, and 300 baguettes were prepared. The right level of caffeine in the veins was maintained by coffee prepared from 16 kg of coffee beans. Once again, a big thank you to all sponsors, the organizing team, and the attendees for the amazing conference atmosphere, and we invite you to the XVI. AKUTNĚ.CZ Conference, which will take place again at the University Campus in Bohunice on November 23, 2024.
