respiratory distress ARDS chest X-ray lung

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or not found"

mkdir -p /home/daytona/workspace/respiratory-distress-ppt

~/respiratory-distress-ppt/build.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Respiratory Distress";
pres.author = "Medical Intern";

// ── COLOUR PALETTE ──────────────────────────────────────────────────────────
const C = {
  darkBg:    "0B1A2C",   // deep navy  (dominant)
  midBg:     "0E2240",   // mid navy
  panelBg:   "112B50",   // card background
  accent:    "E74C3C",   // red accent (medical urgency)
  accentSoft:"C0392B",   // darker red
  teal:      "1ABC9C",   // teal highlight
  gold:      "F39C12",   // warning amber
  white:     "FFFFFF",
  offWhite:  "ECF0F1",
  lightGray: "BDC3C7",
  textMuted: "7F8C8D",
};

// ── HELPER: slide background ─────────────────────────────────────────────────
function bg(slide, color) {
  slide.background = { color: color || C.darkBg };
}

// ── HELPER: header bar ────────────────────────────────────────────────────────
function headerBar(slide, title, subtitle) {
  // Red top accent strip
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: 0.08, fill: { color: C.accent }, line: { color: C.accent }
  });
  // Navy header band
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0.08, w: "100%", h: 0.9, fill: { color: C.midBg }, line: { color: C.midBg }
  });
  slide.addText(title.toUpperCase(), {
    x: 0.4, y: 0.08, w: 8, h: 0.55,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", margin: 0,
    charSpacing: 1
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.4, y: 0.6, w: 9, h: 0.35,
      fontSize: 11, color: C.teal, fontFace: "Calibri", margin: 0
    });
  }
  // Bottom gradient strip
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0.98, w: "100%", h: 0.03, fill: { color: C.accent }, line: { color: C.accent }
  });
}

// ── HELPER: footer ────────────────────────────────────────────────────────────
function footer(slide, text) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 5.5, w: "100%", h: 0.125, fill: { color: C.midBg }, line: { color: C.midBg }
  });
  slide.addText(text || "Respiratory Distress | Medical Internship Presentation", {
    x: 0.3, y: 5.5, w: 9.4, h: 0.125,
    fontSize: 7.5, color: C.textMuted, fontFace: "Calibri", margin: 0
  });
}

// ── HELPER: card ──────────────────────────────────────────────────────────────
function card(slide, x, y, w, h, title, lines, titleColor) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: C.panelBg },
    line: { color: C.accent, pt: 1 },
    rectRadius: 0.08
  });
  slide.addText(title, {
    x: x + 0.12, y: y + 0.06, w: w - 0.24, h: 0.32,
    fontSize: 11, bold: true, color: titleColor || C.teal, fontFace: "Calibri", margin: 0
  });
  // divider
  slide.addShape(pres.ShapeType.line, {
    x: x + 0.12, y: y + 0.38, w: w - 0.24, h: 0,
    line: { color: C.accent, pt: 0.8 }
  });
  const items = lines.map((l, i) => ({
    text: l,
    options: { bullet: { type: "bullet", code: "2022" }, breakLine: i < lines.length - 1, color: C.offWhite, fontSize: 9.5, fontFace: "Calibri" }
  }));
  slide.addText(items, {
    x: x + 0.18, y: y + 0.42, w: w - 0.3, h: h - 0.52,
    valign: "top", margin: 0
  });
}

// ── HELPER: numbered badge ────────────────────────────────────────────────────
function badge(slide, num, x, y) {
  slide.addShape(pres.ShapeType.ellipse, {
    x, y, w: 0.32, h: 0.32, fill: { color: C.accent }, line: { color: C.accent }
  });
  slide.addText(String(num), {
    x, y: y + 0.01, w: 0.32, h: 0.3,
    fontSize: 12, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s, C.darkBg);

  // Red vertical accent bar
  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.12, h: "100%", fill: { color: C.accent }, line: { color: C.accent }
  });

  // Decorative circles
  s.addShape(pres.ShapeType.ellipse, {
    x: 7.8, y: -0.8, w: 3.5, h: 3.5, fill: { color: C.midBg }, line: { color: C.midBg }
  });
  s.addShape(pres.ShapeType.ellipse, {
    x: 8.4, y: 0.3, w: 2, h: 2, fill: { color: C.accent, transparency: 85 }, line: { color: "none" }
  });

  s.addText("RESPIRATORY", {
    x: 0.5, y: 0.9, w: 9, h: 0.9,
    fontSize: 52, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 4, margin: 0
  });
  s.addText("DISTRESS", {
    x: 0.5, y: 1.7, w: 9, h: 0.9,
    fontSize: 52, bold: true, color: C.accent, fontFace: "Calibri", charSpacing: 4, margin: 0
  });

  s.addShape(pres.ShapeType.line, {
    x: 0.5, y: 2.7, w: 6, h: 0, line: { color: C.teal, pt: 2 }
  });

  s.addText("A Comprehensive Clinical Overview for Medical Interns", {
    x: 0.5, y: 2.85, w: 8.5, h: 0.4,
    fontSize: 15, color: C.offWhite, fontFace: "Calibri", italic: true, margin: 0
  });

  // Tags
  const tags = ["Pathophysiology", "Diagnosis", "ARDS", "Treatment", "Real Cases"];
  tags.forEach((t, i) => {
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.5 + i * 1.8, y: 3.45, w: 1.65, h: 0.32,
      fill: { color: C.panelBg }, line: { color: C.teal, pt: 0.8 }, rectRadius: 0.1
    });
    s.addText(t, {
      x: 0.5 + i * 1.8, y: 3.45, w: 1.65, h: 0.32,
      fontSize: 9, color: C.teal, align: "center", fontFace: "Calibri", margin: 0
    });
  });

  s.addText("Department of Internal Medicine  •  Medical Internship Programme  •  2026", {
    x: 0.5, y: 5.1, w: 9, h: 0.25,
    fontSize: 9, color: C.textMuted, fontFace: "Calibri", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – DEFINITIONS & OVERVIEW
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "Definitions & Overview", "Understanding the spectrum of respiratory compromise");
  footer(s);

  // Definition box
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 1.1, w: 9.4, h: 1.05,
    fill: { color: C.panelBg }, line: { color: C.teal, pt: 1.5 }, rectRadius: 0.1
  });
  s.addText([
    { text: "Respiratory Distress: ", options: { bold: true, color: C.teal, fontSize: 11 } },
    { text: "A clinical term combining the patient's subjective dyspnea with objective signs of difficulty breathing — tachypnea, accessory muscle use, cyanosis, altered mentation.", options: { color: C.offWhite, fontSize: 10.5 } }
  ], { x: 0.5, y: 1.12, w: 9, h: 1, valign: "middle", fontFace: "Calibri", margin: 0 });

  // Spectrum cards
  const spectrum = [
    { title: "Dyspnea", body: "Subjective sensation of\ndifficult or uncomfortable\nbreathing ('breathlessness')", col: C.teal },
    { title: "Tachypnea", body: "Objective rapid breathing\n>20 breaths/min in adults;\nobjective sign", col: C.gold },
    { title: "Respiratory Distress", body: "Dyspnea + objective signs\n(retractions, accessory\nmuscle use, cyanosis)", col: C.accent },
    { title: "Respiratory Failure", body: "PaO₂ <60 mmHg &/or\nPaCO₂ >50 mmHg;\nrequires intervention", col: "C0392B" },
  ];
  spectrum.forEach((item, i) => {
    const x = 0.3 + i * 2.37;
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 2.3, w: 2.2, h: 2.9,
      fill: { color: C.panelBg }, line: { color: item.col, pt: 1.5 }, rectRadius: 0.1
    });
    // number badge top
    s.addShape(pres.ShapeType.ellipse, {
      x: x + 0.87, y: 2.18, w: 0.44, h: 0.44,
      fill: { color: item.col }, line: { color: item.col }
    });
    s.addText(String(i + 1), {
      x: x + 0.87, y: 2.18, w: 0.44, h: 0.44,
      fontSize: 14, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(item.title, {
      x: x + 0.1, y: 2.68, w: 2, h: 0.4,
      fontSize: 11, bold: true, color: item.col, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(item.body, {
      x: x + 0.1, y: 3.1, w: 2, h: 1.9,
      fontSize: 9.5, color: C.offWhite, align: "center", fontFace: "Calibri", valign: "top", margin: 0
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – CAUSES & AETIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "Causes & Aetiology", "Common and life-threatening causes in the ED — Tintinalli's Emergency Medicine");
  footer(s);

  const cols = [
    {
      title: "🫁  Pulmonary Causes",
      color: C.teal,
      items: [
        "Pneumonia / LRTI",
        "Asthma (acute severe)",
        "COPD exacerbation",
        "Pulmonary embolism",
        "Pneumothorax (tension)",
        "Pleural effusion",
        "ARDS (non-cardiogenic edema)",
        "Interstitial lung disease",
        "Pulmonary fibrosis",
      ]
    },
    {
      title: "❤️  Cardiac Causes",
      color: C.gold,
      items: [
        "Acute decompensated heart failure",
        "Cardiogenic pulmonary edema",
        "Acute MI / unstable angina",
        "Cardiac tamponade",
        "Arrhythmias with low CO",
        "Myocarditis / cardiomyopathy",
      ]
    },
    {
      title: "⚠️  Other Causes",
      color: C.accent,
      items: [
        "Upper airway obstruction (FB, angioedema)",
        "Sepsis / systemic infection",
        "Anaphylaxis",
        "Metabolic acidosis (DKA, lactic)",
        "Neuromuscular: Guillain-Barré, MG",
        "Anaemia (severe)",
        "Trauma / flail chest",
        "Toxic inhalation / poisoning",
      ]
    }
  ];

  cols.forEach((col, i) => {
    const x = 0.25 + i * 3.25;
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 1.08, w: 3.1, h: 4.3,
      fill: { color: C.panelBg }, line: { color: col.color, pt: 1.2 }, rectRadius: 0.1
    });
    s.addText(col.title, {
      x: x + 0.1, y: 1.12, w: 2.9, h: 0.36,
      fontSize: 10.5, bold: true, color: col.color, fontFace: "Calibri", margin: 0
    });
    s.addShape(pres.ShapeType.line, {
      x: x + 0.1, y: 1.5, w: 2.9, h: 0, line: { color: col.color, pt: 0.7 }
    });
    const bullets = col.items.map((item, idx) => ({
      text: item,
      options: { bullet: true, breakLine: idx < col.items.length - 1, fontSize: 9.5, color: C.offWhite, fontFace: "Calibri" }
    }));
    s.addText(bullets, {
      x: x + 0.18, y: 1.56, w: 2.7, h: 3.7, valign: "top", margin: 0
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – SIGNS & SYMPTOMS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "Signs & Symptoms", "Physical examination findings in the distressed patient");
  footer(s);

  // Left: subjective
  card(s, 0.25, 1.08, 4.55, 4.3, "SUBJECTIVE (Symptoms — Patient Reports)", [
    "Dyspnea / breathlessness ('can't get enough air')",
    "Orthopnea — dyspnea on lying flat",
    "Paroxysmal nocturnal dyspnea (PND)",
    "Chest tightness or pressure",
    "Palpitations, anxiety, restlessness",
    "Inability to speak in full sentences",
    "Sense of impending doom",
    "Wheezing or noisy breathing",
  ], C.gold);

  // Right: objective
  card(s, 5.05, 1.08, 4.7, 4.3, "OBJECTIVE (Signs — Clinician Observes)", [
    "Tachypnea (RR >20; severe >30 bpm)",
    "Tachycardia, diaphoresis",
    "Use of accessory muscles (SCM, scalenes)",
    "Nasal flaring, pursed-lip breathing",
    "Intercostal / subcostal retractions",
    "Paradoxical abdominal movement",
    "Central cyanosis (late, severe sign)",
    "Hypoxia on pulse oximetry (SpO₂ <94%)",
    "Altered consciousness — agitation → drowsiness",
  ], C.accent);

  // Alert bar
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 5.28, w: 9.5, h: 0.22,
    fill: { color: "7D1C1C" }, line: { color: C.accent }
  });
  s.addText("🚨  RED FLAGS: Inability to speak, GCS ↓, SpO₂ <90%, cyanosis, silent chest → immediate intervention", {
    x: 0.35, y: 5.28, w: 9.3, h: 0.22,
    fontSize: 9, bold: true, color: "FFD1D1", fontFace: "Calibri", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CLINICAL MANIFESTATIONS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "Clinical Manifestations", "System-by-system effects of acute respiratory compromise");
  footer(s);

  const boxes = [
    { title: "Respiratory System", color: C.teal, x: 0.25, y: 1.08, items: [
      "Laboured, shallow or deep rapid breaths",
      "Wheezing (bronchospasm) or stridor (upper airway)",
      "Crackles / rales (pulmonary oedema, pneumonia)",
      "Diminished breath sounds (effusion, tension PTX)",
      "Use of accessory muscles — intercostal, SCM"
    ]},
    { title: "Cardiovascular System", color: C.gold, x: 5.05, y: 1.08, items: [
      "Compensatory tachycardia (HR >100 bpm)",
      "Hypertension early → hypotension in failure",
      "Pulsus paradoxus (tamponade, severe asthma)",
      "Jugular venous distension (cor pulmonale, HF)",
      "Right heart strain on ECG (PE, severe hypoxia)"
    ]},
    { title: "Neurological System", color: C.accent, x: 0.25, y: 3.1, items: [
      "Restlessness, anxiety → hallmark of hypoxia",
      "Confusion, agitation as hypoxia worsens",
      "Drowsiness / obtundation from hypercapnia",
      "Headache (CO₂ retention — 'CO₂ narcosis')",
      "Seizures, coma in extreme hypoxia"
    ]},
    { title: "Skin & Peripheral Signs", color: C.teal, x: 5.05, y: 3.1, items: [
      "Central cyanosis — tongue & mucous membranes",
      "Peripheral cyanosis — fingernails, extremities",
      "Diaphoresis (sympathetic activation)",
      "Oedema (right HF, cor pulmonale)",
      "Clubbing (chronic lung disease — not acute)"
    ]},
  ];

  boxes.forEach(box => {
    card(s, box.x, box.y, 4.55, 2.0, box.title, box.items, box.color);
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – INVESTIGATIONS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "Investigations", "Systematic workup for the patient in respiratory distress");
  footer(s);

  // Left column
  card(s, 0.25, 1.08, 4.55, 2.15, "Bedside / First-Line", [
    "Pulse oximetry — SpO₂ (rapid, non-invasive)",
    "12-lead ECG — ischaemia, PE strain pattern, arrhythmia",
    "Arterial Blood Gas (ABG) — PaO₂, PaCO₂, pH, HCO₃",
    "Peak Expiratory Flow (PEF) — obstructive disease",
    "Bedside point-of-care ultrasound (POCUS)"
  ], C.teal);

  card(s, 0.25, 3.38, 4.55, 2.0, "Laboratory Tests", [
    "FBC — anaemia, infection (neutrophilia/lymphopenia)",
    "BNP / NT-proBNP — heart failure (<100 excludes HF)",
    "D-dimer — PE screening (high sensitivity)",
    "CRP / Procalcitonin — infection/sepsis",
    "Troponin — ACS, myocarditis"
  ], C.gold);

  // Right column
  card(s, 5.05, 1.08, 4.7, 2.15, "Imaging", [
    "Chest X-ray — bilateral infiltrates, cardiomegaly, PTX",
    "CT Pulmonary Angiography (CTPA) — PE diagnosis",
    "High-resolution CT chest (HRCT) — ILD, fibrosis",
    "Echocardiography — cardiac function, tamponade, PE",
    "V/Q scan — PE (if CTPA contraindicated)"
  ], C.teal);

  card(s, 5.05, 3.38, 4.7, 2.0, "ABG Interpretation Key", [
    "Type 1 RF: PaO₂ <60 mmHg, PaCO₂ normal/low",
    "Type 2 RF: PaO₂ <60 + PaCO₂ >50 mmHg",
    "P/F ratio = PaO₂ ÷ FiO₂ (ARDS severity)",
    "Respiratory acidosis → CO₂ retention (hypoventilation)",
    "Metabolic acidosis + ↑RR → Kussmaul breathing (DKA)"
  ], C.accent);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – ARDS: BERLIN CRITERIA & INVESTIGATING CRITERIA
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "ARDS: Berlin Definition & Diagnostic Criteria", "Acute Respiratory Distress Syndrome — 2012 Berlin Consensus");
  footer(s);

  // Berlin criteria table
  s.addText("Berlin Definition of ARDS (2012)", {
    x: 0.3, y: 1.08, w: 9.4, h: 0.3,
    fontSize: 11, bold: true, color: C.teal, fontFace: "Calibri", margin: 0
  });

  const headers = ["Criterion", "Details"];
  const rows = [
    ["Timing", "Onset within 1 week of a known clinical insult or new/worsening respiratory symptoms"],
    ["Imaging (CXR/CT)", "Bilateral opacities — not fully explained by effusions, atelectasis, or nodules"],
    ["Origin of Oedema", "Not fully explained by cardiac failure or fluid overload; if no risk factor → echo needed"],
    ["Oxygenation", "PaO₂/FiO₂ ≤300 with PEEP or CPAP ≥5 cmH₂O on mechanical ventilation"],
  ];

  const rowH = 0.52;
  const startY = 1.42;
  const colW = [2.6, 6.8];
  const colX = [0.25, 2.9];

  // Header row
  [0, 1].forEach(ci => {
    s.addShape(pres.ShapeType.rect, {
      x: colX[ci], y: startY, w: colW[ci], h: 0.38,
      fill: { color: C.accent }, line: { color: C.accentSoft }
    });
    s.addText(headers[ci], {
      x: colX[ci] + 0.08, y: startY, w: colW[ci] - 0.1, h: 0.38,
      fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0
    });
  });

  rows.forEach((row, ri) => {
    const y = startY + 0.38 + ri * rowH;
    const bg_color = ri % 2 === 0 ? C.panelBg : C.midBg;
    [0, 1].forEach(ci => {
      s.addShape(pres.ShapeType.rect, {
        x: colX[ci], y, w: colW[ci], h: rowH,
        fill: { color: bg_color }, line: { color: C.accent, pt: 0.5 }
      });
      s.addText(row[ci], {
        x: colX[ci] + 0.1, y, w: colW[ci] - 0.15, h: rowH,
        fontSize: 9.5, color: C.offWhite, fontFace: "Calibri", valign: "middle", wrap: true, margin: 0
      });
    });
  });

  // Severity sub-table
  s.addText("ARDS Severity Classification (P/F Ratio)", {
    x: 0.3, y: 3.64, w: 9.4, h: 0.28,
    fontSize: 10.5, bold: true, color: C.gold, fontFace: "Calibri", margin: 0
  });

  const sev = [
    { label: "MILD ARDS", pf: "PaO₂/FiO₂  201–300", mortal: "~27%", color: C.teal },
    { label: "MODERATE ARDS", pf: "PaO₂/FiO₂  101–200", mortal: "~32%", color: C.gold },
    { label: "SEVERE ARDS", pf: "PaO₂/FiO₂  ≤100", mortal: "~45%", color: C.accent },
  ];
  sev.forEach((item, i) => {
    const x = 0.25 + i * 3.2;
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 3.95, w: 3.0, h: 1.3,
      fill: { color: C.panelBg }, line: { color: item.color, pt: 1.5 }, rectRadius: 0.1
    });
    s.addText(item.label, {
      x: x + 0.1, y: 4.0, w: 2.8, h: 0.32,
      fontSize: 10, bold: true, color: item.color, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(item.pf, {
      x: x + 0.1, y: 4.34, w: 2.8, h: 0.32,
      fontSize: 9.5, color: C.offWhite, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText("Mortality: " + item.mortal, {
      x: x + 0.1, y: 4.68, w: 2.8, h: 0.42,
      fontSize: 10, bold: true, color: item.color, align: "center", fontFace: "Calibri", margin: 0
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – DIAGNOSTIC TOOLS (Imaging)
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  bg(s);
  headerBar(s, "Diagnostic Tools", "Imaging & monitoring modalities in respiratory distress");
  footer(s);

  const tools = [
    {
      title: "Chest X-Ray (CXR)",
      icon: "📷",
      color: C.teal,
      x: 0.25, y: 1.1, w: 4.55, h: 2.1,
      items: [
        "First-line imaging in ALL patients",
        "ARDS: Bilateral diffuse opacities ('white-out')",
        "HF: Cardiomegaly, Kerley B lines, bat-wing oedema",
        "Pneumothorax: absent lung markings, tracheal deviation",
        "Pneumonia: lobar/segmental consolidation",
        "PE: Westermark sign, Hampton's hump (rare)"
      ]
    },
    {
      title: "CT Pulmonary Angiography (CTPA)",
      icon: "🩻",
      color: C.gold,
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        "HRCT: ILD patterns (UIP, NSIP, COP)",
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        "Identifies pneumonia complications (empyema, abscess)",
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        "Ejection fraction — systolic HF assessment",
        "POCUS (bedside echo) — rapid, highly valuable in ED"
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – TREATMENT
// ═══════════════════════════════════════════════════════════════════════════
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        "PE: Anticoagulation (LMWH/UFH); thrombolysis if massive",
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – REAL-LIFE CASES
// ═══════════════════════════════════════════════════════════════════════════
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      management: "Continuous salbutamol nebulisers + ipratropium. IV hydrocortisone 200 mg. IV MgSO₄ 2 g over 20 min. NIV not indicated for asthma. SpO₂ improved to 96% at 90 min. Admitted to HDU. Discharged on MART regimen with FeNO and spirometry follow-up."
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – SUMMARY / KEY TAKEAWAYS
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    { num: 2, text: "SpO₂ < 94% needs supplemental oxygen immediately; SpO₂ < 90% on oxygen → escalate to NIV / intubation." },
    { num: 3, text: "ABG is indispensable — classify Type I vs Type II RF; calculate P/F ratio to grade ARDS severity." },
    { num: 4, text: "ARDS Berlin Criteria: bilateral opacities + PaO₂/FiO₂ ≤300 + PEEP ≥5 + onset within 1 week." },
    { num: 5, text: "Treat the underlying cause: bronchodilators for asthma/COPD, diuretics for cardiogenic oedema, anticoagulation for PE." },
    { num: 6, text: "Lung-protective ventilation (6 mL/kg TV, PEEP titration, plateau <30 cmH₂O) reduces ARDS mortality." },
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// ═══════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/respiratory-distress-ppt/Respiratory_Distress.pptx" })
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cd /home/daytona/workspace/respiratory-distress-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/respiratory-distress-ppt/Respiratory_Distress.ppt…