Make PPT on latest Pediatric’s surviving sepsis guidelines for DNB Ped

Make PPT on latest Pediatric’s surviving sepsis guidelines for DNB Pediatric residents as I will be conducting one webinar. make it informative - attractive - interactive . Scenario based fluid therapy / case based approach and practical aspects.
Reading File
Searching PubMed
"pediatric sepsis" AND "surviving sepsis campaign" AND guidelines
Searching the Web
Surviving Sepsis Campaign pediatric guidelines 2024 2025 latest recommendations fluid resuscitation
Reading File
Reading Web Page
https://www.pulmonologyadvisor.com/features/pediatric-sepsis…
Reading Article
PMID: 41869826
Running Command
mkdir -p /home/daytona/workspace/pediatric-sepsis-ppt && ls /home/daytona/worksp…
Writing File
~/pediatric-sepsis-ppt/build.js
const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Pediatric Sepsis 2026 - SSC Guidelines";
pres.author = "DNB Pediatrics Webinar";

// ─── MASTER PALETTE ──────────────────────────────────────────────────────────
const C = {
  navy:      "0A1628",   // dominant dark
  teal:      "007B8A",   // supporting accent
  orange:    "E8620A",   // sharp accent / alerts
  white:     "FFFFFF",
  offwhite:  "F2F6FA",
  lightBlue: "D4EBF2",
  mint:      "B2DFD8",
  red:       "C0392B",
  yellow:    "F4C430",
  green:     "1A7A4A",
  gray:      "7F8C8D",
  lightGray: "ECF0F1",
  midGray:   "BDC3C7",
  darkTeal:  "005F6B",
};

// ─── HELPER: Slide banner background (dark navy) ─────────────────────────────
function navyBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
}

function lightBg(slide) {
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}

function addTitleBar(slide, text, subtitle) {
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  slide.addText(text, { x: 0.35, y: 0.08, w: 9.3, h: 0.75, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
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    slide.addText(subtitle, { x: 0.35, y: 0.78, w: 9.3, h: 0.38, fontSize: 12, color: C.mint, fontFace: "Calibri", margin: 0 });
  }
}

function addFooter(slide, text) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.33, w: 10, h: 0.295, fill: { color: C.navy } });
  slide.addText(text || "SSC Pediatric Sepsis Guidelines 2026  |  DNB Pediatrics Webinar", {
    x: 0.2, y: 5.35, w: 9.6, h: 0.25, fontSize: 8, color: C.midGray, fontFace: "Calibri", margin: 0
  });
}

function badge(slide, label, color, x, y, w) {
  slide.addShape(pres.ShapeType.roundRect, { x, y, w: w || 1.6, h: 0.3, fill: { color }, rectRadius: 0.08 });
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}

function iconBox(slide, emoji, label, x, y, w, h, bg) {
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  slide.addText(label, { x: x + 0.06, y: y + h * 0.48, w: w - 0.12, h: h * 0.5, fontSize: 10, bold: true, color: C.navy, align: "center", fontFace: "Calibri", wrap: true, margin: 0 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – COVER
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  navyBg(sl);

  // Diagonal accent strip
  sl.addShape(pres.ShapeType.rect, { x: 7.8, y: 0, w: 2.2, h: 5.625, fill: { color: C.teal }, transparency: 60 });
  sl.addShape(pres.ShapeType.rect, { x: 8.6, y: 0, w: 1.4, h: 5.625, fill: { color: C.orange }, transparency: 70 });

  // Red alert badge
  sl.addShape(pres.ShapeType.roundRect, { x: 0.5, y: 0.6, w: 2.2, h: 0.38, fill: { color: C.red }, rectRadius: 0.08 });
  sl.addText("🚨 CRITICAL CARE UPDATE", { x: 0.5, y: 0.62, w: 2.2, h: 0.34, fontSize: 9, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0 });

  // Main title
  sl.addText("Pediatric Sepsis", { x: 0.5, y: 1.1, w: 7.5, h: 0.9, fontSize: 46, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
  sl.addText("Surviving Sepsis Campaign", { x: 0.5, y: 1.95, w: 7.5, h: 0.55, fontSize: 28, bold: false, color: C.mint, fontFace: "Calibri", margin: 0 });
  sl.addText("International Guidelines 2026", { x: 0.5, y: 2.45, w: 7.5, h: 0.55, fontSize: 28, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0 });

  // Divider
  sl.addShape(pres.ShapeType.rect, { x: 0.5, y: 3.1, w: 5.5, h: 0.05, fill: { color: C.orange } });

  // Subtitle block
  sl.addText("Case-Based Learning | Fluid Therapy Scenarios | Practical Management", {
    x: 0.5, y: 3.25, w: 7.5, h: 0.4, fontSize: 14, color: C.lightBlue, fontFace: "Calibri", italic: true, margin: 0
  });

  // Bottom info
  sl.addText([
    { text: "Weiss SL et al. Pediatr Crit Care Med / Intensive Care Med. 2026", options: { bold: false } }
  ], { x: 0.5, y: 4.0, w: 7, h: 0.3, fontSize: 10, color: C.midGray, fontFace: "Calibri", margin: 0 });

  sl.addText("DNB Pediatrics Webinar Series  |  May 2026", {
    x: 0.5, y: 4.35, w: 7, h: 0.3, fontSize: 11, color: C.midGray, fontFace: "Calibri", margin: 0
  });

  // Stethoscope emoji large
  sl.addText("🩺", { x: 7.6, y: 1.6, w: 2, h: 2, fontSize: 80, align: "center", fontFace: "Segoe UI Emoji", margin: 0 });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – AGENDA
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "Webinar Agenda", "What we will cover today");

  const items = [
    ["01", "📖", "New 2026 Sepsis Definition – What changed?"],
    ["02", "🔍", "Early Recognition – Phoenix Sepsis Score"],
    ["03", "💉", "Fluid Resuscitation – Scenario-Based (ATTAIN Study)"],
    ["04", "💊", "Antimicrobials – 1-hour & 3-hour bundle"],
    ["05", "⚡", "Vasopressors & Hemodynamic Support"],
    ["06", "🫁", "Ventilation & Oxygenation Targets"],
    ["07", "🏥", "Adjunctive Therapies – Steroids, Glucose, Nutrition"],
    ["08", "📋", "Case Scenarios – Interactive Q&A"],
  ];

  items.forEach(([num, icon, text], i) => {
    const col = i < 4 ? 0 : 1;
    const row = i < 4 ? i : i - 4;
    const x = col === 0 ? 0.3 : 5.2;
    const y = 1.4 + row * 0.95;

    sl.addShape(pres.ShapeType.roundRect, { x, y, w: 4.6, h: 0.78, fill: { color: col === 0 ? C.navy : C.darkTeal }, rectRadius: 0.1 });
    sl.addText(num, { x: x + 0.08, y: y + 0.08, w: 0.45, h: 0.62, fontSize: 14, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0 });
    sl.addText(icon + "  " + text, { x: x + 0.55, y: y + 0.1, w: 3.95, h: 0.6, fontSize: 11.5, color: C.white, fontFace: "Calibri", wrap: true, margin: 0 });
  });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – NEW DEFINITION
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "🆕 New 2026 Pediatric Sepsis Definition", "Phoenix Sepsis Criteria – Major Paradigm Shift");

  // Old vs New comparison
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.3, w: 4.4, h: 3.8, fill: { color: "FFE0DC" }, line: { color: C.red, width: 1.5 } });
  sl.addText("❌  OLD Definition (2005 IPSCC)", { x: 0.35, y: 1.35, w: 4.3, h: 0.4, fontSize: 12, bold: true, color: C.red, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "SIRS-based:\n", options: { bold: true, breakLine: true } },
    { text: "• Temp >38.5°C or <36°C\n", options: { breakLine: true } },
    { text: "• HR/RR abnormal for age\n", options: { breakLine: true } },
    { text: "• WBC count criteria\n", options: { breakLine: true } },
    { text: "• Suspected infection\n", options: { breakLine: true } },
    { text: "\n⚠️ Problem: Too sensitive, not\n", options: { breakLine: true } },
    { text: "organ dysfunction-specific", options: {} },
  ], { x: 0.4, y: 1.8, w: 4.1, h: 3.1, fontSize: 11.5, color: C.navy, fontFace: "Calibri", valign: "top", margin: 4 });

  sl.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.3, w: 4.7, h: 3.8, fill: { color: "D9F2E6" }, line: { color: C.green, width: 1.5 } });
  sl.addText("✅  NEW Definition (2026 SSC)", { x: 5.05, y: 1.35, w: 4.6, h: 0.4, fontSize: 12, bold: true, color: C.green, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "Phoenix Sepsis Score:\n", options: { bold: true, breakLine: true } },
    { text: "Infection + Life-threatening ORGAN DYSFUNCTION\n", options: { bold: true, breakLine: true } },
    { text: "\nScored Systems (≥2 points = sepsis):\n", options: { breakLine: true } },
    { text: "• Respiratory (SpO₂/FiO₂, PaO₂/FiO₂)\n", options: { breakLine: true } },
    { text: "• Cardiovascular (MAP, vasoactives, pH)\n", options: { breakLine: true } },
    { text: "• Coagulation (platelets, INR, D-dimer, fibrinogen)\n", options: { breakLine: true } },
    { text: "• Neurological (GCS, AVPU)\n", options: { breakLine: true } },
    { text: "\n🔬 Validated in 3 million+ children globally", options: { bold: true } },
  ], { x: 5.05, y: 1.8, w: 4.5, h: 3.1, fontSize: 11, color: C.navy, fontFace: "Calibri", valign: "top", margin: 4 });

  sl.addText("➜", { x: 4.45, y: 2.9, w: 0.5, h: 0.5, fontSize: 22, color: C.orange, align: "center", bold: true, fontFace: "Calibri", margin: 0 });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – PHOENIX SEPSIS SCORE TABLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "🔢 Phoenix Sepsis Score – Scoring Quick Reference", "Used for Recognition & Severity Assessment");

  const rows = [
    ["Domain", "Criterion", "Points", "Clinical Tip"],
    ["🫁 Respiratory", "PaO₂/FiO₂ <400 OR SpO₂/FiO₂ <292 (no support)", "1", "Check pulse ox + O₂ carefully"],
    ["", "PaO₂/FiO₂ <200 OR SpO₂/FiO₂ <220 (with support)", "2", "Invasive ventilation likely"],
    ["", "PaO₂/FiO₂ <100 OR SpO₂/FiO₂ <148 (with support)", "3", "Severe ARDS territory"],
    ["❤️ Cardiovascular", "MAP below age-norm OR vasopressor/fluid bolus needed", "1", "Know age-specific MAP norms"],
    ["", "Dopamine >5 OR any epinephrine/norepinephrine", "2", "Start vasopressors early"],
    ["", "pH <7.0 OR lactate >11 OR on ECMO", "3", "ICU escalation immediately"],
    ["🩸 Coagulation", "Platelets <100k OR INR >1.3 OR D-dimer >2 mg/L", "1", "Early DIC screen"],
    ["🧠 Neurological", "GCS ≤10 OR AVPU = P or U", "1", "Neuro exam every hour"],
  ];

  const colW = [1.65, 3.4, 0.8, 2.85];
  const colX = [0.2, 1.88, 5.3, 6.13];
  const rowH = 0.47;
  const startY = 1.28;

  rows.forEach((row, rIdx) => {
    const y = startY + rIdx * rowH;
    const isHeader = rIdx === 0;
    const bgColor = isHeader ? C.navy : (rIdx % 2 === 0 ? C.lightGray : C.white);
    row.forEach((cell, cIdx) => {
      sl.addShape(pres.ShapeType.rect, { x: colX[cIdx], y, w: colW[cIdx], h: rowH, fill: { color: bgColor }, line: { color: C.midGray, width: 0.5 } });
      sl.addText(cell, {
        x: colX[cIdx] + 0.05, y: y + 0.03, w: colW[cIdx] - 0.1, h: rowH - 0.06,
        fontSize: isHeader ? 11 : 9.5, bold: isHeader, color: isHeader ? C.white : C.navy,
        fontFace: "Calibri", valign: "middle", wrap: true, margin: 0
      });
    });
  });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 5.05, w: 9.6, h: 0.25, fill: { color: C.orange }, rectRadius: 0.04 });
  sl.addText("⭐  Septic Shock = Sepsis + cardiovascular dysfunction (score ≥1 cardiovascular point)", {
    x: 0.3, y: 5.06, w: 9.4, h: 0.22, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CASE 1 INTRO (Scenario card)
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  navyBg(sl);
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.orange } });
  sl.addText("📋  CASE SCENARIO 1  –  Fluid Therapy in Septic Shock", {
    x: 0.2, y: 0.07, w: 9.6, h: 0.42, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.65, w: 9.4, h: 2.1, fill: { color: "1A2A3A" }, rectRadius: 0.15 });
  sl.addText([
    { text: "Ravi, 4-year-old boy  ", options: { bold: true, color: C.yellow } },
    { text: "wt 15 kg  |  Rural district hospital  |  No ICU on-site\n", options: { color: C.mint, breakLine: true } },
    { text: "\nPresentation: ", options: { bold: true, color: C.lightBlue } },
    { text: "High-grade fever 5 days, vomiting, decreased urine output, lethargic\n", options: { color: C.white, breakLine: true } },
    { text: "Vitals: ", options: { bold: true, color: C.lightBlue } },
    { text: "HR 158/min  |  BP 68/40 mmHg  |  RR 44/min  |  SpO₂ 91% (RA)  |  Temp 39.6°C  |  CRT 5 sec\n", options: { color: C.white, breakLine: true } },
    { text: "Examination: ", options: { bold: true, color: C.lightBlue } },
    { text: "Cold extremities, mottled skin, AVPU = V, No meningism", options: { color: C.white } },
  ], { x: 0.45, y: 0.72, w: 9.1, h: 1.95, fontSize: 11, fontFace: "Calibri", valign: "top", wrap: true, margin: 4 });

  // Question box
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 2.85, w: 9.4, h: 0.08, fill: { color: C.teal } });
  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 2.9, w: 9.4, h: 2.1, fill: { color: "0D2137" }, rectRadius: 0.1 });
  sl.addText("❓  QUESTION: What is your FIRST priority for fluid management?", {
    x: 0.45, y: 2.95, w: 9.1, h: 0.45, fontSize: 13.5, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0
  });

  const opts = [
    ["A", "Give 20 mL/kg NS bolus immediately over 15 min then reassess"],
    ["B", "Start maintenance only – avoid bolus (no ICU available)"],
    ["C", "Give 10 mL/kg NS bolus, reassess, repeat up to 40 mL/kg total"],
    ["D", "Colloid bolus 10 mL/kg (albumin 5%)"],
  ];

  opts.forEach(([letter, text], i) => {
    const y = 3.45 + i * 0.4;
    const bg = letter === "B" ? "1A3A2A" : "0D2137";
    sl.addShape(pres.ShapeType.roundRect, { x: 0.45, y, w: 9.1, h: 0.36, fill: { color: bg }, rectRadius: 0.06 });
    sl.addText(`${letter}.  ${text}`, { x: 0.55, y: y + 0.03, w: 9.0, h: 0.3, fontSize: 11, color: C.white, fontFace: "Calibri", margin: 0 });
  });

  addFooter(sl, "Interactive Q&A – Pause here for audience response");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – CASE 1 ANSWER: FLUID THERAPY (WITH ICU)
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "💧 SSC 2026: Fluid Resuscitation Guidelines", "Case 1 Debrief | Context-Sensitive Fluid Therapy");

  // Answer reveal
  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.28, w: 9.4, h: 0.5, fill: { color: C.green }, rectRadius: 0.1 });
  sl.addText("✅  Answer: C – 10 mL/kg bolus, reassess after each bolus, max 40-60 mL/kg in first hour (if ICU AVAILABLE)", {
    x: 0.4, y: 1.33, w: 9.2, h: 0.4, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  // Two boxes: ICU vs No-ICU
  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.88, w: 4.5, h: 2.9, fill: { color: C.lightBlue }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.12 });
  sl.addText("🏥  WITH ICU Availability", { x: 0.4, y: 1.93, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: C.darkTeal, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "• Bolus: 10-20 mL/kg crystalloid per bolus\n", options: { breakLine: true } },
    { text: "• Max: 40-60 mL/kg in first hour\n", options: { breakLine: true } },
    { text: "• Reassess after EVERY bolus\n", options: { breakLine: true } },
    { text: "• Use balanced crystalloid (PlasmaLyte/RL)\n", options: { breakLine: true } },
    { text: "• Stop if: shock resolves OR fluid overload signs\n", options: { breakLine: true } },
    { text: "• POCUS: assess IVC, cardiac function if available\n", options: { breakLine: true } },
    { text: "\nStrength: Conditional | Evidence: Low", options: { italic: true, color: C.gray } },
  ], { x: 0.4, y: 2.35, w: 4.2, h: 2.35, fontSize: 10.5, color: C.navy, fontFace: "Calibri", valign: "top", margin: 4 });

  sl.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 1.88, w: 4.5, h: 2.9, fill: { color: "FFE8E8" }, line: { color: C.red, width: 1.5 }, rectRadius: 0.12 });
  sl.addText("🌍  WITHOUT ICU Availability", { x: 5.3, y: 1.93, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: C.red, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "• NO BOLUS in sepsis WITHOUT hypotension\n", options: { bold: true, breakLine: true } },
    { text: "  Start maintenance fluids only\n", options: { breakLine: true } },
    { text: "\n• If septic SHOCK WITH hypotension:\n", options: { breakLine: true } },
    { text: "  Suggest up to 40 mL/kg (10-20 mL/kg per bolus)\n", options: { breakLine: true } },
    { text: "\n• Evidence base: FEAST trial (Africa)\n", options: { breakLine: true } },
    { text: "  Boluses ↑ mortality in resource-limited settings\n", options: { breakLine: true } },
    { text: "\nStrength: STRONG (No bolus) | Evidence: HIGH", options: { italic: true, bold: true, color: C.red } },
  ], { x: 5.3, y: 2.35, w: 4.3, h: 2.35, fontSize: 10.5, color: C.navy, fontFace: "Calibri", valign: "top", margin: 4 });

  addFooter(sl, "SSC 2026 | Fluid Therapy – Context matters: ICU availability changes the recommendation!");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – FLUID THERAPY: WHICH FLUID?
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "🧪 Which Fluid? Crystalloid vs Colloid vs Blood Products", "SSC 2026 Recommendations on Fluid Type");

  const boxes = [
    { x: 0.25, title: "✅ Crystalloids – FIRST-LINE", color: C.green, bg: "D9F2E6", text: "• Balanced crystalloids preferred\n  (PlasmaLyte / Hartmann's / RL)\n• Normal saline acceptable if\n  balanced not available\n• Avoid hypotonic fluids\n  (0.45% NaCl, D5W alone)\n\nEvidence: Low\nStrength: Conditional" },
    { x: 3.5, title: "⚠️ Albumin 5% – SELECTED USE", color: C.orange, bg: "FFF3E0", text: "• Consider albumin if substantial\n  crystalloid volumes already given\n• Especially if hypoalbuminemia\n  present\n• NOT as routine first-line bolus\n\nNew 2026 statement:\nInsufficient evidence for routine\nuse vs crystalloids\n\nEvidence: Very Low" },
    { x: 6.75, title: "❌ Avoid These Fluids", color: C.red, bg: "FFE0DC", text: "• Gelatin: NOT recommended\n  (new strong statement 2026)\n• Dextran: Avoid\n• HES (starches): Avoid\n• Hypotonic solutions: Avoid\n  as resuscitation fluid\n• Hypertonic saline: Insufficient\n  evidence\n\nStrength: Strong (for gelatin)" },
  ];

  boxes.forEach(b => {
    sl.addShape(pres.ShapeType.roundRect, { x: b.x, y: 1.28, w: 3.15, h: 3.98, fill: { color: b.bg }, line: { color: b.color, width: 1.8 }, rectRadius: 0.12 });
    sl.addText(b.title, { x: b.x + 0.1, y: 1.33, w: 2.95, h: 0.42, fontSize: 11.5, bold: true, color: b.color, fontFace: "Calibri", margin: 0 });
    sl.addText(b.text, { x: b.x + 0.1, y: 1.8, w: 2.95, h: 3.35, fontSize: 10, color: C.navy, fontFace: "Calibri", valign: "top", wrap: true, margin: 4 });
  });

  addFooter(sl, "SSC 2026 | Key change: STRONG recommendation AGAINST gelatin solutions");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – FLUID OVERLOAD WARNING (Important new concept)
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  navyBg(sl);
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.red } });
  sl.addText("⚠️  FLUID OVERLOAD – The Silent Killer in Pediatric Sepsis", {
    x: 0.2, y: 0.07, w: 9.6, h: 0.42, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.65, w: 4.4, h: 2.55, fill: { color: "1A0A0A" }, line: { color: C.red, width: 1 }, rectRadius: 0.1 });
  sl.addText("🚩 Signs to STOP Fluid Bolus", { x: 0.4, y: 0.72, w: 4.2, h: 0.38, fontSize: 13, bold: true, color: C.red, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "• Respiratory distress worsening\n", options: { breakLine: true } },
    { text: "• New crackles / wheeze\n", options: { breakLine: true } },
    { text: "• SpO₂ falling despite O₂\n", options: { breakLine: true } },
    { text: "• Hepatomegaly appearing\n", options: { breakLine: true } },
    { text: "• Periorbital / sacral edema\n", options: { breakLine: true } },
    { text: "• POCUS: B-lines lung, IVC plethoric\n", options: { breakLine: true } },
  ], { x: 0.4, y: 1.15, w: 4.1, h: 2.0, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "top", margin: 4 });

  sl.addShape(pres.ShapeType.roundRect, { x: 5.0, y: 0.65, w: 4.7, h: 2.55, fill: { color: "0A1A0A" }, line: { color: C.green, width: 1 }, rectRadius: 0.1 });
  sl.addText("📊 Fluid Monitoring Strategy", { x: 5.1, y: 0.72, w: 4.5, h: 0.38, fontSize: 13, bold: true, color: C.mint, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "• Reassess after EVERY bolus (HR, BP, CRT, UO)\n", options: { breakLine: true } },
    { text: "• Target: CRT ≤2 sec, HR normal for age\n", options: { breakLine: true } },
    { text: "• Track fluid balance carefully (ml/kg/day)\n", options: { breakLine: true } },
    { text: "• POCUS: assess cardiac function, IVC\n", options: { breakLine: true } },
    { text: "• Consider fluid restriction/de-resuscitation\n", options: { breakLine: true } },
    { text: "  once shock resolves (FISSH trial data)\n", options: { breakLine: true } },
  ], { x: 5.1, y: 1.15, w: 4.5, h: 2.0, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "top", margin: 4 });

  // Central key message
  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 3.3, w: 9.4, h: 1.05, fill: { color: C.orange }, rectRadius: 0.1 });
  sl.addText("🎯  KEY SSC 2026 CONCEPT", { x: 0.45, y: 3.35, w: 4, h: 0.35, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
  sl.addText("Fluid bolus therapy should be TITRATED to clinical markers of cardiac output and DISCONTINUED if shock resolves OR if signs of fluid overload develop. Resuscitation end-points: MAP > age-norm, CRT ≤2s, UO >0.5 mL/kg/hr.", {
    x: 0.45, y: 3.73, w: 9.1, h: 0.55, fontSize: 11, color: C.white, fontFace: "Calibri", wrap: true, margin: 4
  });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – ANTIMICROBIALS
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "💊 Antimicrobial Therapy – Time is Tissue!", "SSC 2026: Hour-1 Bundle for Septic Shock");

  // Timeline graphic
  const timeline = [
    { t: "0 min", label: "RECOGNIZE SEPSIS", color: C.red, icon: "🚨" },
    { t: "15 min", label: "Blood Cultures\n(before antibiotics)", color: C.orange, icon: "🧫" },
    { t: "30 min", label: "Empiric Antibiotic\nORDER placed", color: C.teal, icon: "💊" },
    { t: "60 min", label: "First dose given\n(SEPTIC SHOCK)", color: C.green, icon: "✅" },
    { t: "3 hours", label: "First dose given\n(SEPSIS no shock)", color: C.navy, icon: "⏱️" },
  ];

  timeline.forEach((item, i) => {
    const x = 0.4 + i * 1.88;
    sl.addShape(pres.ShapeType.roundRect, { x, y: 1.3, w: 1.6, h: 2.2, fill: { color: item.color }, rectRadius: 0.12 });
    sl.addText(item.icon, { x, y: 1.38, w: 1.6, h: 0.5, fontSize: 22, align: "center", fontFace: "Segoe UI Emoji", margin: 0 });
    sl.addText(item.t, { x, y: 1.88, w: 1.6, h: 0.38, fontSize: 13, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0 });
    sl.addText(item.label, { x: x + 0.08, y: 2.3, w: 1.45, h: 1.1, fontSize: 9.5, color: C.white, align: "center", fontFace: "Calibri", wrap: true, margin: 0 });
  });

  // Connecting arrows
  for (let i = 0; i < 4; i++) {
    sl.addText("→", { x: 1.88 + i * 1.88, y: 2.1, w: 0.4, h: 0.4, fontSize: 20, bold: true, color: C.gray, align: "center", fontFace: "Calibri", margin: 0 });
  }

  // Bottom rules
  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 3.65, w: 9.4, h: 1.55, fill: { color: C.navy }, rectRadius: 0.1 });
  sl.addText("SSC 2026 Antibiotic Recommendations", { x: 0.45, y: 3.7, w: 9, h: 0.35, fontSize: 13, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0 });
  sl.addText([
    { text: "🔴 STRONG: ", options: { bold: true, color: C.red } },
    { text: "Start antibiotics ASAP – ideally within 1 hr for SUSPECTED SEPTIC SHOCK\n", options: { color: C.white, breakLine: true } },
    { text: "🟡 CONDITIONAL: ", options: { bold: true, color: C.yellow } },
    { text: "Sepsis without shock – within 3 hours after rapid evaluation confirms infection\n", options: { color: C.white, breakLine: true } },
    { text: "🟢 Best Practice: ", options: { bold: true, color: C.mint } },
    { text: "Blood cultures BEFORE antibiotics – but do NOT delay antibiotics to get cultures", options: { color: C.white } },
  ], { x: 0.45, y: 4.08, w: 9.1, h: 1.1, fontSize: 10.5, fontFace: "Calibri", valign: "top", margin: 4 });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – EMPIRIC ANTIBIOTIC CHOICE
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "🧫 Empiric Antibiotic Selection – Practical Guide", "Broad → Narrow: SSC 2026 Stewardship Principles");

  const abxData = [
    { setting: "Community-acquired sepsis (Infant <3 m)", choice: "Ampicillin + Gentamicin ± Cefotaxime", cover: "GBS, E.coli, Listeria, gram-negatives", color: C.teal },
    { setting: "Community-acquired sepsis (Child >3 m)", choice: "Ceftriaxone ± Vancomycin (if CNS/MRSA risk)", cover: "S.pneumoniae, N.meningitidis, H.influenzae", color: C.green },
    { setting: "Hospital-acquired / PICU / Ventilated", choice: "Pip-Tazo OR Meropenem + Vancomycin", cover: "ESKAPE organisms, MRSA, Pseudomonas", color: C.orange },
    { setting: "Immunocompromised / Post-transplant", choice: "Meropenem + Vancomycin ± Antifungal", cover: "Gram-negatives, MRSA, Fungi", color: C.red },
    { setting: "Suspected Fungal (neutropenic, TPN-dep)", choice: "Echinocandin (Caspofungin) or Fluconazole", cover: "Candida spp (check local sensitivity)", color: C.navy },
  ];

  abxData.forEach((row, i) => {
    const y = 1.3 + i * 0.78;
    sl.addShape(pres.ShapeType.rect, { x: 0.2, y, w: 0.12, h: 0.72, fill: { color: row.color } });
    sl.addShape(pres.ShapeType.roundRect, { x: 0.36, y, w: 9.4, h: 0.72, fill: { color: i % 2 === 0 ? C.lightGray : C.white }, rectRadius: 0.04 });
    sl.addText(row.setting, { x: 0.45, y: y + 0.05, w: 2.9, h: 0.3, fontSize: 10, bold: true, color: row.color, fontFace: "Calibri", margin: 0 });
    sl.addText("Choice: " + row.choice, { x: 0.45, y: y + 0.35, w: 5.4, h: 0.3, fontSize: 10, color: C.navy, fontFace: "Calibri", margin: 0 });
    sl.addText("Cover: " + row.cover, { x: 5.95, y: y + 0.05, w: 3.65, h: 0.6, fontSize: 9.5, color: C.gray, fontFace: "Calibri", italic: true, wrap: true, margin: 0 });
  });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 5.08, w: 9.6, h: 0.22, fill: { color: C.teal }, rectRadius: 0.04 });
  sl.addText("🔄 De-escalate within 24-48 hours based on cultures & clinical response – Avoid 'antibiotic collateral damage'", {
    x: 0.3, y: 5.09, w: 9.4, h: 0.2, fontSize: 9, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – CASE 2: VASOPRESSOR DECISION
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  navyBg(sl);
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.teal } });
  sl.addText("📋  CASE SCENARIO 2  –  Persistent Shock: When to Start Vasopressors?", {
    x: 0.2, y: 0.07, w: 9.6, h: 0.42, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.65, w: 9.4, h: 1.8, fill: { color: "1A2A3A" }, rectRadius: 0.12 });
  sl.addText([
    { text: "Priya, 8-year-old girl  |  20 kg  |  Urban tertiary PICU\n", options: { bold: true, color: C.yellow, breakLine: true } },
    { text: "Post-40 mL/kg fluid resuscitation over 60 min\n", options: { color: C.mint, breakLine: true } },
    { text: "\nHR 148/min  |  BP 72/44 mmHg (MAP 53 – below normal)  |  CRT 4 sec  |  SpO₂ 95% (4L O₂)\n", options: { color: C.white, breakLine: true } },
    { text: "Lung POCUS: bilateral B-lines (early fluid overload sign)\n", options: { color: C.orange, breakLine: true } },
    { text: "Echocardiogram: EF 45%, dilated LV, no effusion. Blood cultures sent. Antibiotics given at T+30 min.", options: { color: C.white } },
  ], { x: 0.45, y: 0.72, w: 9.1, h: 1.65, fontSize: 11, fontFace: "Calibri", valign: "top", wrap: true, margin: 4 });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 2.55, w: 9.4, h: 0.38, fill: { color: C.orange }, rectRadius: 0.06 });
  sl.addText("❓  Which vasopressor would you choose FIRST and why?", {
    x: 0.45, y: 2.6, w: 9.1, h: 0.28, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const opts = [
    ["A", "Dopamine 5 mcg/kg/min via PIV"],
    ["B", "Norepinephrine 0.1 mcg/kg/min via PIV (while arranging CVC)"],
    ["C", "Epinephrine 0.05 mcg/kg/min via PIV"],
    ["D", "Wait for central access before starting any vasopressor"],
  ];

  opts.forEach(([letter, text], i) => {
    const y = 3.02 + i * 0.45;
    const highlight = ["B","C"].includes(letter);
    sl.addShape(pres.ShapeType.roundRect, { x: 0.4, y, w: 9.2, h: 0.4, fill: { color: highlight ? "1A2A1A" : "0D1F2D" }, rectRadius: 0.06 });
    sl.addText(`${letter}.  ${text}`, { x: 0.55, y: y + 0.04, w: 9.0, h: 0.32, fontSize: 11, color: C.white, fontFace: "Calibri", margin: 0 });
  });

  addFooter(sl, "Interactive – Pause for audience poll | Answer on next slide");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – VASOPRESSORS
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "⚡ Vasopressors & Hemodynamic Support – SSC 2026", "Case 2 Debrief | Key Updates");

  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.28, w: 9.4, h: 0.5, fill: { color: C.teal }, rectRadius: 0.08 });
  sl.addText("✅  B & C both acceptable – NEW 2026: Insufficient evidence to prefer epinephrine OR norepinephrine as first-line", {
    x: 0.4, y: 1.33, w: 9.2, h: 0.4, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  const vasopData = [
    { drug: "Epinephrine", dose: "0.05–1 mcg/kg/min", notes: "Cold shock / myocardial depression preferred; inotropic+vasopressor; Watch tachycardia, hyperglycemia", color: C.orange },
    { drug: "Norepinephrine", dose: "0.05–1 mcg/kg/min", notes: "Warm shock / vasoplegia preferred; potent vasopressor; less chronotropy", color: C.teal },
    { drug: "Dopamine", dose: "5–20 mcg/kg/min", notes: "≥10 mcg alpha effects; 2026: no longer 'preferred first-line'; less specific receptor action; still used", color: C.gray },
    { drug: "Vasopressin", dose: "0.0003–0.002 U/kg/min", notes: "Add-on for catecholamine-resistant shock; preserves renal blood flow; 2026: conditional for refractory shock", color: C.navy },
    { drug: "Milrinone", dose: "0.25–0.75 mcg/kg/min", notes: "If myocardial dysfunction dominates; PDE inhibitor; use with norepinephrine for support", color: C.green },
  ];

  vasopData.forEach((d, i) => {
    const y = 1.88 + i * 0.66;
    sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y, w: 1.5, h: 0.6, fill: { color: d.color }, rectRadius: 0.08 });
    sl.addText(d.drug, { x: 0.35, y: y + 0.05, w: 1.4, h: 0.5, fontSize: 10.5, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0 });
    sl.addText("Dose: " + d.dose, { x: 1.9, y: y + 0.04, w: 2.5, h: 0.26, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    sl.addText(d.notes, { x: 1.9, y: y + 0.3, w: 7.95, h: 0.26, fontSize: 9.5, color: C.gray, fontFace: "Calibri", wrap: true, margin: 0 });
  });

  // PIV key point
  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 5.08, w: 9.4, h: 0.22, fill: { color: C.orange }, rectRadius: 0.04 });
  sl.addText("🆕  2026 SSC: Start vasopressors via PERIPHERAL IV – do NOT delay for central access! (Conditional, Very Low evidence)", {
    x: 0.4, y: 5.09, w: 9.2, h: 0.2, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – VENTILATION & OXYGENATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "🫁 Ventilation & Oxygenation – SSC 2026 Targets", "Oxygen is a Drug – Use Wisely");

  const ventBoxes = [
    {
      x: 0.3, title: "🎯 SpO₂ / O₂ Targets", color: C.teal, bg: C.lightBlue,
      items: ["• Target SpO₂ 92–97% (avoid hyperoxia!)", "• In neonates: 90–95%", "• Permissive hypoxemia NOT recommended", "• PaO₂/FiO₂: optimize per Phoenix score", "SSC 2026: Conditional recommendation"]
    },
    {
      x: 3.55, title: "💨 High-Flow & NIV", color: C.green, bg: "D9F2E6",
      items: ["• HFNC: First-line for mild-moderate ARDS", "• NIV (BiPAP/CPAP): Consider pre-intubation", "• Avoid prolonged NIV trial if deteriorating", "• 2026: Insufficient evidence HFNC vs NIV", "  → Use what's available & watch closely"]
    },
    {
      x: 6.8, title: "🫀 Invasive Ventilation", color: C.orange, bg: "FFF3E0",
      items: ["• TV: 5-7 mL/kg IBW (lung-protective)", "• PEEP: titrate to FiO₂ (table strategy)", "• Pplat ≤28 cmH₂O", "• Consider prone positioning in severe ARDS", "• Permissive hypercapnia: PaCO₂ 45-60 ok"]
    },
  ];

  ventBoxes.forEach(b => {
    sl.addShape(pres.ShapeType.roundRect, { x: b.x, y: 1.28, w: 3.12, h: 3.98, fill: { color: b.bg }, line: { color: b.color, width: 1.5 }, rectRadius: 0.12 });
    sl.addText(b.title, { x: b.x + 0.1, y: 1.33, w: 2.9, h: 0.4, fontSize: 12, bold: true, color: b.color, fontFace: "Calibri", margin: 0 });
    b.items.forEach((item, i) => {
      sl.addText(item, { x: b.x + 0.1, y: 1.78 + i * 0.6, w: 2.9, h: 0.55, fontSize: 10, color: C.navy, fontFace: "Calibri", wrap: true, margin: 4 });
    });
  });

  addFooter(sl, "SSC 2026 | Avoid routine intubation for hemodynamics alone – address the cause first!");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – STEROIDS & ADJUNCTS
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  lightBg(sl);
  addTitleBar(sl, "💉 Adjunctive Therapies – SSC 2026 Updates", "Steroids | Glucose | IVIG | Nutrition");

  const adjData = [
    {
      title: "🧪 Corticosteroids", icon: "💉", color: C.orange,
      text: "UPDATED 2026:\n• Septic shock UNRESPONSIVE to fluids + vasopressors\n→ Hydrocortisone 50 mg/m²/day (or 2 mg/kg/day) continuous infusion\n• Do NOT use routine steroids for all sepsis\n• Unclear if bolus vs continuous better → either acceptable\nStrength: Conditional | Evidence: Low"
    },
    {
      title: "🍬 Glucose Management", icon: "🩸", color: C.teal,
      text: "2026 RECOMMENDATION:\n• Target glucose: 72–180 mg/dL (4–10 mmol/L)\n• Avoid hypoglycemia (BG <72) – worse outcomes\n• Avoid severe hyperglycemia (BG >180)\n• Check BG every 1–2 hours when on insulin\n• Continuous glucose monitoring: insufficient evidence\nStrength: Conditional | Evidence: Low"
    },
    {
      title: "🩸 IVIG & Blood Products", icon: "🔬", color: C.red,
      text: "2026 UPDATES:\n• Standard IVIG: Insufficient evidence (no routine use)\n• Polyclonal IVIG: No recommendation for routine use in sepsis\n• Transfusion threshold:\n  - Hb <7 g/dL in stable sepsis → PRBC transfusion\n  - Hb <10 if myocardial ischemia/severe hypoxemia\n• Platelets: <10k prophylactic; <20k if bleeding risk\nStrength: Conditional"
    },
    {
      title: "🥗 Nutrition", icon: "🍼", color: C.green,
      text: "2026 RECOMMENDATIONS:\n• Start ENTERAL nutrition within 24–48 hrs if stable\n• Avoid PN in first 7 days if EN possible\n• No extra benefit from early PN supplementation\n• Caloric target: 45–65 kcal/kg/day (1-3 yrs)\n• Avoid overfeeding (↑ CO₂, hepatic steatosis)\n• Selenium/zinc supplementation: insufficient evidence\nStrength: Conditional | Evidence: Low"
    },
  ];

  adjData.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.25 : 5.2;
    const y = 1.3 + row * 2.1;
    sl.addShape(pres.ShapeType.roundRect, { x, y, w: 4.65, h: 1.98, fill: { color: C.white }, line: { color: d.color, width: 1.5 }, rectRadius: 0.1 });
    sl.addShape(pres.ShapeType.roundRect, { x, y, w: 4.65, h: 0.4, fill: { color: d.color }, rectRadius: 0.1 });
    sl.addShape(pres.ShapeType.rect, { x, y: y + 0.3, w: 4.65, h: 0.1, fill: { color: d.color } });
    sl.addText(d.title, { x: x + 0.1, y: y + 0.04, w: 4.45, h: 0.35, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    sl.addText(d.text, { x: x + 0.1, y: y + 0.48, w: 4.45, h: 1.42, fontSize: 9.5, color: C.navy, fontFace: "Calibri", wrap: true, valign: "top", margin: 4 });
  });

  addFooter(sl);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – CASE 3: INTERACTIVE SCENARIO (Neonatal sepsis)
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  navyBg(sl);
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.green } });
  sl.addText("📋  CASE SCENARIO 3  –  Neonatal Sepsis in a Peripheral Hospital", {
    x: 0.2, y: 0.07, w: 9.6, h: 0.42, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });

  sl.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.65, w: 9.4, h: 2.0, fill: { color: "0D1F0D" }, rectRadius: 0.12 });
  sl.addText([
    { text: "Baby Arjun, 28 days old  |  3.4 kg  |  Community Health Center (no ICU, no PICU)\n", options: { bold: true, color: C.yellow, breakLine: true } },
    { text: "\nFever since 2 days, poor feeding, decreased activity, 1 episode of seizure\n", options: { color: C.white, breakLine: true } },
    { text: "Vitals: T 38.8°C  |  HR 178/min  |  RR 62/min  |  BP 52/30 mmHg  |  SpO₂ 88% (RA)  |  CRT 6 sec\n", options: { color: C.orange, breakLine: true } },
    { text: "Bulging fontanelle  |  Lethargic  |  Umbilical stump normal  |  No skin pustules", options: { color: C.white } },
  ], { x: 0.45, y: 0.72, w: 9.1, h: 1.85, fontSize: 11, fontFace: "Calibri", valign: "top", wrap: true, margin: 4 });

  // Three question cards
  const questions = [
    { q: "Q1: Start antibiotics first OR LP first?", hint: "Blood cultures → LP → Antibiotics OR Antibiotics → LP → discuss", color: C.teal },
    { q: "Q2: Fluid bolus – Yes or No? (No ICU)", hint: "Remember SSC 2026: No bolus if no ICU + no hypotension; here there IS hypotension → carefully titrate 10mL/kg", color: C.orange },
    { q: "Q3: Which antibiotic? (Meningitis risk high)", hint: "Ampicillin + Cefotaxime (NOT Ceftriaxone in neonates – displaces bilirubin)", color: C.green },
  ];

  questions.forEach((item, i) => {
    const y = 2.75 + i * 0.88;
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  addFooter(sl, "Interactive Discussion – Engage audience before revealing answers");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 – SOURCE CONTROL & DIAGNOSTICS
// ══════════════════════════════════════════════════════════════════════════════
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  addTitleBar(sl, "🔬 Diagnostics & Source Control – SSC 2026", "Identify → Culture → Control");

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    ["🩸 Blood Cultures", "2 sets (aerobic/anaerobic) before antibiotics\n(ideally >10 mL total; from 2 different sites)"],
    ["🧫 CSF", "LP before antibiotics IF safe and no contraindication; if unsure – antibiotics first"],
    ["🔬 Biomarkers", "Procalcitonin (PCT): useful for monitoring; not for starting antibiotics\nCRP: adjunct, less specific\nLactate: prognostic; target <2 mmol/L"],
    ["🦠 Resistance screening", "MRSA nasal swab, rectal swab (ESBL/CRE) if healthcare-associated"],
  ];

  const rightItems = [
    ["⚡ Source Control Timing", "Drain/debride infectious foci ASAP after stabilization (6-12 hrs target)\nDon't delay: abscess, empyema, peritonitis, infected hardware"],
    ["🔌 Remove Infected Devices", "Strong recommendation: remove infected catheters/lines\nBalance: CVC removal vs access need – individualize"],
    ["🏥 POCUS in Sepsis (NEW)", "2026 NEW: POCUS recommended to guide resuscitation if training available\nAssess: IVC, cardiac function, B-lines (lung), effusions"],
    ["📊 Lactate-guided Resus", "Measure lactate on presentation\nTarget: normalize within 2-6 hours\nHigh lactate + normal BP = cryptic shock – treat aggressively"],
  ];

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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 – WHAT'S NEW? 2020 vs 2026 COMPARISON
// ══════════════════════════════════════════════════════════════════════════════
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    ["Topic", "2020 Guideline", "2026 Update", "Impact"],
    ["Sepsis Definition", "SIRS + infection + organ dysfunction", "Phoenix Score-based: ≥2 systems", "🔴 Major"],
    ["Fluid Bolus (no ICU)", "Limited guidance", "STRONG against bolus if no hypotension", "🔴 Major"],
    ["Fluid Type", "Crystalloids preferred", "Strong: Avoid GELATIN (new)", "🟠 Significant"],
    ["Vasopressors", "Epi or NorEpi – center preference", "Insufficient evidence: no preference stated", "🟡 Clarified"],
    ["PIV Vasopressors", "Not specifically mentioned", "NEW: Start via PIV, don't delay for CVC", "🟠 Significant"],
    ["POCUS", "Not addressed", "NEW: Recommend POCUS if resources allow", "🟢 Added"],
    ["Antibiotics (shock)", "1 hour target", "STRONG: ASAP ideally within 1 hr", "🟡 Reinforced"],
    ["Antibiotics (sepsis)", "1 hour target", "CONDITIONAL: within 3 hrs after evaluation", "🟡 Updated"],
    ["Corticosteroids", "Refractory shock", "Same – continuous vs bolus both acceptable", "🟡 Clarified"],
  ];

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  addFooter(sl, "SSC 2026 | 61 total statements: 5 Strong, 24 Conditional, 10 Good Practice | Weiss SL et al. 2026");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 – RESUSCITATION BUNDLE (1-HOUR BUNDLE)
// ══════════════════════════════════════════════════════════════════════════════
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    { time: "T=0", action: "RECOGNIZE SEPSIS / SEPTIC SHOCK", detail: "Phoenix score ≥2 in infected child\nEarly warning: tachycardia + poor perfusion + altered sensorium", color: C.red, icon: "🚨" },
    { time: "T=5m", action: "IV/IO ACCESS + LABS + CULTURES", detail: "CBC, CMP, CRP, PCT, Lactate, Blood gas\n2 blood cultures (before antibiotics if safe)", color: C.orange, icon: "🩸" },
    { time: "T=15m", action: "OXYGEN + FLUID BOLUS #1", detail: "High-flow O₂ target SpO₂ ≥92%\n10-20 mL/kg balanced crystalloid (if ICU available)", color: C.teal, icon: "💧" },
    { time: "T=30m", action: "ANTIBIOTICS – DOSE 1", detail: "Empiric broad-spectrum per protocol\nDo NOT delay for cultures if septic shock", color: C.green, icon: "💊" },
    { time: "T=45m", action: "REASSESS – SHOCK PERSISTING?", detail: "Reassess: HR, BP, CRT, UO, AVPU\nIf shock persists → vasopressors via PIV", color: C.yellow, icon: "🔄" },
    { time: "T=60m", action: "VASOPRESSORS + ESCALATE", detail: "Epinephrine or Norepinephrine 0.05 mcg/kg/min\nActivate ICU transfer / PICU referral if needed", color: C.red, icon: "⚡" },
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  addFooter(sl, "Memorize this bundle! Print it. Pin it in your ward/ER.");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 – MONITORING & END-POINTS
// ══════════════════════════════════════════════════════════════════════════════
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  addTitleBar(sl, "📊 Monitoring & Resuscitation End-Points", "SSC 2026 | Know When You Have Done Enough");

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    { label: "Heart Rate", target: "< 2 SD above mean for age", normal: "Neonate: 120-160 | Infant: 80-140 | Child: 70-120", color: C.red },
    { label: "Blood Pressure", target: "MAP ≥ 5th percentile for age", normal: "1yr: >55 | 5yr: >65 | 10yr: >70 | 15yr: >75 mmHg", color: C.orange },
    { label: "Capillary Refill", target: "≤ 2 seconds", normal: "Central CRT (sternum/forehead) preferred", color: C.teal },
    { label: "Urine Output", target: "> 0.5–1 mL/kg/hr", normal: "Insert Foley catheter early; hourly monitoring", color: C.green },
    { label: "Lactate", target: "< 2 mmol/L (or clearing ≥20% q2h)", normal: "Serial measurements; elevated = occult shock", color: C.navy },
    { label: "ScvO₂", target: "≥ 70%", normal: "CVC needed; reflects O₂ supply-demand balance", color: C.gray },
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  addFooter(sl, "Regular reassessment is THE most important intervention in sepsis management");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 20 – SPECIAL POPULATIONS
// ══════════════════════════════════════════════════════════════════════════════
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  addTitleBar(sl, "👶 Special Considerations – Neonates | Immunocompromised | Low-Resource", "SSC 2026 Population-Specific Adjustments");

  const populations = [
    {
      title: "👶 Neonates (<28 days)", color: C.teal, bg: C.lightBlue,
      points: [
        "Definition: Phoenix score same but neonatal vital norm cut-offs",
        "Fluid: Very cautious – 10 mL/kg boluses only; max 20-30 mL/kg",
        "Antibiotics: Ampicillin + Cefotaxime (NOT Ceftriaxone)",
        "GBS screen: consider penicillin if late-onset GBS",
        "Temperature regulation: radiant warmer during resus",
        "Monitor glucose every 30 min during resus",
      ]
    },
    {
      title: "🛡️ Immunocompromised", color: C.orange, bg: "FFF3E0",
      points: [
        "Broader empiric coverage (Meropenem + Vancomycin baseline)",
        "Add antifungal early (echinocandin) if prolonged neutropenia",
        "G-CSF: insufficient evidence per SSC 2026 (no routine use)",
        "IVIG: consider in primary immunodeficiency-related sepsis",
        "Lower threshold for invasive fungal disease workup",
        "Reverse isolation precautions during resus",
      ]
    },
    {
      title: "🌍 Low/Middle-Income Settings", color: C.red, bg: "FFE0DC",
      points: [
        "FEAST trial: bolus harmful without ICU → no bolus in normotensive sepsis",
        "Use available antibiotics: Ampicillin + Gentamicin still effective",
        "CPAP from nasal prongs if HFNC unavailable",
        "Dopamine still acceptable if Epi/NorEpi unavailable",
        "Focus on early recognition, antibiotics, O₂",
        "Referral pathways: prepare early, don't wait for deterioration",
      ]
    },
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 21 – 10 PEARLS FOR RESIDENTS
// ══════════════════════════════════════════════════════════════════════════════
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    "Use Phoenix Score (not SIRS) to define sepsis – KNOW the 4 domains",
    "Septic shock = sepsis + cardiovascular dysfunction (don't wait for BP to drop!)",
    "Antibiotics within 1 hour for septic shock – don't delay for cultures if shocked",
    "Fluid resuscitation: 10-20 mL/kg per bolus, reassess EVERY time, stop if fluid overload",
    "NO fluid bolus in sepsis without hypotension if no ICU (SSC 2026 STRONG recommendation)",
    "Start vasopressors via PIV – don't waste time on central line when shocked",
    "Avoid gelatin – new STRONG recommendation against gelatin in 2026",
    "Target SpO₂ 92-97% – avoid hyperoxia as aggressively as hypoxia",
    "Glucose target 72-180 mg/dL – hypoglycemia kills; check every 1-2 hrs",
    "POCUS is your friend – learn IVC, cardiac windows, B-lines; use to guide resus",
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  addFooter(sl, "Print this slide and keep it in your white coat!");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 22 – Q&A INTERACTIVE RAPID FIRE
// ══════════════════════════════════════════════════════════════════════════════
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    { q: "Q1: A 5yr child has sepsis WITHOUT hypotension in a district hospital with no ICU. Fluid bolus?", a: "A: NO bolus. Start maintenance fluids only. SSC 2026 STRONG recommendation.", color: C.teal },
    { q: "Q2: You need vasopressors urgently. No CVC yet. Action?", a: "A: Start via peripheral IV immediately – SSC 2026 NEW recommendation; arrange CVC in parallel.", color: C.green },
    { q: "Q3: Which fluid type is CONTRAINDICATED in pediatric sepsis per SSC 2026?", a: "A: GELATIN solutions – new STRONG recommendation against their use.", color: C.red },
    { q: "Q4: A 2yr child in septic shock. Which FIRST antibiotic concern?", a: "A: Broad empiric coverage within 1 hour. Draw cultures first but don't delay antibiotics.", color: C.orange },
    { q: "Q5: Phoenix Sepsis Score ≥2 = ?", a: "A: SEPSIS (requires ≥2 organ dysfunction points across 4 scored systems: resp, CVS, coag, neuro).", color: C.yellow },
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 23 – SUMMARY & CLOSING
// ══════════════════════════════════════════════════════════════════════════════
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    ["🆕", "New Phoenix Score-based definition – 4 organ systems scored"],
    ["💧", "Fluid: 10-20 mL/kg boluses (max 40-60 mL/kg) – reassess always; NO bolus without ICU if normotensive"],
    ["❌", "AVOID gelatin – strong 2026 recommendation; prefer balanced crystalloids"],
    ["⚡", "Vasopressors via PIV – don't delay. Epi or NorEpi equally acceptable as first-line"],
    ["💊", "Antibiotics: 1 hr for septic shock | 3 hrs for sepsis without shock"],
    ["🫁", "Oxygen: SpO₂ 92-97%. HFNC first-line for mild-moderate respiratory failure"],
    ["🔬", "POCUS now recommended for hemodynamic guidance – learn IVC, cardiac, lung views"],
    ["📋", "Know your bundle: Recognize → Access → O₂ → Culture → Antibiotics → Fluids → Vasopressors"],
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// ══════════════════════════════════════════════════════════════════════════════
// SAVE
// ══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/pediatric-sepsis-ppt/Pediatric_Sepsis_SSC2026_DNB_Webinar.pptx" })
  .then(() => console.log("✅ PPTX saved successfully!"))
  .catch(err => console.error("❌ Error:", err));
Running Command
cd /home/daytona/workspace/pediatric-sepsis-ppt && node build.js 2>&1
Running Command
ls -lh /home/daytona/workspace/pediatric-sepsis-ppt/
Your webinar presentation is ready!
Pediatric Sepsis SSC2026 DNB Webinar
Presentation · PPTX
What's Inside – 23 Slides

The deck is built around the SSC 2026 Pediatric Guidelines (Weiss SL et al., Pediatr Crit Care Med / Intensive Care Med, April 2026 - the very latest publication).
#	Slide	Type
1	Cover – Bold dark navy/teal/orange design	Title
2	Agenda – 8-item numbered visual menu	Overview
3	New 2026 Sepsis Definition – Old SIRS vs New Phoenix (side-by-side)	Concept
4	Phoenix Sepsis Score – Full scoring table with clinical tips	Reference
5	Case 1 – Ravi, 4yr, rural hospital, septic shock	Interactive
6	Fluid Therapy Answer – WITH ICU vs WITHOUT ICU context	Debrief
7	Which Fluid? – Crystalloid vs Albumin vs Avoid (gelatin)	Guidelines
8	Fluid Overload – When to STOP fluids, POCUS monitoring	Safety
9	Antimicrobial Timeline – Visual 0-to-3hr bundle graphic	Practical
10	Empiric Antibiotic Guide – 5 clinical scenarios	Reference
11	Case 2 – Priya, 8yr, PICU, vasopressor decision	Interactive
12	Vasopressors – All agents, doses, new PIV recommendation	Guidelines
13	Ventilation – SpO₂ targets, HFNC, lung-protective ventilation	Practical
14	Adjuncts – Steroids, glucose targets, IVIG, nutrition	Guidelines
15	Case 3 – Baby Arjun, 28-day neonate, peripheral hospital	Interactive
16	Diagnostics & Source Control – POCUS (NEW 2026), lactate	Practical
17	2020 vs 2026 Changes – Comparison table, all key updates	Summary
18	Hour-1 Bundle Checklist – 6-step visual timeline	Action
19	Monitoring & End-Points – 6 targets with age norms	Reference
20	Special Populations – Neonates, immunocompromised, low-resource	Clinical
21	Top 10 Pearls for DNB Residents – Print-worthy slide	Summary
22	Rapid Fire Q&A – 5 questions with answers revealed	Interactive
23	Final Summary + Reference	Closing
Key 2026 Updates Highlighted in the Deck

Phoenix Score replaces SIRS-based definition (validated in 3 million+ children globally)
STRONG recommendation AGAINST fluid bolus in sepsis without hypotension when no ICU available (FEAST trial)
STRONG recommendation AGAINST gelatin solutions (new 2026)
NEW: Start vasopressors via PIV - don't delay for central access
Insufficient evidence to prefer epinephrine vs norepinephrine as first-line (updated)
NEW: POCUS recommended to guide resuscitation if resources allow
Antibiotic timing: 1 hour for septic shock (Strong) | 3 hours for sepsis without shock (Conditional)
Why it’s not getting downloaded and seen ?
Running Command
ls -lh /home/daytona/workspace/pediatric-sepsis-ppt/ && file /home/daytona/works…
The file is valid (645 KB, proper ZIP/PPTX format). The issue is likely on your end. Here are the most common reasons and fixes:
Why the Download May Not Work

1. You're using this in a chat interface that doesn't support file downloads

The link I provide (/home/daytona/workspace/...) is a sandbox path - it only works if your chat interface has file download enabled. Some interfaces show the link but the download button is not active, or the platform hasn't wired up file serving.
What to do: Look for a paperclip icon, download button, or "Files" panel in the interface you're using.
2. Try right-clicking the link

If the link appears clickable, try right-click → Save link as...
3. The interface may need the file served differently

If you're on a web-based platform, the sandbox file path may not be publicly accessible. In that case, I can:
Convert to PDF and show you a preview here
Generate a shareable Google Slides-compatible version
Export the content as a structured Word document (.docx)
What would you like me to do?

A. Try regenerating and serving via a different method (PDF thumbnail preview) B. Export as a .pdf file instead (universally openable) C. The link worked - you just needed guidance on how to click it
Let me know and I'll fix it right away!
Convert to pdf
Running Command
cd /home/daytona/workspace/pediatric-sepsis-ppt && libreoffice --headless --conv…
Running Command
cp /home/daytona/workspace/pediatric-sepsis-ppt/Pediatric_Sepsis_SSC2026_DNB_Web…
Running Command
cp /tmp/sepsis.pdf /home/daytona/workspace/pediatric-sepsis-ppt/Pediatric_Sepsis…
Done! PDF is ready (298 KB, 23 slides):
Pediatric Sepsis SSC2026 DNB Webinar
PDF Document · PDF
Try clicking that link - it should open directly in your browser or prompt a download. If you still can't access it, let me know and I can try an alternative delivery method.
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