Let´s explore new virtual clinical cases on acute medicine. There you can find all virtual cases created during this school year 2016/2017.
ANAESTHESIA OF NEWBORN 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. (Authors: Martina Klincová, MD, Kristýna Dvořáková, Marie Bartošíková)
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. (Authors: Assoc. Prof. Petr Štourač, MD, PhD, Pavla Miřátská, Petr Zámečník)
ILEUS FROM A SURGICAL VIEWPOINT 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. (Authors: Kateřina Gajdošíková, MD, Michal Sochor, Vendula Svobodová)
CARDIAC PACING 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. (Authors: Jan Hudec, MD, Daniela Charwátová, Roman Kula)
PENETRATING EYE INJURY 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. (Authors: Jitka Chlupová, MD, Adam Lužák, Lukáš Majerčák)
BURN 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. (Authors: Monika Zamborská, MD, Václav Vafek, Igor Ferenčák)
POSTRESUSCITATION CARE 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. (Authors: Olga Smékalová, MD, Veronika Machalová, Tereza Novotná)
PREOPERATIVE EVALUATION AND PATIENT PREPARATION 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. (Authors: Ivo Křikava, MD, PhD, Martin Kovář, Radovan Lamoš)
THYREOTOXICOSIS 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 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. (Authors: Hana Harazim, MD, Denisa Ölveczká, Tereza Tesaříková)
TRIAGE AND HOSPITAL SURGE PLAN 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. (Authors: Martin Polášek, MD, Veronika Sochorová, Michaela Spoustová)
