from docx import Document
from docx.shared import Pt, Inches, RGBColor, Cm
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL
from docx.oxml.ns import qn
from docx.oxml import OxmlElement
import copy

doc = Document()

# ── Page margins ──────────────────────────────────────────────
for section in doc.sections:
    section.top_margin    = Cm(2.0)
    section.bottom_margin = Cm(2.0)
    section.left_margin   = Cm(2.2)
    section.right_margin  = Cm(2.2)

# ── Helper: set cell background colour ───────────────────────
def set_cell_bg(cell, hex_color):
    tc = cell._tc
    tcPr = tc.get_or_add_tcPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), hex_color)
    tcPr.append(shd)

def set_cell_borders(cell, hex_color='AAAAAA', size='4'):
    tc = cell._tc
    tcPr = tc.get_or_add_tcPr()
    tcBorders = OxmlElement('w:tcBorders')
    for side in ['top','left','bottom','right']:
        border = OxmlElement(f'w:{side}')
        border.set(qn('w:val'), 'single')
        border.set(qn('w:sz'), size)
        border.set(qn('w:space'), '0')
        border.set(qn('w:color'), hex_color)
        tcBorders.append(border)
    tcPr.append(tcBorders)

# ── Global font default ───────────────────────────────────────
style = doc.styles['Normal']
style.font.name = 'Calibri'
style.font.size = Pt(10)

# ── Title page ────────────────────────────────────────────────
title_para = doc.add_paragraph()
title_para.alignment = WD_ALIGN_PARAGRAPH.CENTER
run = title_para.add_run('EMERGENCY DRUGS')
run.bold = True
run.font.size = Pt(26)
run.font.color.rgb = RGBColor(0xC0, 0x00, 0x00)
run.font.name = 'Calibri'

sub_para = doc.add_paragraph()
sub_para.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub_run = sub_para.add_run('Quick-Reference Clinical Compendium')
sub_run.font.size = Pt(13)
sub_run.font.color.rgb = RGBColor(0x44, 0x44, 0x44)
sub_run.italic = True

doc.add_paragraph()  # spacer

note_para = doc.add_paragraph()
note_para.alignment = WD_ALIGN_PARAGRAPH.CENTER
note_run = note_para.add_run(
    'Sources: Miller\'s Anesthesia 10e | Tintinalli\'s Emergency Medicine | '
    'Barash Clinical Anesthesia 9e | Goodman & Gilman\'s Pharmacology | '
    'Washington Manual of Medical Therapeutics'
)
note_run.font.size = Pt(8)
note_run.font.color.rgb = RGBColor(0x88, 0x88, 0x88)
note_run.italic = True

doc.add_page_break()

# ══════════════════════════════════════════════════════════════
# HELPER: add a colour-banded section heading
# ══════════════════════════════════════════════════════════════
def section_heading(text, color_hex='1F3864'):
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(14)
    p.paragraph_format.space_after  = Pt(4)
    run = p.add_run(text.upper())
    run.bold = True
    run.font.size = Pt(13)
    run.font.name = 'Calibri'
    run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
    # shade the paragraph background via direct XML
    pPr = p._p.get_or_add_pPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), color_hex)
    pPr.append(shd)
    return p

def sub_heading(text):
    p = doc.add_paragraph()
    p.paragraph_format.space_before = Pt(8)
    p.paragraph_format.space_after  = Pt(2)
    run = p.add_run(text)
    run.bold = True
    run.font.size = Pt(11)
    run.font.color.rgb = RGBColor(0x1F, 0x38, 0x64)
    return p

def body(text):
    p = doc.add_paragraph(text)
    p.paragraph_format.space_before = Pt(1)
    p.paragraph_format.space_after  = Pt(1)
    p.runs[0].font.size = Pt(10) if p.runs else None
    return p

def bullet(text, level=0):
    p = doc.add_paragraph(text, style='List Bullet')
    p.paragraph_format.left_indent  = Inches(0.3 + level * 0.25)
    p.paragraph_format.space_before = Pt(1)
    p.paragraph_format.space_after  = Pt(1)
    return p

# ══════════════════════════════════════════════════════════════
# BIG TABLE helper
# ══════════════════════════════════════════════════════════════
HEADER_BG  = '1F3864'   # dark navy
ROW1_BG    = 'DEEAF1'   # light blue
ROW2_BG    = 'FFFFFF'   # white

def drug_table(headers, rows, col_widths_cm=None):
    """headers: list of strings; rows: list of lists."""
    n_cols = len(headers)
    tbl = doc.add_table(rows=1, cols=n_cols)
    tbl.style = 'Table Grid'
    tbl.alignment = WD_TABLE_ALIGNMENT.CENTER

    # Set column widths
    if col_widths_cm:
        for i, cell in enumerate(tbl.columns[i].cells[0] for i in range(n_cols)):
            pass  # done per-cell below

    # Header row
    hdr_cells = tbl.rows[0].cells
    for i, h in enumerate(headers):
        cell = hdr_cells[i]
        set_cell_bg(cell, HEADER_BG)
        p = cell.paragraphs[0]
        p.alignment = WD_ALIGN_PARAGRAPH.CENTER
        run = p.add_run(h)
        run.bold = True
        run.font.size = Pt(9)
        run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
        run.font.name = 'Calibri'
        if col_widths_cm:
            cell.width = Cm(col_widths_cm[i])

    # Data rows
    for ri, row_data in enumerate(rows):
        row = tbl.add_row()
        bg = ROW1_BG if ri % 2 == 0 else ROW2_BG
        for ci, val in enumerate(row_data):
            cell = row.cells[ci]
            set_cell_bg(cell, bg)
            set_cell_borders(cell)
            p = cell.paragraphs[0]
            if ci == 0:
                run = p.add_run(str(val))
                run.bold = True
                run.font.size = Pt(9)
                run.font.color.rgb = RGBColor(0x1F, 0x38, 0x64)
            else:
                run = p.add_run(str(val))
                run.font.size = Pt(9)
            run.font.name = 'Calibri'
            if col_widths_cm:
                cell.width = Cm(col_widths_cm[ci])

    doc.add_paragraph()  # spacer after table
    return tbl


# ══════════════════════════════════════════════════════════════
# SECTION 1 – CARDIAC ARREST / ACLS
# ══════════════════════════════════════════════════════════════
section_heading('1. Cardiac Arrest — ACLS Drugs', '7B0C02')

body('Per 2020 AHA Guidelines for CPR & ECC. Standard approach: CPR + defibrillation for shockable rhythms, then vasopressors and antiarrhythmics.')

drug_table(
    ['Drug', 'Indication', 'Dose & Route', 'Mechanism / Notes'],
    [
        ['Epinephrine (Adrenaline)',
         'VF, pulseless VT, PEA, Asystole',
         '1 mg IV/IO every 3-5 min\n(High-dose NOT routine)',
         'α-agonist: ↑ coronary & cerebral perfusion pressure during CPR.\nEarly use recommended for non-shockable rhythms (PEA/asystole).\nException: beta-blocker/Ca-channel blocker OD may need higher doses.'],
        ['Amiodarone',
         'Shock-refractory VF / pulseless VT',
         '1st dose: 300 mg IV/IO bolus\n2nd dose: 150 mg IV/IO',
         'Class III antiarrhythmic. Facilitates restoration of perfusing rhythm.\nNone proven to increase long-term survival.\nPreferred over lidocaine; both are acceptable alternatives.'],
        ['Lidocaine',
         'VF / pulseless VT (alternative to amiodarone)',
         '1st dose: 1-1.5 mg/kg IV/IO\n2nd dose: 0.5-0.75 mg/kg IV/IO',
         'Class Ib antiarrhythmic.\nAlternative when amiodarone unavailable.\nDo NOT use routinely together with amiodarone.'],
        ['Atropine',
         'Symptomatic bradycardia (NOT asystole/PEA)',
         '0.5 mg IV every 3-5 min\nMax total: 3 mg',
         'Muscarinic antagonist. Increases SA node firing rate.\nRemoved from asystole/PEA algorithm (no benefit shown).'],
        ['Magnesium Sulfate',
         'Torsades de Pointes (TdP)',
         '1-2 g IV over 5-20 min\n(Maintenance infusion if needed)',
         'NOT recommended for routine VF/VT.\nDrug of choice specifically for TdP / hypomagnesaemia-related VF.'],
        ['Sodium Bicarbonate',
         'Severe acidosis, hyperkalemia, TCA OD',
         '1 mEq/kg IV bolus initially\nGuided by ABG thereafter',
         'NOT recommended routinely in cardiac arrest.\nUse for TCA overdose, severe metabolic acidosis (pH <7.1), hyperkalemia.'],
        ['Calcium Chloride',
         'Hyperkalemia, hypocalcemia, Ca-channel blocker OD',
         '1 g IV (CaCl2 10%)\nor 3 g calcium gluconate IV',
         'Stabilises cardiac membrane potential.\nCaCl2 provides 3x more elemental Ca vs gluconate.\nCautious use with digoxin toxicity.'],
        ['Adenosine',
         'Stable narrow-complex SVT',
         '6 mg rapid IV push (antecubital)\n12 mg if no response (×2)\nCentral line: halve doses',
         'Transiently blocks AV node. Very short half-life (~10 sec).\nMust be given as RAPID IV push followed by 20 mL saline flush.\nWarning: monitor for bronchospasm in asthma.'],
        ['Vasopressin',
         'Removed from 2015 ACLS algorithm',
         'Historical: 40 units IV ×1\n(No longer recommended)',
         'Non-adrenergic vasoconstrictor. No benefit vs epinephrine alone in multiple trials. Not in current AHA 2020 adult arrest algorithm.'],
    ],
    [4.5, 4.0, 4.5, 7.5]
)

# ══════════════════════════════════════════════════════════════
# SECTION 2 – ACUTE CORONARY SYNDROME (STEMI)
# ══════════════════════════════════════════════════════════════
section_heading('2. Acute Coronary Syndrome / STEMI', '1F3864')

drug_table(
    ['Drug / Class', 'Dose', 'Notes'],
    [
        ['Aspirin (Antiplatelet)', '162-325 mg PO (chew)', 'First-line for all ACS; inhibits TXA2-mediated platelet aggregation.'],
        ['Clopidogrel (P2Y12)', '600 mg PO loading, then 75 mg daily\n(No loading in >75y receiving fibrinolytic)', 'Thienopyridine; irreversible P2Y12 inhibition.'],
        ['Ticagrelor (P2Y12)', '180 mg loading, then 90 mg twice daily', 'Reversible P2Y12 inhibitor. Preferred over clopidogrel in NSTEMI/STEMI.'],
        ['Prasugrel (P2Y12)', '60 mg loading, then 10 mg daily\n(Post-PCI, once anatomy defined)', 'Avoid if prior stroke/TIA, age >75, or weight <60 kg.'],
        ['UFH (Unfractionated Heparin)', '60 units/kg bolus (max 4,000 U)\nthen 12 units/kg/h (max 1,000 U/h)\nTarget aPTT 1.5-2.5x control', 'Antithrombotic; used during PCI and fibrinolysis.'],
        ['Enoxaparin (LMWH)', '30 mg IV bolus + 1 mg/kg SC q12h', 'Reduce dose in renal impairment. Simpler monitoring than UFH.'],
        ['Alteplase (Fibrinolytic)', '<67 kg: 15 mg IV bolus, then 50 mg/30 min, then 35 mg/60 min\n≥67 kg: 15 mg bolus, 0.75 mg/kg/30 min, 0.5 mg/kg/60 min', 'tPA. Use within 12h of symptom onset if PCI unavailable.'],
        ['Tenecteplase (Fibrinolytic)', '30-50 mg IV bolus (weight-based)', '<60 kg=30 mg; 60-70 kg=35 mg; 70-80 kg=40 mg; 80-90 kg=45 mg; ≥90 kg=50 mg.'],
        ['Nitroglycerin', 'SL: 0.4 mg q5 min x3\nIV: Start 10 mcg/min, titrate\n(10% MAP ↓ if normotensive; 30% if hypertensive)', 'Venodilator; reduces preload and ischemic pain. CONTRAINDICATED with PDE5 inhibitors.'],
        ['Morphine', '2-5 mg IV q5-15 min PRN pain', 'Use cautiously — may mask symptoms; some data suggest worse outcomes in ACS.'],
        ['Metoprolol (Beta-blocker)', 'Oral if stable; IV if needed\n(Withhold if cardiogenic shock/bradycardia/heart block)', 'Reduces myocardial O2 demand. CONTRAINDICATED in decompensated HF, severe bradycardia.'],
    ],
    [4.5, 5.0, 7.0]
)

# ══════════════════════════════════════════════════════════════
# SECTION 3 – ANAPHYLAXIS
# ══════════════════════════════════════════════════════════════
section_heading('3. Anaphylaxis', 'C45911')

drug_table(
    ['Drug', 'Dose & Route', 'Priority', 'Notes'],
    [
        ['Epinephrine (Adrenaline)',
         'Adults: 0.3-0.5 mg IM (anterolateral thigh)\nChildren: 0.01 mg/kg IM (max 0.5 mg)\nSelf-injector: EpiPen 0.3 mg / EpiPen Jr 0.15 mg\nSevere/refractory: 0.1-0.2 mg IV slow push',
         '1st LINE',
         'ALWAYS first drug. IM thigh > SC/deltoid. Repeat every 5-15 min if needed.\nβ-agonist: reverses bronchospasm.\nα-agonist: reverses vasodilation & hypotension.'],
        ['Normal Saline (IV Fluids)',
         '1-2 L rapid IV bolus (adults)\n20 mL/kg bolus (children)',
         '1st LINE',
         'Given immediately for hypotension. May need several litres for refractory shock.'],
        ['Diphenhydramine (H1-blocker)',
         '25-50 mg IV/IM/PO',
         '2nd LINE',
         'Treats urticaria/pruritus — does NOT reverse respiratory/cardiovascular effects.\nNever give as sole treatment; always after epinephrine.'],
        ['Ranitidine / Famotidine (H2-blocker)',
         'Ranitidine 50 mg IV or Famotidine 20 mg IV',
         '2nd LINE',
         'Additive benefit with H1 blocker for cutaneous symptoms. NOT a substitute for epinephrine.'],
        ['Hydrocortisone / Methylprednisolone',
         'Hydrocortisone 200 mg IV or\nMethylprednisolone 1-2 mg/kg IV',
         '2nd LINE',
         'Prevents biphasic reaction (onset 4-8h). NOT for acute management — too slow.\nMonitor for observation period of 4-8h after anaphylaxis.'],
        ['Salbutamol / Albuterol (Nebulised)',
         '2.5-5 mg nebulised; repeat as needed',
         'Adjunct',
         'For bronchospasm refractory to epinephrine.\nDoes NOT replace epinephrine.'],
        ['Glucagon',
         '1-5 mg IV over 5 min, then 5-15 mcg/min infusion',
         'Adjunct',
         'For patients on beta-blockers (who may not respond to epinephrine).\nBypass β-receptor to increase cAMP and cardiac output.'],
    ],
    [3.5, 5.0, 2.0, 6.0]
)

# ══════════════════════════════════════════════════════════════
# SECTION 4 – SEIZURES / STATUS EPILEPTICUS
# ══════════════════════════════════════════════════════════════
section_heading('4. Seizures & Status Epilepticus', '1F3864')

drug_table(
    ['Drug', 'Dose & Route', 'Timing', 'Notes'],
    [
        ['Lorazepam (Ativan)',
         '0.1 mg/kg IV (max 4 mg/dose)\nRepeat once after 5 min if needed',
         '0-5 min (1st line IV)',
         'Benzodiazepine. First choice if IV access available. Longer duration than diazepam.'],
        ['Midazolam (Buccal/IM)',
         '10 mg IM (>40 kg) / 5 mg (13-40 kg)\nBuccal: 10 mg',
         '0-5 min (1st line no IV)',
         'Preferred when no IV access. IM midazolam as effective as IV lorazepam for prehospital SE.'],
        ['Diazepam (Rectal/IV)',
         'IV: 0.15 mg/kg (max 10 mg)\nRectal: 0.5 mg/kg',
         '0-5 min (alternative)',
         'Rectal route useful in paediatrics/prehospital. Shorter duration than lorazepam; more rebound.'],
        ['Phenytoin / Fosphenytoin',
         'Phenytoin: 20 mg/kg IV at ≤50 mg/min\nFosphenytoin: 20 mg PE/kg at ≤150 mg PE/min',
         '5-30 min (2nd line)',
         'Fosphenytoin preferred (less phlebitis, faster admin).\nMonitor for hypotension and arrhythmia during loading.'],
        ['Valproate (Sodium Valproate)',
         '40 mg/kg IV over 10 min (max 3000 mg)',
         '5-30 min (2nd line alt.)',
         'Safe alternative to phenytoin. Avoid in liver disease/pregnancy (mitochondrial effects).'],
        ['Levetiracetam',
         '60 mg/kg IV over 10 min (max 4500 mg)',
         '5-30 min (2nd line alt.)',
         'Minimal drug interactions. Well-tolerated. Increasingly preferred over phenytoin.'],
        ['Phenobarbital',
         '20 mg/kg IV at ≤60 mg/min',
         '30-60 min (3rd line)',
         'Particularly useful in neonatal seizures. Causes significant sedation and respiratory depression.'],
        ['Propofol',
         '1-2 mg/kg IV induction\nThen 2-10 mg/kg/h infusion',
         'Refractory SE (ICU)',
         'For refractory SE requiring anaesthetic depth. Requires intubation/ventilatory support.\nPropofol infusion syndrome risk with prolonged high doses.'],
        ['Midazolam Infusion',
         '0.2 mg/kg IV bolus then 0.05-2 mg/kg/h',
         'Refractory SE (ICU)',
         'Preferred for refractory SE in many protocols. Titrate to EEG burst suppression.'],
    ],
    [3.5, 5.0, 3.0, 5.0]
)

# ══════════════════════════════════════════════════════════════
# SECTION 5 – HYPERTENSIVE EMERGENCY
# ══════════════════════════════════════════════════════════════
section_heading('5. Hypertensive Emergency', '1F3864')

body('Target: Reduce MAP by no more than 25% in the first hour, then to 160/100-110 over next 2-6h. Exceptions: aortic dissection (SBP <120 rapidly), ischaemic stroke (permissive hypertension).')

drug_table(
    ['Drug', 'Dose', 'Use Case', 'Notes'],
    [
        ['Labetalol', '20 mg IV over 2 min; then 40-80 mg q10 min (max 300 mg)\nOR infusion 0.5-2 mg/min', 'Most hypertensive emergencies, aortic dissection, hypertension in pregnancy (not 1st trim)', 'Alpha+beta blocker. Avoid in acute HF, bronchospasm, cocaine-induced HTN.'],
        ['Nicardipine', '5 mg/h IV infusion; titrate up to 15 mg/h', 'Hypertensive encephalopathy, perioperative HTN, stroke', 'Dihydropyridine Ca-channel blocker. Smooth, titratable. Safe in renal/hepatic disease.'],
        ['Nitroprusside', '0.3-0.5 mcg/kg/min IV; max 10 mcg/kg/min', 'Hypertensive emergency with HF (acute pulmonary oedema)', 'Arterio-venous dilator. Risk of cyanide toxicity at high doses/prolonged use. Avoid in renal failure.'],
        ['Nitroglycerin IV', '5-200 mcg/min IV infusion', 'ACS with hypertension, pulmonary oedema', 'Predominantly venodilator; less potent for BP than nitroprusside. Tolerance develops after 24h.'],
        ['Esmolol', '500 mcg/kg IV bolus over 1 min\nthen 50-200 mcg/kg/min infusion', 'Perioperative hypertension, aortic dissection', 'Ultra-short-acting selective β1-blocker. Half-life ~9 min. Rapidly titratable.'],
        ['Hydralazine', '10-20 mg IV (repeat q4-6h PRN)', 'Hypertension in pregnancy / eclampsia', 'Direct arteriolar vasodilator. Unpredictable duration; reflex tachycardia. IV onset 10-20 min.'],
        ['Phentolamine', '5-15 mg IV bolus; repeat PRN', 'Phaeochromocytoma crisis, cocaine/MAOI-induced HTN', 'Non-selective alpha blocker. Drug of choice for catecholamine excess.'],
        ['Magnesium Sulfate', '4-6 g IV over 15-20 min\nthen 1-2 g/h infusion', 'Eclampsia seizure prevention/treatment', 'Reduces neuromuscular excitability. Target Mg 4-7 mEq/L. Monitor for toxicity (loss of patellar reflex, respiratory depression).'],
    ],
    [3.5, 5.0, 3.5, 5.0]
)

# ══════════════════════════════════════════════════════════════
# SECTION 6 – REVERSAL AGENTS
# ══════════════════════════════════════════════════════════════
section_heading('6. Reversal Agents & Antidotes', 'C45911')

drug_table(
    ['Agent', 'Reverses', 'Dose', 'Notes'],
    [
        ['Naloxone (Narcan)',
         'Opioid toxicity (all mu-agonists)',
         '0.4-2 mg IV/IM/IN every 2-3 min\n(Low dose 0.04 mg in opioid-tolerant patients)',
         'Competitive opioid receptor antagonist. Short half-life (30-90 min) — re-dosing or infusion needed for long-acting opioids.\nAvoid precipitating acute withdrawal in dependent patients.'],
        ['Flumazenil (Annexate)',
         'Benzodiazepine toxicity',
         '0.2 mg IV over 30 sec; repeat 0.2 mg q60 sec\nMax 1 mg (or 3 mg in ICU setting)',
         'Competitive GABA-A receptor antagonist. Short half-life — resedation common.\nCONTRAINDICATED in benzodiazepine-dependent patients (risk of seizures) and in TCA co-ingestion.'],
        ['Sugammadex',
         'Rocuronium / Vecuronium (NMB)',
         'Routine reversal: 2 mg/kg\nDeep block: 4 mg/kg\nEmergency (can\'t intubate/ventilate): 16 mg/kg',
         'Encapsulates aminosteroid NMB agents. Rapid and complete reversal. Does not require anticholinesterase. Preferred over neostigmine for deep or immediate reversal.'],
        ['Neostigmine + Glycopyrrolate',
         'Non-depolarising NMB (residual block only)',
         'Neostigmine 0.04-0.07 mg/kg IV\n+ Glycopyrrolate 0.01 mg/kg IV',
         'Acetylcholinesterase inhibitor. Glycopyrrolate prevents muscarinic side-effects (bradycardia, bronchospasm). Not for deep block.'],
        ['Atropine',
         'Organophosphate / Nerve agent poisoning; Bradycardia',
         'Organophosphate: 2-4 mg IV q5-10 min until secretions dry\nBradycardia: 0.5 mg IV q3-5 min (max 3 mg)',
         'Muscarinic antagonist. In OP poisoning: titrate to dry secretions (not HR). Pralidoxime (2-PAM) given concurrently for OP to reactivate AChE.'],
        ['Protamine Sulfate',
         'Heparin (UFH > LMWH)',
         '1 mg per 100 units UFH (last 2-4h)\n(LMWH: 1 mg per 1 mg enoxaparin — 60-80% reversal only)',
         'Reversal occurs within 5 min. Risk of hypotension, bradycardia, anaphylaxis. Have epinephrine ready.'],
        ['Vitamin K (Phytomenadione)',
         'Warfarin / Vitamin K antagonists',
         'Non-urgent: 1-2.5 mg PO\nUrgent: 5-10 mg slow IV (anaphylaxis risk)\nImmediate: combine with FFP or 4F-PCC',
         'Onset slow (6-12h IV; 24h PO). Give with PCC/FFP for urgent reversal.'],
        ['Idarucizumab (Praxbind)',
         'Dabigatran',
         '5 g IV (2×2.5 g within 15 min)',
         'Monoclonal antibody fragment. Rapid, complete reversal of dabigatran. Used for life-threatening bleeding or urgent surgery.'],
        ['Andexanet Alfa (Ondexxya)',
         'Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban)',
         'Rivaroxaban/Apixaban high-dose: 800 mg IV bolus then 960 mg over 2h\nLow-dose: 400 mg bolus then 480 mg over 2h',
         'Decoy Xa protein. Expensive; limited availability. 4F-PCC (50 units/kg) is a practical alternative.'],
        ['Dantrolene',
         'Malignant Hyperthermia',
         '2.5 mg/kg IV bolus; repeat every 5 min up to 10 mg/kg\nthen 1 mg/kg q6h × 24-48h',
         'Prevents Ca2+ release from sarcoplasmic reticulum. Stop all triggering agents (volatile anaesthetics, succinylcholine). Treat hyperkalemia, acidosis concurrently.\nMinimum 12 vials (each 20 mg) must be available wherever triggering agents are used.'],
        ['Lipid Emulsion (Intralipid 20%)',
         'Local anaesthetic systemic toxicity (LAST)',
         'Bolus: 1.5 mL/kg over 1 min\nthen 0.25 mL/kg/min for 30-60 min\n(Repeat bolus ×1-2 if cardiac arrest)',
         '"Lipid sink" — sequesters lipophilic LA from myocardium. Use for bupivacaine/levobupivacaine/ropivacaine toxicity. Continue CPR during administration.'],
        ['N-Acetylcysteine (NAC)',
         'Paracetamol (Acetaminophen) OD',
         'IV: 150 mg/kg over 60 min, then 50 mg/kg/4h, then 100 mg/kg/16h\nOral: 140 mg/kg loading, then 70 mg/kg q4h × 17 doses',
         'Replenishes glutathione; prevents NAPQI-induced hepatotoxicity.\nMost effective within 8-10h of ingestion. Can still benefit up to 24h+. Assess via Rumack-Matthew nomogram.'],
    ],
    [3.5, 4.0, 4.5, 5.5]
)

# ══════════════════════════════════════════════════════════════
# SECTION 7 – VASOPRESSORS & INOTROPES
# ══════════════════════════════════════════════════════════════
section_heading('7. Vasopressors & Inotropes', '1F3864')

drug_table(
    ['Drug', 'Dose Range', 'Primary Effect', 'Use Case', 'Notes'],
    [
        ['Norepinephrine\n(Noradrenaline)',
         '0.01-3 mcg/kg/min IV',
         'α1++ / β1+\n(predominantly vasoconstriction)',
         'Septic shock (1st line per SSC)',
         'MAP target ≥65 mmHg. First-line vasopressor in septic shock. Monitor for ischaemia of extremities.'],
        ['Epinephrine\n(Adrenaline)',
         '0.01-1 mcg/kg/min IV',
         'α1++ / β1++ / β2++',
         'Anaphylaxis, cardiogenic shock, post-cardiac surgery',
         'Low dose: β-predominant (↑CO). High dose: α-predominant (↑SVR). Causes hyperglycaemia and lactic acidosis.'],
        ['Dopamine',
         '2-20 mcg/kg/min IV',
         'Dose-dependent:\n<5: D1 (renal)\n5-10: β1\n>10: α1',
         '2nd line vasopressor; cardiogenic shock with bradycardia',
         '"Renal dose dopamine" for renal protection: NOT supported by evidence. Higher rates of arrhythmia vs norepinephrine.'],
        ['Vasopressin',
         '0.03-0.04 units/min IV (fixed dose)',
         'V1 receptor\n(vasoconstriction)',
         'Catecholamine-sparing in septic shock; post-cardiac surgery vasodilation',
         'Add-on to norepinephrine; allows norepinephrine dose reduction. VASST trial: benefit in less severe septic shock.'],
        ['Phenylephrine',
         '0.5-5 mcg/kg/min IV\n(or 50-200 mcg IV bolus)',
         'α1 only\n(pure vasoconstriction)',
         'Anaesthetic-induced hypotension; SVT with hypotension',
         'No direct cardiac effect. Can cause reflex bradycardia. Avoids tachycardia. Avoid in cardiogenic shock (↑afterload).'],
        ['Dobutamine',
         '2-20 mcg/kg/min IV',
         'β1++ / β2+\n(inotrope/vasodilator)',
         'Cardiogenic shock (with adequate MAP)',
         'Positive inotrope. Reduces afterload. Combine with norepinephrine if hypotensive. Tachycardia limits use.'],
        ['Milrinone',
         '0.375-0.75 mcg/kg/min IV\n(Loading: 50 mcg/kg optional)',
         'PDE3 inhibitor\n(inodilator)',
         'Cardiogenic shock, post-cardiac surgery low output, pulmonary hypertension',
         'Increases cAMP; positive inotropy + vasodilation. Does not require β-receptor. Caution in renal failure (renally cleared).'],
        ['Levosimendan',
         '0.05-0.2 mcg/kg/min IV ×24h\n(Loading: 6-12 mcg/kg optional)',
         'Ca2+ sensitiser + K-ATP channel opener\n(inodilator)',
         'Acute decompensated HF, cardiogenic shock',
         'Does not ↑ myocardial O2 demand. Sustained effect up to 1 week. Used in Europe/Asia; limited US approval.'],
    ],
    [3.0, 3.0, 3.0, 3.0, 5.5]
)

# ══════════════════════════════════════════════════════════════
# SECTION 8 – AIRWAY / RAPID SEQUENCE INTUBATION
# ══════════════════════════════════════════════════════════════
section_heading('8. Rapid Sequence Intubation (RSI) Drugs', 'C45911')

drug_table(
    ['Drug', 'Dose', 'Class', 'Notes'],
    [
        ['Succinylcholine\n(Suxamethonium)',
         '1.5 mg/kg IV (adults)\n2 mg/kg IV (children <10 kg)',
         'Depolarising NMB (1st choice RSI)',
         'Fastest onset (~60 sec), shortest duration (~10 min). CONTRAINDICATED: hyperkalemia, burn/crush >48h, upper motor neuron lesions, malignant hyperthermia history, myopathies. Check pseudo-cholinesterase deficiency risk.'],
        ['Rocuronium',
         'RSI: 1.2 mg/kg IV\nRoutine: 0.6 mg/kg IV',
         'Non-depolarising NMB (2nd choice RSI)',
         'Preferred when succinylcholine is contraindicated. RSI dose provides intubating conditions in 60-90 sec.\nReversal: Sugammadex 16 mg/kg for emergency. Longer duration than suxamethonium.'],
        ['Propofol',
         '1-2 mg/kg IV (titrate to effect)\n(Reduced in elderly/haemodynamically unstable: 0.5 mg/kg)',
         'IV Induction agent',
         'Rapid onset (<30 sec), pleasant induction. Causes hypotension (↓SVR, ↓CO). Have vasopressor ready. Also treats laryngospasm/bronchospasm (small doses 0.5 mg/kg).'],
        ['Ketamine',
         '1-2 mg/kg IV (or 4-6 mg/kg IM)',
         'Dissociative anaesthetic',
         'Preferred induction for haemodynamically unstable patients (catecholamine release). Maintains airway reflexes (partial). Bronchodilator. Use with benzodiazepine to reduce emergence phenomena. Avoid in severe hypertension/raised ICP.'],
        ['Etomidate',
         '0.3 mg/kg IV',
         'IV Induction agent',
         'Best haemodynamic stability. Preferred for trauma/haemodynamic instability where ketamine is contraindicated. Single dose adrenal suppression (avoid repeat dosing or infusion). Myoclonus common.'],
        ['Thiopental (Thiopentone)',
         '3-5 mg/kg IV\n(Reduced in elderly: 1-2 mg/kg)',
         'IV Induction agent (barbiturate)',
         'Historically first-line; now largely superseded by propofol. Still used where propofol unavailable. Reduces ICP — useful in neurosurgical emergencies.'],
        ['Fentanyl',
         '1-3 mcg/kg IV (pre-induction)\n"LOADS": 3 mcg/kg to blunt laryngoscopy',
         'Opioid (pre-treatment)',
         'Blunts sympathetic response to laryngoscopy (important in raised ICP, severe HTN). Onset 3-5 min. Causes chest wall rigidity at high doses.'],
        ['Midazolam',
         '0.01-0.05 mg/kg IV (sedation)\n0.1-0.15 mg/kg IV (induction)',
         'Benzodiazepine (sedation/co-induction)',
         'Reduces induction dose requirements. Anxiolytic. Used for procedural sedation (0.02-0.04 mg/kg). Longer recovery than propofol. Reversed by flumazenil.'],
        ['Lidocaine (pre-RSI)',
         '1.5 mg/kg IV 3 min before laryngoscopy',
         'Local anaesthetic (adjunct)',
         'Attenuates rise in ICP, laryngospasm reflex, and bronchospasm during intubation. Controversial evidence but widely used in neurological emergencies.'],
    ],
    [3.5, 3.5, 3.0, 7.0]
)

# ══════════════════════════════════════════════════════════════
# SECTION 9 – METABOLIC / OTHER EMERGENCIES
# ══════════════════════════════════════════════════════════════
section_heading('9. Metabolic & Other Emergencies', '1F3864')

drug_table(
    ['Drug', 'Indication', 'Dose', 'Notes'],
    [
        ['50% Dextrose (D50W)', 'Hypoglycaemia (<3 mmol/L with symptoms)', '25-50 mL (12.5-25 g) IV; repeat PRN', 'Rapid onset. Check BGL after 10-15 min. Follow with oral carbohydrates/dextrose infusion to prevent relapse.'],
        ['Glucagon', 'Hypoglycaemia (no IV access)', '1 mg IM/SC', 'Onset 8-10 min. Stimulates hepatic glycogenolysis. Ineffective if glycogen-depleted (starvation, alcohol-related). Also used in beta-blocker overdose (1-5 mg IV).'],
        ['Insulin (Regular)', 'Hyperglycaemia, DKA, HHS, Hyperkalemia', 'DKA: 0.1 units/kg/h IV infusion\nHyperkalemia: 10 units IV + 50 mL D50W\nHHS: 0.05 units/kg/h IV', 'For hyperkalemia: drives K+ intracellularly. Always give with dextrose to avoid hypoglycaemia.'],
        ['Calcium (IV)', 'Hyperkalemia, Hypocalcemia, Ca-channel blocker OD', 'CaCl2 10%: 1 g (10 mL) IV over 10 min\nCalcium gluconate 10%: 10-30 mL IV over 10 min', 'Stabilises cardiac membrane potential. CaCl2 provides more elemental Ca2+ (3x) but is more irritating to veins (prefer central line).'],
        ['Sodium Bicarbonate', 'Severe metabolic acidosis (pH <7.1), Hyperkalemia, TCA OD', '1-2 mEq/kg IV bolus, guided by ABG', 'For TCA: alkalinises serum; reduces Na-channel blockade. For hyperkalemia: temporary transcellular shift. Do not over-alkalinise: left-shifts O2-Hb curve.'],
        ['Potassium Chloride (IV)', 'Severe hypokalaemia (<2.5 mEq/L, with ECG changes)', 'Peripheral: ≤10 mEq/h (max 20 mEq/h central)\nConcentration: ≤40 mEq/L peripheral', 'NEVER IV bolus undiluted — causes cardiac arrest. Replace with continuous ECG monitoring. Oral route always preferred if possible.'],
        ['Thiamine (Vitamin B1)', 'Suspected Wernicke\'s encephalopathy, alcohol-related emergency', '100-500 mg IV (give BEFORE dextrose)', 'Prevents precipitation of acute Wernicke\'s. Classic triad: confusion, ataxia, ophthalmoplegia. Give empirically in any malnourished/alcohol-use patient requiring glucose.'],
        ['Activated Charcoal', 'Oral drug/poison ingestion (within 1-2h)', '50 g PO / via NG tube (adults)\n1 g/kg (children)', 'Most effective within 1h of ingestion. CONTRAINDICATED in: unconscious patient without protected airway, caustic ingestion, hydrocarbon ingestion, intestinal obstruction.'],
        ['Sodium Nitrite + Sodium Thiosulfate', 'Cyanide poisoning', 'Na Nitrite: 300 mg (10 mL of 3%) IV over 5-10 min\nNa Thiosulfate: 12.5 g (50 mL of 25%) IV over 10 min', 'Nitrite induces methaemoglobinaemia (cyanide binds preferentially to metHb). Thiosulfate converts cyanothiosulfate to thiocyanate. Hydroxocobalamin (5 g IV) is preferred modern alternative.'],
        ['Hydroxocobalamin (Cyanokit)', 'Cyanide poisoning', '5 g IV over 15 min (repeat ×1-2 for severe poisoning)', 'Binds cyanide directly to form cyanocobalamin. Preferred over nitrite/thiosulfate (no methaemoglobinaemia). Turns skin/urine red-brown.'],
    ],
    [3.5, 3.5, 4.0, 6.5]
)

# ══════════════════════════════════════════════════════════════
# SECTION 10 – RAPID REFERENCE: KEY DOSES AT A GLANCE
# ══════════════════════════════════════════════════════════════
doc.add_page_break()
section_heading('10. Rapid Reference — Key Doses At A Glance', '1F3864')

drug_table(
    ['Situation', 'Drug of Choice', 'Quick Dose'],
    [
        ['Cardiac arrest (any rhythm)', 'Epinephrine', '1 mg IV/IO q3-5 min'],
        ['VF / pulseless VT (refractory)', 'Amiodarone', '300 mg IV/IO bolus'],
        ['Torsades de Pointes', 'Magnesium Sulfate', '2 g IV over 5-20 min'],
        ['Symptomatic bradycardia', 'Atropine', '0.5 mg IV (max 3 mg)'],
        ['SVT (stable)', 'Adenosine', '6 mg rapid IV; 12 mg ×2 if needed'],
        ['Anaphylaxis', 'Epinephrine IM', '0.3 mg IM (anterolateral thigh)'],
        ['Seizure (1st line IV)', 'Lorazepam', '0.1 mg/kg IV (max 4 mg)'],
        ['Seizure (no IV access)', 'Midazolam IM', '10 mg IM'],
        ['Opioid overdose', 'Naloxone', '0.4-2 mg IV/IM/IN'],
        ['Benzodiazepine overdose', 'Flumazenil', '0.2 mg IV q60s to max 1 mg'],
        ['Rocuronium reversal (emergency)', 'Sugammadex', '16 mg/kg IV'],
        ['Malignant hyperthermia', 'Dantrolene', '2.5 mg/kg IV bolus (repeat to 10 mg/kg)'],
        ['Local anaesthetic toxicity', 'Intralipid 20%', '1.5 mL/kg IV bolus; then 0.25 mL/kg/min'],
        ['Paracetamol overdose', 'N-Acetylcysteine', '150 mg/kg IV over 1h (then infusions)'],
        ['Septic shock (vasopressor)', 'Norepinephrine', '0.01-3 mcg/kg/min IV (MAP ≥65)'],
        ['Hypertensive emergency', 'Labetalol / Nicardipine', '20 mg IV; or 5 mg/h infusion (nicardipine)'],
        ['Eclampsia', 'Magnesium Sulfate', '4-6 g IV over 15 min, then 1-2 g/h'],
        ['Cyanide poisoning', 'Hydroxocobalamin', '5 g IV over 15 min'],
        ['Hypoglycaemia (no IV)', 'Glucagon', '1 mg IM/SC'],
        ['Hyperkalemia (cardiac)', 'Calcium Chloride', '1 g (10 mL 10%) IV over 10 min'],
    ],
    [6.0, 5.0, 6.5]
)

# ── Footer note ───────────────────────────────────────────────
doc.add_paragraph()
footer_p = doc.add_paragraph()
footer_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
fr = footer_p.add_run(
    'DISCLAIMER: This document is a clinical quick-reference compiled from authoritative medical textbooks. '
    'Always verify doses against current local guidelines, product information, and patient-specific factors. '
    'Not a substitute for clinical judgement.'
)
fr.italic = True
fr.font.size = Pt(8)
fr.font.color.rgb = RGBColor(0x88, 0x88, 0x88)

# ── Save ──────────────────────────────────────────────────────
out_path = '/tmp/workspace/emergency-drugs/Emergency_Drugs_Reference.docx'
doc.save(out_path)
print(f'Saved: {out_path}')