from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont
import datetime

OUTPUT = "/tmp/workspace/icu-orientation/ICU_Orientation_Report.pdf"

# ── Color Palette ──────────────────────────────────────────────────────────────
NAVY      = colors.HexColor("#0D3362")
TEAL      = colors.HexColor("#1A7B8C")
LIGHT_TEAL= colors.HexColor("#E6F4F7")
ORANGE    = colors.HexColor("#E07B39")
LIGHT_ORANGE = colors.HexColor("#FDF1E8")
GREY      = colors.HexColor("#F4F6F8")
DARK_GREY = colors.HexColor("#5A6472")
WHITE     = colors.white
LINE_GREY = colors.HexColor("#D0D7DE")

# ── Styles ─────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

title_style = ParagraphStyle(
    "TitleStyle", fontName="Helvetica-Bold", fontSize=26,
    textColor=WHITE, alignment=TA_CENTER, spaceAfter=4, leading=32
)
subtitle_style = ParagraphStyle(
    "SubtitleStyle", fontName="Helvetica", fontSize=13,
    textColor=colors.HexColor("#C8E8EF"), alignment=TA_CENTER, spaceAfter=2
)
date_style = ParagraphStyle(
    "DateStyle", fontName="Helvetica", fontSize=10,
    textColor=colors.HexColor("#A0C8D4"), alignment=TA_CENTER
)
section_header_style = ParagraphStyle(
    "SectionHeader", fontName="Helvetica-Bold", fontSize=14,
    textColor=WHITE, spaceAfter=6, spaceBefore=4, leftIndent=0
)
subsection_style = ParagraphStyle(
    "SubSection", fontName="Helvetica-Bold", fontSize=11,
    textColor=NAVY, spaceAfter=4, spaceBefore=8
)
body_style = ParagraphStyle(
    "Body", fontName="Helvetica", fontSize=9.5,
    textColor=colors.HexColor("#2C3E50"), leading=15,
    spaceAfter=5, alignment=TA_JUSTIFY
)
bullet_style = ParagraphStyle(
    "Bullet", fontName="Helvetica", fontSize=9.5,
    textColor=colors.HexColor("#2C3E50"), leading=14,
    spaceAfter=3, leftIndent=14, bulletIndent=2
)
bold_bullet_style = ParagraphStyle(
    "BoldBullet", fontName="Helvetica-Bold", fontSize=9.5,
    textColor=NAVY, leading=14, spaceAfter=2, leftIndent=14, bulletIndent=2
)
note_style = ParagraphStyle(
    "Note", fontName="Helvetica-Oblique", fontSize=8.5,
    textColor=DARK_GREY, leading=12, spaceAfter=4
)
caption_style = ParagraphStyle(
    "Caption", fontName="Helvetica-Bold", fontSize=8,
    textColor=TEAL, spaceAfter=2
)
table_header_style = ParagraphStyle(
    "TH", fontName="Helvetica-Bold", fontSize=9,
    textColor=WHITE, alignment=TA_CENTER, leading=12
)
table_cell_style = ParagraphStyle(
    "TC", fontName="Helvetica", fontSize=9,
    textColor=colors.HexColor("#2C3E50"), leading=12
)

def section_block(title, elements, color=NAVY):
    """Returns a colored section header + content list."""
    header_data = [[Paragraph(title, section_header_style)]]
    header_table = Table(header_data, colWidths=[17*cm])
    header_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING", (0,0), (-1,-1), 7),
        ("BOTTOMPADDING", (0,0), (-1,-1), 7),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4,4,4,4]),
    ]))
    return [header_table, Spacer(1, 5)] + elements + [Spacer(1, 10)]

def info_box(content_paragraphs, bg=LIGHT_TEAL, border=TEAL):
    """A light-colored callout box."""
    data = [[p] for p in content_paragraphs]
    t = Table([[Paragraph("<br/>".join([p.text if hasattr(p,'text') else "" for p in content_paragraphs]),
                          ParagraphStyle("IB", fontName="Helvetica", fontSize=9.5,
                                         textColor=colors.HexColor("#2C3E50"), leading=14,
                                         alignment=TA_JUSTIFY))]],
              colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("BOX", (0,0), (-1,-1), 1, border),
        ("TOPPADDING", (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
    ]))
    return t

def make_table(headers, rows, col_widths):
    header_row = [Paragraph(h, table_header_style) for h in headers]
    data = [header_row]
    for row in rows:
        data.append([Paragraph(str(c), table_cell_style) for c in row])
    t = Table(data, colWidths=col_widths)
    style = [
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, GREY]),
        ("GRID", (0,0), (-1,-1), 0.5, LINE_GREY),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]
    t.setStyle(TableStyle(style))
    return t


# ── Document Setup ─────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2.2*cm,
    title="ICU Orientation Report",
    author="Orris Clinical Education",
    subject="Intensive Care Unit Orientation for Students and Trainees"
)

story = []

# ══════════════════════════════════════════════════════════════════════════════
# COVER PAGE
# ══════════════════════════════════════════════════════════════════════════════
cover_title_data = [
    [Paragraph("INTENSIVE CARE UNIT", title_style)],
    [Paragraph("Orientation Report", subtitle_style)],
    [Spacer(1, 4)],
    [Paragraph("For Students &amp; Trainees", subtitle_style)],
    [Spacer(1, 8)],
    [Paragraph("Date: July 15, 2026", date_style)],
]
cover_table = Table(cover_title_data, colWidths=[17*cm])
cover_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), NAVY),
    ("TOPPADDING", (0,0), (-1,-1), 18),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING", (0,0), (-1,-1), 16),
    ("RIGHTPADDING", (0,0), (-1,-1), 16),
    ("ROUNDEDCORNERS", [8,8,8,8]),
]))
story.append(Spacer(1, 1.5*cm))
story.append(cover_table)
story.append(Spacer(1, 0.8*cm))

# Objective box
story.append(info_box([
    Paragraph(
        "<b>Purpose of This Report:</b> This orientation document is designed to equip medical students "
        "and trainees entering the Intensive Care Unit (ICU) with a structured overview of the unit's "
        "physical environment, multidisciplinary team roles, essential monitoring principles, mechanical "
        "ventilation fundamentals, common vasoactive infusions, and key emergency protocols. "
        "It is intended as a practical reference companion during the first weeks of ICU rotation.",
        body_style
    )
]))
story.append(Spacer(1, 0.5*cm))

# Table of Contents
toc_data = [
    [Paragraph("<b>CONTENTS</b>", ParagraphStyle("TOCH", fontName="Helvetica-Bold", fontSize=11, textColor=NAVY))],
    [Paragraph("1. ICU Overview &amp; Physical Environment", body_style)],
    [Paragraph("2. ICU Team Roles &amp; Organizational Structure", body_style)],
    [Paragraph("3. Admission Criteria &amp; Triage", body_style)],
    [Paragraph("4. Essential Monitoring in the ICU", body_style)],
    [Paragraph("5. Mechanical Ventilation Fundamentals", body_style)],
    [Paragraph("6. Common ICU Drips &amp; Vasoactive Agents", body_style)],
    [Paragraph("7. Sepsis &amp; Septic Shock: Recognition &amp; Management", body_style)],
    [Paragraph("8. ARDS: Recognition &amp; Ventilator Strategy", body_style)],
    [Paragraph("9. Common ICU Emergencies &amp; Key Protocols", body_style)],
    [Paragraph("10. Communication, Safety &amp; Trainee Expectations", body_style)],
]
toc_table = Table(toc_data, colWidths=[17*cm])
toc_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), LIGHT_TEAL),
    ("GRID", (0,0), (-1,-1), 0.3, LINE_GREY),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 10),
]))
story.append(toc_table)
story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 1 - ICU OVERVIEW
# ══════════════════════════════════════════════════════════════════════════════
s1_content = [
    Paragraph(
        "The Intensive Care Unit (ICU) is a specialized hospital ward designed to provide concentrated "
        "monitoring and treatment for patients with life-threatening conditions. Though critical care can "
        "technically be delivered anywhere in the hospital, the ICU provides a dedicated environment that "
        "enables continuous surveillance and rapid intervention by a multidisciplinary team.",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>Common features of all modern ICUs include:</b>", subsection_style),
    Paragraph("- A designated, geographically defined space with controlled access", bullet_style),
    Paragraph("- Specialized monitoring and therapeutic capabilities (invasive hemodynamic monitoring, ventilators, dialysis, ECMO)", bullet_style),
    Paragraph("- Resources to provide continuous 24/7 care", bullet_style),
    Paragraph("- Appropriate staffing with a reduced nurse-to-patient ratio (typically 1:1 or 1:2)", bullet_style),
    Spacer(1, 6),
    Paragraph("<b>ICU Types You May Encounter:</b>", subsection_style),
    make_table(
        ["ICU Type", "Primary Patient Population", "Key Specialties"],
        [
            ["Medical ICU (MICU)", "Sepsis, respiratory failure, metabolic emergencies", "Internal medicine, pulmonology, nephrology"],
            ["Surgical ICU (SICU)", "Post-operative major surgery, trauma", "Surgery, anesthesia"],
            ["Cardiac ICU (CICU)", "Acute MI, heart failure, arrhythmias, post-cardiac surgery", "Cardiology, cardiac surgery"],
            ["Neuro ICU (NICU)", "Stroke, TBI, post-neurosurgery, status epilepticus", "Neurology, neurosurgery"],
            ["Pediatric ICU (PICU)", "Critically ill children", "Pediatrics, pediatric surgery"],
        ],
        [4*cm, 6*cm, 7*cm]
    ),
    Spacer(1, 8),
    Paragraph(
        "<i>Source: Mulholland and Greenfield's Surgery: Scientific Principles and Practice, 7e</i>",
        note_style
    ),
]
story += section_block("1. ICU OVERVIEW & PHYSICAL ENVIRONMENT", s1_content, NAVY)

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 2 - TEAM ROLES
# ══════════════════════════════════════════════════════════════════════════════
s2_content = [
    Paragraph(
        "The ICU is driven by a multidisciplinary team. Understanding each member's role is essential "
        "for effective communication and safe patient care during your rotation.",
        body_style
    ),
    Spacer(1, 4),
    make_table(
        ["Team Member", "Role & Responsibilities"],
        [
            ["Intensivist (Attending)", "Leads daily rounds; responsible for all major clinical decisions; supervises trainees. In a closed ICU, they are the primary physician."],
            ["Fellow / Senior Resident", "Oversees day-to-day management; supervises junior trainees; first point of escalation after hours."],
            ["Intern / Junior Trainee", "Takes admissions, writes notes, performs procedures under supervision, presents on rounds."],
            ["ICU Nurse (1:1 or 1:2)", "Continuous bedside monitoring; medication administration; hourly assessments; first to identify acute changes."],
            ["Respiratory Therapist (RT)", "Manages ventilators, ABG sampling, weaning trials, nebulization, and airway care."],
            ["Clinical Pharmacist", "Medication reconciliation, dose optimization, drug interaction review, antibiotic stewardship."],
            ["Dietician / Nutritionist", "Nutrition assessment, calorie/protein targets, enteral/parenteral feeding orders."],
            ["Physiotherapist", "Early mobilization, chest physiotherapy, ventilator weaning support."],
            ["Social Worker", "Family support, discharge planning, ethics consultations."],
        ],
        [4.5*cm, 12.5*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Staffing Models:</b>", subsection_style),
    Paragraph(
        "<b>Open ICU:</b> Primary team (medical/surgical) admits and manages the patient; may consult intensivist. "
        "Provides continuity but dilutes ICU-focused care.",
        bullet_style
    ),
    Paragraph(
        "<b>Closed ICU:</b> Care is transferred entirely to an intensivist team. Associated with improved guideline adherence, "
        "shorter ICU stay, and better outcomes. Recommended ratio: 1 intensivist to max 14 patients.",
        bullet_style
    ),
    Paragraph(
        "<b>Hybrid Model:</b> Mandatory intensivist consultation alongside the admitting team.",
        bullet_style
    ),
    Spacer(1, 4),
    Paragraph(
        "<i>Source: Mulholland and Greenfield's Surgery: Scientific Principles and Practice, 7e</i>",
        note_style
    ),
]
story += section_block("2. ICU TEAM ROLES & ORGANIZATIONAL STRUCTURE", s2_content, TEAL)

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 3 - ADMISSION CRITERIA
# ══════════════════════════════════════════════════════════════════════════════
s3_content = [
    Paragraph(
        "Not all critically ill patients need a formal ICU bed; some may be managed in intermediate care or "
        "high-dependency units (HDU). Triage decisions should be based on clinical status, acuity, and available resources.",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>General ICU Admission Indications:</b>", subsection_style),
    Paragraph("- Acute respiratory failure requiring ventilatory support (invasive or non-invasive)", bullet_style),
    Paragraph("- Hemodynamic instability requiring vasoactive agents (e.g., septic shock, cardiogenic shock)", bullet_style),
    Paragraph("- Decreased level of consciousness (GCS ≤ 8) at risk of airway compromise", bullet_style),
    Paragraph("- Acute organ failure: renal (requiring CRRT), hepatic failure, multi-organ dysfunction", bullet_style),
    Paragraph("- Post-cardiac arrest resuscitation and targeted temperature management", bullet_style),
    Paragraph("- Life-threatening arrhythmias or acute coronary syndromes with instability", bullet_style),
    Paragraph("- Major trauma with physiologic compromise", bullet_style),
    Paragraph("- High-risk post-operative monitoring (cardiac surgery, major abdominal surgery)", bullet_style),
    Spacer(1, 6),
    Paragraph("<b>ICU Triage Priorities:</b>", subsection_style),
    make_table(
        ["Priority", "Description", "Examples"],
        [
            ["Priority 1", "Unstable - requires immediate ICU level care", "Intubated patients, septic shock on vasopressors"],
            ["Priority 2", "At high risk of deterioration - intensive monitoring needed", "Post-cardiac surgery, post-thrombolysis"],
            ["Priority 3", "Unstable with limited chance of recovery or ICU benefit", "Terminal malignancy with acute illness"],
            ["Priority 4", "Does not require ICU care (too well or too ill)", "Minor illness; comfort-focused only care"],
        ],
        [2.5*cm, 7*cm, 7.5*cm]
    ),
]
story += section_block("3. ADMISSION CRITERIA & TRIAGE", s3_content, colors.HexColor("#1E5F74"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 4 - MONITORING
# ══════════════════════════════════════════════════════════════════════════════
s4_content = [
    Paragraph(
        "Every ICU patient requires a minimum set of continuous monitoring. As a trainee, you must be able to "
        "interpret these parameters and recognize abnormal trends.",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>Standard Monitoring in All ICU Patients:</b>", subsection_style),
    make_table(
        ["Parameter", "Method", "Normal Range / Target"],
        [
            ["Heart Rate", "Continuous ECG", "60-100 bpm"],
            ["Rhythm", "Continuous 5-lead ECG", "Sinus rhythm; identify arrhythmias"],
            ["Blood Pressure", "Non-invasive (NIBP) q1-4h or continuous arterial line", "MAP > 65 mmHg in shock states"],
            ["SpO2", "Pulse oximetry (continuous)", "≥ 94% (or per disease protocol)"],
            ["Respiratory Rate", "Continuous or q1h nursing assessment", "12-20 breaths/min"],
            ["Temperature", "Core (rectal, bladder, or esophageal)", "36-38°C"],
            ["Urine Output", "Urinary catheter (hourly)", "≥ 0.5 mL/kg/hr"],
            ["End-tidal CO2 (EtCO2)", "Capnography (intubated patients)", "35-45 mmHg"],
            ["Arterial Blood Gas (ABG)", "Arterial line sample or radial puncture", "pH 7.35-7.45; PaO2 >80 mmHg; PaCO2 35-45"],
        ],
        [4*cm, 5.5*cm, 7.5*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Advanced Hemodynamic Monitoring:</b>", subsection_style),
    Paragraph(
        "- <b>Arterial Line (A-line):</b> Continuous BP monitoring; allows frequent ABG sampling without repeated punctures. "
        "Commonly placed in the radial artery. Waveform dampening or over-damping must be identified and corrected.",
        bullet_style
    ),
    Paragraph(
        "- <b>Central Venous Catheter (CVC):</b> Measures central venous pressure (CVP); route for vasoactive drugs, TPN, "
        "and medications unsuitable for peripheral lines. Normal CVP: 2-8 mmHg.",
        bullet_style
    ),
    Paragraph(
        "- <b>Pulmonary Artery Catheter (PAC/Swan-Ganz):</b> Measures pulmonary artery pressures, cardiac output/index, "
        "and mixed venous oxygen saturation (SvO2). Now used selectively - avoid routine use in ARDS.",
        bullet_style
    ),
    Paragraph(
        "- <b>Bedside Echocardiography (POCUS):</b> Increasingly used at the bedside for rapid assessment of cardiac function, "
        "preload status, and pericardial effusion. Trainees should recognize key POCUS views.",
        bullet_style
    ),
    Paragraph(
        "- <b>Serum Lactate:</b> A biochemical marker of tissue hypoperfusion. Serial lactate measurements guide resuscitation "
        "adequacy. Lactate > 2 mmol/L is abnormal; > 4 mmol/L = high risk for mortality in sepsis.",
        bullet_style
    ),
]
story += section_block("4. ESSENTIAL MONITORING IN THE ICU", s4_content, NAVY)

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 5 - MECHANICAL VENTILATION
# ══════════════════════════════════════════════════════════════════════════════
s5_content = [
    Paragraph(
        "Mechanical ventilation is one of the most common and complex interventions in the ICU. "
        "The primary goal is to ensure adequate oxygenation and CO2 elimination while minimizing ventilator-induced lung injury (VILI).",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>Key Ventilator Parameters:</b>", subsection_style),
    make_table(
        ["Parameter", "Description", "Typical Starting Value"],
        [
            ["FiO2", "Fraction of inspired oxygen", "Start 1.0 (100%); wean to maintain SpO2 ≥94%"],
            ["Tidal Volume (Vt)", "Volume per breath delivered", "6 mL/kg of ideal body weight (IBW) - lung protective"],
            ["Respiratory Rate (RR)", "Machine-set breaths per minute", "14-18 breaths/min; adjust for PaCO2"],
            ["PEEP", "Positive end-expiratory pressure - keeps alveoli open", "5-8 cmH2O standard; higher in ARDS"],
            ["Plateau Pressure (Pplat)", "Reflects alveolar pressure", "Keep ≤ 30 cmH2O"],
            ["Driving Pressure", "Pplat - PEEP", "Target < 15 cmH2O in ARDS"],
            ["I:E Ratio", "Inspiratory to expiratory time ratio", "1:2 standard; may adjust"],
        ],
        [3.5*cm, 6*cm, 7.5*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Common Ventilation Modes:</b>", subsection_style),
    Paragraph(
        "<b>Assist-Control (AC/CMV):</b> Machine delivers a set number of breaths; patient can trigger additional breaths "
        "which are supported to the full set volume/pressure. Most common mode for initial ventilation.",
        bullet_style
    ),
    Paragraph(
        "<b>SIMV (Synchronized Intermittent Mandatory Ventilation):</b> Machine delivers mandatory breaths; patient can "
        "breathe spontaneously between them. Less commonly used now.",
        bullet_style
    ),
    Paragraph(
        "<b>Pressure Support Ventilation (PSV):</b> Patient initiates all breaths; machine provides a pressure boost. "
        "Used during weaning trials.",
        bullet_style
    ),
    Paragraph(
        "<b>CPAP:</b> Continuous positive airway pressure without mandatory breaths. Used in weaning and for sleep apnea.",
        bullet_style
    ),
    Spacer(1, 6),
    Paragraph("<b>Ventilator-Induced Lung Injury (VILI) - Key Mechanisms:</b>", subsection_style),
    make_table(
        ["Mechanism", "Cause", "Prevention"],
        [
            ["Barotrauma", "Excess airway pressure", "Limit plateau pressure ≤ 30 cmH2O"],
            ["Volutrauma", "Alveolar overdistension from high volumes", "Use 6 mL/kg IBW tidal volumes"],
            ["Atelectrauma", "Repeated collapse/re-expansion of alveoli", "Adequate PEEP to maintain recruitment"],
            ["Biotrauma", "Release of inflammatory mediators", "Lung-protective ventilation strategy"],
        ],
        [3.5*cm, 6*cm, 7.5*cm]
    ),
    Spacer(1, 6),
    Paragraph("<b>Weaning from Mechanical Ventilation:</b>", subsection_style),
    Paragraph("Daily assessment using the following criteria before attempting a Spontaneous Breathing Trial (SBT):", body_style),
    Paragraph("- Cause of respiratory failure is improving or resolved", bullet_style),
    Paragraph("- FiO2 ≤ 0.4-0.5 with SpO2 ≥ 92%", bullet_style),
    Paragraph("- PEEP ≤ 5-8 cmH2O", bullet_style),
    Paragraph("- Patient awake, cooperative, following commands", bullet_style),
    Paragraph("- Hemodynamically stable, not on or on low vasopressor support", bullet_style),
    Paragraph("- Secretions manageable and cough adequate", bullet_style),
    Spacer(1,4),
    Paragraph(
        "<i>Sources: Current Surgical Therapy 14e; Goldman-Cecil Medicine; Miller's Anesthesia 10e</i>",
        note_style
    ),
]
story += section_block("5. MECHANICAL VENTILATION FUNDAMENTALS", s5_content, TEAL)

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 6 - ICU DRIPS
# ══════════════════════════════════════════════════════════════════════════════
s6_content = [
    Paragraph(
        "Vasoactive and sedative infusions are the backbone of ICU hemodynamic and comfort management. "
        "Know the mechanism, indication, and key monitoring parameters for each agent.",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>Vasoactive Agents (Vasopressors &amp; Inotropes):</b>", subsection_style),
    make_table(
        ["Agent", "Receptor", "Primary Use", "Key Notes"],
        [
            ["Norepinephrine", "α1 >> β1", "First-line vasopressor in septic shock", "Target MAP ≥ 65 mmHg; can cause peripheral ischemia"],
            ["Vasopressin", "V1 receptors", "Add-on to NE; spares catecholamines", "Fixed dose 0.03-0.04 U/min; do not titrate alone"],
            ["Epinephrine", "α1, β1, β2", "Anaphylaxis; refractory shock; cardiac arrest", "Increases lactate; monitor for tachyarrhythmias"],
            ["Dobutamine", "β1 >> β2", "Low cardiac output state (cardiogenic shock)", "Can cause hypotension; use with vasopressor"],
            ["Dopamine", "Dopamine, β1, α1 (dose-dependent)", "Rarely used; selected bradycardia + hypotension", "Higher arrhythmia risk; avoid in most sepsis"],
            ["Phenylephrine", "α1 only", "Distributive shock; perioperative hypotension", "No inotropic effect; pure vasoconstrictor"],
            ["Milrinone", "PDE-3 inhibitor", "Cardiac failure + pulmonary hypertension", "Vasodilatory; use with caution in hypotension"],
        ],
        [3*cm, 2.5*cm, 4.5*cm, 7*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Sedation &amp; Analgesia in the ICU:</b>", subsection_style),
    Paragraph(
        "Use the ABCDEF bundle (Assess, Both SAT &amp; SBT, Choice of sedation, Delirium, Early mobility, Family engagement). "
        "Target the lightest level of sedation possible using validated scales (RASS, CAM-ICU).",
        body_style
    ),
    make_table(
        ["Agent", "Class", "Indication", "Key Notes"],
        [
            ["Propofol", "Alkylphenol (IV anesthetic)", "Short-term sedation; status epilepticus", "Watch for propofol infusion syndrome (PRIS) with high doses/prolonged use"],
            ["Midazolam", "Benzodiazepine", "Procedural sedation; alcohol withdrawal", "Accumulates; associated with delirium; avoid long-term infusion"],
            ["Dexmedetomidine", "Alpha-2 agonist", "ICU sedation; CAM-ICU score reduction", "Arousable sedation; bradycardia risk; preferred over BZD"],
            ["Morphine / Fentanyl", "Opioid analgesic", "Pain control in mechanically ventilated patients", "Fentanyl preferred in hemodynamic instability and renal failure"],
            ["Ketamine", "NMDA antagonist", "Procedural sedation; bronchospasm; pain", "Preserves airway reflexes; bronchodilator; dissociative"],
        ],
        [3*cm, 3*cm, 4*cm, 7*cm]
    ),
    Spacer(1, 4),
    Paragraph(
        "<i>Sources: Barash Clinical Anesthesia 9e; Goldman-Cecil Medicine</i>",
        note_style
    ),
]
story += section_block("6. COMMON ICU DRIPS & VASOACTIVE AGENTS", s6_content, colors.HexColor("#1E5F74"))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 7 - SEPSIS
# ══════════════════════════════════════════════════════════════════════════════
s7_content = [
    Paragraph(
        "Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. "
        "Septic shock is a subset with circulatory, cellular, and metabolic abnormalities. "
        "Early recognition and bundle compliance saves lives.",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>Sepsis-3 Definitions (2016):</b>", subsection_style),
    Paragraph(
        "<b>Sepsis:</b> Life-threatening organ dysfunction (SOFA score increase ≥ 2) caused by a dysregulated host response to infection.",
        bullet_style
    ),
    Paragraph(
        "<b>Septic Shock:</b> Sepsis + vasopressor requirement to maintain MAP ≥ 65 mmHg AND lactate > 2 mmol/L despite adequate fluid resuscitation.",
        bullet_style
    ),
    Paragraph(
        "<b>qSOFA Screening (bedside):</b> RR ≥ 22, Altered mentation, SBP ≤ 100 - if 2+ criteria met, assess for sepsis.",
        bullet_style
    ),
    Spacer(1, 6),
    Paragraph("<b>Sepsis Hour-1 Bundle:</b>", subsection_style),
    make_table(
        ["Time", "Action"],
        [
            ["Immediate", "Measure serum lactate (repeat if initial lactate >2 mmol/L)"],
            ["Immediate", "Obtain blood cultures x2 (aerobic + anaerobic) BEFORE antibiotics"],
            ["Within 1 hour", "Administer empiric broad-spectrum IV antibiotics"],
            ["Within 1-3 hours", "Crystalloid resuscitation: 30 mL/kg IV bolus for hypotension or lactate ≥4 mmol/L"],
            ["Within 1 hour", "Start vasopressors (norepinephrine) if MAP <65 mmHg despite initial fluids"],
        ],
        [3.5*cm, 13.5*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Vasopressor Hierarchy in Septic Shock:</b>", subsection_style),
    Paragraph("1. <b>Norepinephrine</b> - first-line; target MAP ≥ 65 mmHg", bullet_style),
    Paragraph("2. <b>Add Vasopressin</b> 0.03 U/min when NE dose reaches 0.25-0.5 mcg/kg/min", bullet_style),
    Paragraph("3. <b>Epinephrine</b> - if shock persists despite NE + Vasopressin", bullet_style),
    Paragraph("4. <b>Corticosteroids</b> (hydrocortisone 200 mg/day) if shock refractory to vasopressors", bullet_style),
    Spacer(1, 4),
    Paragraph(
        "<i>Source: Barash Clinical Anesthesia 9e - Table 57-4: Management of Sepsis and Septic Shock</i>",
        note_style
    ),
]
story += section_block("7. SEPSIS & SEPTIC SHOCK: RECOGNITION & MANAGEMENT", s7_content, NAVY)

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 8 - ARDS
# ══════════════════════════════════════════════════════════════════════════════
s8_content = [
    Paragraph(
        "ARDS is the abrupt onset of diffuse lung injury characterized by severe hypoxemia and bilateral "
        "pulmonary infiltrates not explained by left-sided cardiac failure. Annual incidence is approximately "
        "80 cases per 100,000 adults in the US, with higher frequency in ICUs.",
        body_style
    ),
    Spacer(1, 4),
    Paragraph("<b>Berlin Definition of ARDS (Severity by P/F Ratio):</b>", subsection_style),
    make_table(
        ["Severity", "PaO2/FiO2 (P/F Ratio)", "PEEP Requirement", "Approximate Mortality"],
        [
            ["Mild", "200-300 mmHg", "≥ 5 cmH2O", "~27%"],
            ["Moderate", "100-200 mmHg", "≥ 5 cmH2O", "~32%"],
            ["Severe", "< 100 mmHg", "≥ 5 cmH2O", "~45%"],
        ],
        [3*cm, 4.5*cm, 4*cm, 5.5*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Common Triggers:</b>", subsection_style),
    Paragraph(
        "<b>Direct (pulmonary):</b> Pneumonia, aspiration, smoke inhalation, pulmonary contusion",
        bullet_style
    ),
    Paragraph(
        "<b>Indirect (extrapulmonary):</b> Sepsis from non-pulmonary source, severe trauma, "
        "pancreatitis, massive transfusions",
        bullet_style
    ),
    Spacer(1, 6),
    Paragraph("<b>Lung-Protective Ventilation Strategy for ARDS:</b>", subsection_style),
    Paragraph("- Low tidal volume: <b>6 mL/kg IBW</b> (may go to 4 mL/kg in severe ARDS)", bullet_style),
    Paragraph("- Plateau pressure: <b>≤ 30 cmH2O</b>", bullet_style),
    Paragraph("- Driving pressure: <b>&lt; 15 cmH2O</b> (Pplat minus PEEP)", bullet_style),
    Paragraph("- PEEP: Higher PEEP strategies for moderate-severe ARDS (titrate by oxygenation)", bullet_style),
    Paragraph("- <b>Prone positioning:</b> ≥ 12 hours/day in moderate-severe ARDS - reduces mortality", bullet_style),
    Paragraph("- <b>Neuromuscular blockade (NMB):</b> Facilitates prone positioning; use intermittent bolus preferred", bullet_style),
    Paragraph("- <b>ECMO:</b> Consider in severe ARDS failing conventional ventilation (at experienced centers)", bullet_style),
    Spacer(1, 4),
    Paragraph(
        "<i>Source: Goldman-Cecil Medicine International Edition; Murray & Nadel's Textbook of Respiratory Medicine</i>",
        note_style
    ),
]
story += section_block("8. ARDS: RECOGNITION & VENTILATOR STRATEGY", s8_content, TEAL)

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 9 - ICU EMERGENCIES
# ══════════════════════════════════════════════════════════════════════════════
s9_content = [
    Paragraph(
        "As a trainee in the ICU, you must recognize and initiate the response to the following common emergencies. "
        "Always call for senior help early - early escalation is expected and encouraged.",
        body_style
    ),
    Spacer(1, 6),
    make_table(
        ["Emergency", "Key Recognition", "Immediate Action"],
        [
            ["Cardiac Arrest (PEA/VF/VT/Asystole)",
             "Pulseless, unresponsive, no normal breathing",
             "Start CPR immediately, call code team, attach defibrillator, follow ACLS algorithm"],
            ["Acute Respiratory Failure / Desaturation",
             "SpO2 drop, tachypnea, increased work of breathing, altered mentation",
             "Increase FiO2, check tube position, suction airway, call RT, consider re-intubation"],
            ["Tension Pneumothorax",
             "Hypoxia + hypotension + absent breath sounds + tracheal deviation",
             "Immediate needle decompression 2nd ICS MCL, then chest tube"],
            ["Accidental Extubation",
             "Loss of EtCO2 waveform, patient vocalizing, air leak",
             "Apply BVM with 100% O2, call for re-intubation, prepare airway trolley"],
            ["Ventilator Alarm - High Pressure",
             "Peak pressure alarm, patient desaturating/distressed",
             "DOPE: Displacement, Obstruction, Pneumothorax, Equipment failure - assess in order"],
            ["Anaphylaxis",
             "Urticaria, angioedema, hypotension, bronchospasm after trigger",
             "Epinephrine 0.5 mg IM (or IV in arrest), fluids, antihistamines, stop trigger"],
            ["Hypertensive Emergency",
             "SBP > 180-220 with acute end-organ damage (headache, chest pain, AKI)",
             "IV labetalol or nicardipine; avoid excessive rapid correction"],
            ["Acute Arrhythmia",
             "Sudden HR change on monitor, hemodynamic compromise",
             "Unstable (hypotension/altered LOC): synchronized cardioversion. Stable: pharmacologic per ACLS"],
        ],
        [3.5*cm, 5.5*cm, 8*cm]
    ),
    Spacer(1, 6),
    info_box([Paragraph(
        "<b>DOPE Mnemonic for Acute Ventilator Deterioration:</b><br/>"
        "<b>D</b> - Displacement of tube (check ETT position, CXR)<br/>"
        "<b>O</b> - Obstruction of tube (suction; check for kinks or biting)<br/>"
        "<b>P</b> - Pneumothorax (check breath sounds bilaterally)<br/>"
        "<b>E</b> - Equipment failure (disconnect from ventilator; bag manually)",
        body_style
    )], bg=LIGHT_ORANGE, border=ORANGE),
]
story += section_block("9. COMMON ICU EMERGENCIES & KEY PROTOCOLS", s9_content, colors.HexColor("#1E5F74"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 10 - COMMUNICATION, SAFETY & TRAINEE EXPECTATIONS
# ══════════════════════════════════════════════════════════════════════════════
s10_content = [
    Paragraph("<b>Daily ICU Rounds Structure:</b>", subsection_style),
    Paragraph(
        "ICU rounds are multidisciplinary. As a trainee, you are expected to present your patient concisely "
        "in a systematic head-to-toe format, propose a problem list, and suggest a management plan.",
        body_style
    ),
    Paragraph("A standard ICU patient presentation follows the FASTHUG mnemonic:", body_style),
    Spacer(1, 4),
    make_table(
        ["Letter", "Domain", "Key Questions"],
        [
            ["F", "Feeding", "Is the patient on enteral/parenteral nutrition? Meeting caloric targets?"],
            ["A", "Analgesia", "Pain score (NRS or CPOT)? Is analgesic adequate and appropriate?"],
            ["S", "Sedation", "RASS target? Is current sedation level appropriate? Daily SAT done?"],
            ["T", "Thromboembolic prophylaxis", "On heparin/LMWH or SCDs? Contraindications documented?"],
            ["H", "Head of bed elevation", "HOB at 30-45 degrees to prevent VAP?"],
            ["U", "Ulcer prophylaxis", "On PPI or H2 blocker? Is it still indicated?"],
            ["G", "Glucose control", "Blood glucose within target range (140-180 mg/dL)? Insulin protocol?"],
        ],
        [1.5*cm, 4*cm, 11.5*cm]
    ),
    Spacer(1, 8),
    Paragraph("<b>Communication Principles:</b>", subsection_style),
    Paragraph("- Use SBAR (Situation, Background, Assessment, Recommendation) for all clinical communications and escalations", bullet_style),
    Paragraph("- Closed-loop communication during emergencies - repeat back orders aloud to confirm", bullet_style),
    Paragraph("- Document all procedures, assessments, and communications promptly in the medical record", bullet_style),
    Paragraph("- Family communication: involve family early, update daily, involve social work and palliative care as needed", bullet_style),
    Spacer(1, 8),
    Paragraph("<b>Safety Culture in the ICU:</b>", subsection_style),
    Paragraph("- Speak up: If something looks wrong, say so - patient safety takes precedence over hierarchy", bullet_style),
    Paragraph("- Hand hygiene: Before and after every patient contact - the ICU has the highest rates of healthcare-associated infections", bullet_style),
    Paragraph("- Central line care bundles: Daily assessment of line necessity, sterile technique for insertion", bullet_style),
    Paragraph("- Ventilator-Associated Pneumonia (VAP) bundle: HOB elevation, daily SAT/SBT, oral care, subglottic suctioning", bullet_style),
    Paragraph("- Catheter-associated UTI (CAUTI) prevention: Remove urinary catheters as early as possible", bullet_style),
    Spacer(1, 8),
    Paragraph("<b>Trainee Expectations During ICU Rotation:</b>", subsection_style),
    make_table(
        ["Expectation", "Detail"],
        [
            ["Punctuality", "Arrive before rounds; pre-round review of your assigned patients"],
            ["Preparation", "Know your patient's history, active issues, trends in vitals, recent labs/imaging"],
            ["Procedures", "Observe and assist: IV cannulation, ABG, nasogastric tube, urinary catheter, wound care"],
            ["Supervised Procedures", "Central line insertion, arterial line, intubation - observe first, assist next, perform under supervision"],
            ["Logbook", "Document all procedures and clinical encounters for portfolio evidence"],
            ["Self-directed learning", "Read about each patient's primary diagnosis; attend teaching sessions"],
            ["Professionalism", "Respect patient privacy, team hierarchy, and institutional policies at all times"],
        ],
        [4*cm, 13*cm]
    ),
    Spacer(1, 8),
    info_box([Paragraph(
        "<b>Key Resources for ICU Trainees:</b><br/>"
        "- <b>Surviving Sepsis Campaign Guidelines</b> (sccm.org)<br/>"
        "- <b>ACLS Provider Manual</b> (American Heart Association)<br/>"
        "- <b>ICU Delirium &amp; CAM-ICU Assessment</b> (icudelirium.org)<br/>"
        "- <b>ARDSNet Protocol</b> for lung-protective ventilation<br/>"
        "- <b>SCCM ABCDEF Bundle</b> for ICU liberation",
        body_style
    )], bg=LIGHT_TEAL, border=TEAL),
]
story += section_block("10. COMMUNICATION, SAFETY & TRAINEE EXPECTATIONS", s10_content, NAVY)

# Footer note
story.append(Spacer(1, 1*cm))
story.append(HRFlowable(width="100%", thickness=1, color=LINE_GREY))
story.append(Spacer(1, 4))
story.append(Paragraph(
    "<i>This orientation report is compiled from authoritative medical textbooks including Mulholland &amp; Greenfield's Surgery 7e, "
    "Goldman-Cecil Medicine, Barash Clinical Anesthesia 9e, Current Surgical Therapy 14e, Murray &amp; Nadel's Respiratory Medicine, "
    "and Miller's Anesthesia 10e. It is intended as an educational orientation guide for students and trainees and does not replace "
    "institutional protocols or clinical judgment.</i>",
    note_style
))

# ── Build ──────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")