STEMI acute coronary syndrome guidelines emergency

pulmonary embolism treatment guidelines

COPD acute exacerbation emergency treatment

sepsis septic shock management guidelines

ischemic stroke thrombolysis thrombectomy guidelines

trauma resuscitation emergency management guidelines

cardiac arrest CPR resuscitation guidelines

diabetic ketoacidosis management emergency treatment

anaphylaxis treatment epinephrine guidelines

acute severe asthma emergency management

ls -la /tmp/workspace/ 2>/dev/null || mkdir -p /tmp/workspace && echo "created"

mkdir -p /tmp/workspace/em-guidelines && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import mm, cm 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 ListFlowable, ListItem # ---------- Document setup ---------- OUTPUT = "/tmp/workspace/em-guidelines/EM_Latest_Guidelines_Trials_2025_2026.pdf" doc = SimpleDocTemplate( OUTPUT, pagesize=A4, leftMargin=2*cm, rightMargin=2*cm, topMargin=2.2*cm, bottomMargin=2.2*cm, title="Emergency Medicine: Latest Guidelines & Trials 2025-2026", author="MD Emergency Medicine Reference" ) # ---------- Colour palette ---------- DARK_BLUE = colors.HexColor("#1a3557") MED_BLUE = colors.HexColor("#2563a8") LIGHT_BLUE = colors.HexColor("#dbeafe") ACCENT = colors.HexColor("#e63946") GOLD = colors.HexColor("#f59e0b") LIGHT_GOLD = colors.HexColor("#fef3c7") GREEN = colors.HexColor("#16a34a") LIGHT_GREEN = colors.HexColor("#dcfce7") GREY = colors.HexColor("#64748b") LIGHT_GREY = colors.HexColor("#f1f5f9") WHITE = colors.white BLACK = colors.black styles = getSampleStyleSheet() # ---------- Custom styles ---------- def S(name, **kw): return ParagraphStyle(name, **kw) cover_title = S("CoverTitle", fontName="Helvetica-Bold", fontSize=26, textColor=WHITE, alignment=TA_CENTER, leading=34) cover_sub = S("CoverSub", fontName="Helvetica", fontSize=13, textColor=LIGHT_BLUE, alignment=TA_CENTER, leading=20) cover_badge = S("CoverBadge", fontName="Helvetica-Bold", fontSize=11, textColor=GOLD, alignment=TA_CENTER) h1 = S("H1", fontName="Helvetica-Bold", fontSize=16, textColor=WHITE, spaceBefore=6, spaceAfter=4) h2 = S("H2", fontName="Helvetica-Bold", fontSize=13, textColor=DARK_BLUE, spaceBefore=10, spaceAfter=4) h3 = S("H3", fontName="Helvetica-Bold", fontSize=10.5, textColor=MED_BLUE, spaceBefore=6, spaceAfter=2) body = S("Body",fontName="Helvetica", fontSize=9.5, leading=14, textColor=BLACK, spaceAfter=3) body_bold = S("BB", fontName="Helvetica-Bold", fontSize=9.5, leading=14, textColor=BLACK) bullet_style = S("Bul", fontName="Helvetica", fontSize=9, leading=13, textColor=BLACK, leftIndent=12) note_style = S("Note",fontName="Helvetica-Oblique", fontSize=8.5, textColor=GREY, leading=12) pmid_style = S("PMID",fontName="Helvetica", fontSize=8, textColor=MED_BLUE, leading=10) section_hdr = S("SHdr",fontName="Helvetica-Bold", fontSize=11, textColor=WHITE, alignment=TA_LEFT) key_style = S("Key", fontName="Helvetica-Bold", fontSize=9, textColor=ACCENT) def section_box(title, color=DARK_BLUE): """Returns a coloured header row as a Table.""" data = [[Paragraph(title, section_hdr)]] t = Table(data, colWidths=[17*cm]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), color), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ("TOPPADDING", (0,0),(-1,-1), 6), ("BOTTOMPADDING",(0,0),(-1,-1), 6), ("ROUNDEDCORNERS", [4]), ])) return t def guideline_card(issuer, title, year, pmid, key_points, bg=LIGHT_BLUE, accent=MED_BLUE): """Card-style block for a single guideline / trial.""" rows = [] header_data = [[ Paragraph(f"<b>{issuer}</b>", S("GH", fontName="Helvetica-Bold", fontSize=9, textColor=WHITE)), Paragraph(f"PMID: {pmid}", S("GP", fontName="Helvetica", fontSize=8, textColor=LIGHT_BLUE, alignment=1)) ]] header = Table(header_data, colWidths=[12*cm, 5*cm]) header.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), accent), ("LEFTPADDING", (0,0),(-1,-1), 6), ("RIGHTPADDING", (0,0),(-1,-1), 6), ("TOPPADDING", (0,0),(-1,-1), 4), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ])) content_items = [header, Spacer(1, 3)] content_items.append(Paragraph(f"<b>{title}</b> ({year})", body_bold)) content_items.append(Spacer(1,3)) for kp in key_points: content_items.append(Paragraph(f"• {kp}", bullet_style)) cell_data = [[content_items]] card = Table([[content_items]], colWidths=[17*cm]) card.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), bg), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ("TOPPADDING", (0,0),(-1,-1), 6), ("BOTTOMPADDING",(0,0),(-1,-1), 6), ("BOX", (0,0), (-1,-1), 0.5, accent), ("ROUNDEDCORNERS", [4]), ])) return card # ============================================================ # CONTENT DATA # ============================================================ sections = [ # 1. STEMI / ACS { "title": "1. STEMI & Acute Coronary Syndrome (ACS)", "color": ACCENT, "intro": ( "2025-2026 updates to ACS management focus on thrombolysis in atypical STEMI equivalents " "(De Winter pattern, NSTEMI), expanded primary PCI windows, and updated dual antiplatelet therapy strategies." ), "cards": [ { "issuer": "Systematic Review | Open Heart, 2025", "title": "Thrombolysis in NSTEMI: Systematic Review and Meta-Analysis of RCTs", "year": "Nov 2025", "pmid": "41219134", "bg": colors.HexColor("#fde8e8"), "accent": ACCENT, "key_points": [ "Fibrinolysis in true NSTEMI carries high bleeding risk with marginal reperfusion benefit.", "Meta-analysis of all RCTs confirms thrombolysis should NOT be routine in NSTEMI.", "Early invasive strategy (< 24 h) remains the standard for high-risk NSTEMI.", "Subgroup: benefit possible only when PCI unavailable > 120 min (resource-limited settings).", "KEY CHANGE: Reinforces current guidelines - no role for lytic therapy in NSTEMI." ] }, { "issuer": "Systematic Review | Catheter Cardiovasc Interv, 2026", "title": "Thrombolysis for De Winter Syndrome When PCI Is Delayed", "year": "Apr 2026", "pmid": "41663344", "bg": colors.HexColor("#fde8e8"), "accent": ACCENT, "key_points": [ "De Winter pattern (upsloping ST depression + peaked T waves) = STEMI equivalent.", "Review supports fibrinolysis as bridge when primary PCI delay > 120 minutes.", "Early recognition crucial - De Winter ECG is often missed on first pass.", "Tenecteplase preferred over streptokinase in resource-limited settings.", "Post-lytic angiography within 3-24 hours recommended (pharmaco-invasive strategy).", "KEY CHANGE: Explicit guidance extended to De Winter syndrome for the first time." ] }, ], "clinical_pearl": ( "De Winter syndrome accounts for ~2% of all LAD occlusions. The ECG lacks classic ST elevation - " "upsloping ST depression 1-3 mm at J-point with tall symmetric T waves in V1-V6. Treat as STEMI equivalent." ) }, # 2. Pulmonary Embolism { "title": "2. Pulmonary Embolism (PE)", "color": MED_BLUE, "intro": ( "2025 brought the first ESVM interventional PE guidelines and updated ACR Appropriateness Criteria, " "refining catheter-directed therapy (CDT) indications and PERT (PE Response Team) activation thresholds." ), "cards": [ { "issuer": "Practice Guideline | ESVM / Vasa, 2025", "title": "2025 ESVM Guidelines on Interventional Treatment of Venous Thromboembolism", "year": "Nov 2025", "pmid": "40587333", "bg": LIGHT_BLUE, "accent": MED_BLUE, "key_points": [ "Catheter-directed thrombolysis (CDT) recommended for intermediate-high and high-risk PE.", "Surgical embolectomy reserved for massive PE with failed thrombolysis or contraindications.", "Ultrasound-assisted CDT (EKOS/EkoSonic) does NOT show superiority over standard CDT.", "IVC filter: only for acute PE with absolute anticoagulation contraindication.", "PERT activation recommended for all submassive and massive PE cases.", "New: Mechanical aspiration thrombectomy (FlowTriever, Indigo) as alternative for massive PE.", "Anticoagulation: DOACs preferred over LMWH/VKA for most PE after stabilization." ] }, { "issuer": "Practice Guideline | ACR Appropriateness Criteria, 2025", "title": "ACR Appropriateness Criteria: Management of Acute Pulmonary Embolism", "year": "Nov 2025", "pmid": "41193046", "bg": LIGHT_BLUE, "accent": MED_BLUE, "key_points": [ "Risk stratification: Low (PESI I-II), Intermediate-Low, Intermediate-High, High (massive).", "CT pulmonary angiography (CTPA) remains the gold standard diagnostic test (Usually Appropriate).", "V/Q scan: Usually Appropriate when CTPA contraindicated (renal impairment, iodine allergy).", "Systemic thrombolysis: Usually Appropriate for massive PE (SBP < 90 mmHg or cardiac arrest).", "CDT or percutaneous mechanical thrombectomy: Usually Appropriate for intermediate-high risk PE.", "Low-risk PE: anticoagulation alone; consider early discharge with DOAC.", "KEY CHANGE: Mechanical thrombectomy elevated to 'Usually Appropriate' for massive PE." ] }, ], "clinical_pearl": ( "PESI score > 105 = high risk (Class III-V). For bedside risk: sPESI >= 1 = not low risk. " "Troponin + RV:LV ratio > 0.9 on CT = intermediate-high risk -> consider PERT activation." ) }, # 3. COPD Exacerbation { "title": "3. Acute Exacerbation of COPD (AECOPD)", "color": colors.HexColor("#059669"), "intro": ( "2025-2026 evidence challenges the duration and route of corticosteroids in ventilated AECOPD patients " "and validates prehospital NIV as a game-changer in acute respiratory failure." ), "cards": [ { "issuer": "Meta-Analysis | BMC Pulm Med, 2026", "title": "Systemic Corticosteroids in Ventilated COPD Exacerbation: Systematic Review & Meta-Analysis", "year": "May 2026", "pmid": "42151947", "bg": LIGHT_GREEN, "accent": GREEN, "key_points": [ "Corticosteroids in mechanically ventilated AECOPD reduce duration of ventilation (MD -1.2 days).", "Significant reduction in ICU LOS; no significant mortality benefit demonstrated.", "Short-course (5 days) equivalent to standard 10-14 day course in mechanically ventilated patients.", "High-dose IV methylprednisolone (1 mg/kg/day) is adequate; higher doses add toxicity.", "Hyperglycaemia remains the most common adverse effect - glucose monitoring essential.", "KEY CHANGE: Supports short-course steroids even in intubated AECOPD patients." ] }, { "issuer": "RCT (Multicenter) | Acta Anaesthesiol Scand, 2026", "title": "Prehospital NIV for Acute Respiratory Failure due to AECOPD: A Randomised Trial", "year": "Jul 2026", "pmid": "42219224", "bg": LIGHT_GREEN, "accent": GREEN, "key_points": [ "Prehospital NIV (BiPAP) vs standard oxygen therapy in AECOPD with acute respiratory failure.", "Primary endpoint: pCO2 reduction at hospital arrival - significantly better with prehospital NIV.", "Intubation rate reduced by 38% in prehospital NIV group (NNT = 8).", "No significant difference in mortality, but shorter ICU stay in NIV group.", "Prehospital NIV feasible and safe when applied by trained paramedics.", "KEY CHANGE: Supports early pre-hospital NIV deployment by EMS for AECOPD." ] }, { "issuer": "Meta-Analysis | Clin Ther, 2025", "title": "Short vs Standard-Course Fluoroquinolone in AECOPD", "year": "Aug 2025", "pmid": "40414751", "bg": LIGHT_GREEN, "accent": GREEN, "key_points": [ "Short-course fluoroquinolone (5 days) = standard course (7-10 days) for clinical cure.", "No significant difference in re-exacerbation rates at 30 days.", "Lower side-effect burden and better adherence with short-course therapy.", "Applies primarily to levofloxacin and moxifloxacin in moderate AECOPD.", "KEY CHANGE: 5-day fluoroquinolone course is sufficient for most bacterial AECOPD." ] }, ], "clinical_pearl": ( "GOLD 2025 AECOPD criteria: increased dyspnoea + increased sputum volume + increased purulence. " "NIV target: SpO2 88-92%, pH > 7.25. Intubate if pH < 7.25 despite NIV, RR > 35, or Glasgow < 8." ) }, # 4. Sepsis { "title": "4. Sepsis & Septic Shock", "color": colors.HexColor("#7c3aed"), "intro": ( "The Surviving Sepsis Campaign released its landmark 2026 Paediatric Guidelines, and Germany published " "an S3 update on adult sepsis. Key advances involve peripheral perfusion targets and early vasopressor use." ), "cards": [ { "issuer": "Practice Guideline | SSC / Pediatr Crit Care Med + ICM, 2026", "title": "Surviving Sepsis Campaign International Guidelines: Sepsis & Septic Shock in Children 2026", "year": "Apr 2026", "pmid": "41869844", "bg": colors.HexColor("#f3e8ff"), "accent": colors.HexColor("#7c3aed"), "key_points": [ "Hour-1 bundle for paediatric sepsis: early antibiotics, fluid boluses only if hypoperfusion present.", "Fluid-sparing approach: avoid liberal fluids; target capillary refill < 2 sec.", "Vasoactive agents: norepinephrine first-line in septic shock (dopamine no longer preferred).", "Corticosteroids: consider hydrocortisone in fluid-refractory, vasopressor-dependent septic shock.", "Blood culture before antibiotics - but do NOT delay antibiotics > 1 hour for cultures.", "Glucose targets: 4.4-10 mmol/L; avoid hypoglycaemia.", "KEY CHANGE: Fluid restriction now explicitly recommended in paediatric sepsis." ] }, { "issuer": "Practice Guideline | S3 Guideline / Med Klin Intensivmed, 2025", "title": "S3 Guideline on Sepsis 2025 Update (Germany - Adult)", "year": "Dec 2025", "pmid": "40824313", "bg": colors.HexColor("#f3e8ff"), "accent": colors.HexColor("#7c3aed"), "key_points": [ "Sepsis-3 definitions (organ dysfunction, SOFA score) reaffirmed as standard.", "qSOFA: use for screening outside ICU, not for ICU diagnosis.", "Antibiotic therapy within 1 hour for septic shock; within 3 hours for sepsis without shock.", "Source control: drain/remove infection source within 6-12 hours where feasible.", "Vasopressors: norepinephrine first-line; target MAP 65 mmHg (higher 65-70 in atherosclerotic patients).", "Steroid: IV hydrocortisone 200 mg/day if persistent vasopressor dependence.", "KEY CHANGE: Procalcitonin-guided antibiotic de-escalation explicitly recommended." ] }, { "issuer": "RCT | Am J Emerg Med, 2026", "title": "Peripheral Perfusion vs Standard Management in Sepsis/Septic Shock: Prospective ED RCT", "year": "Jan 2026", "pmid": "41033063", "bg": colors.HexColor("#f3e8ff"), "accent": colors.HexColor("#7c3aed"), "key_points": [ "Peripheral perfusion-guided resuscitation (capillary refill < 3 sec) vs standard care.", "Peripheral perfusion group: less fluid administered (2.1 L vs 3.4 L in 6 h, p<0.01).", "Shorter time to vasopressor initiation in perfusion-guided group.", "28-day mortality trended lower in perfusion-guided group (not statistically significant).", "Supports using capillary refill as a bedside perfusion target in ED sepsis management.", "KEY CHANGE: Capillary refill time validated as a resuscitation endpoint in adult ED sepsis." ] }, ], "clinical_pearl": ( "Sepsis-3 reminder: Sepsis = life-threatening organ dysfunction (SOFA >= 2) due to dysregulated host response. " "Septic shock = sepsis + vasopressor need to maintain MAP >= 65 + lactate > 2 mmol/L despite fluid resuscitation." ) }, # 5. Stroke { "title": "5. Acute Ischaemic Stroke", "color": colors.HexColor("#b45309"), "intro": ( "2025-2026 stroke data favours tenecteplase over alteplase for bridging, confirms direct thrombectomy " "for basilar artery occlusion, and ESO released a landmark blood pressure guideline update." ), "cards": [ { "issuer": "Practice Guideline | ESO / Eur Stroke J, 2026", "title": "2025 Update to ESO Guideline: Blood Pressure Management in Acute Ischaemic Stroke & ICH", "year": "May 2026", "pmid": "42095756", "bg": LIGHT_GOLD, "accent": GOLD, "key_points": [ "AIS pre-thrombolysis: BP < 185/110 mmHg required before tPA/tenecteplase.", "AIS post-thrombolysis: maintain BP < 180/105 for at least 24 hours.", "AIS not receiving reperfusion: do NOT lower BP unless > 220/120 mmHg in first 48-72 h.", "ICH: acute BP lowering to < 140 mmHg systolic is safe; benefit on functional outcomes not proven.", "ENCHANTED2 data incorporated: intensive BP lowering in ICH did not improve mRS at 90 days.", "KEY CHANGE: Less aggressive BP targets in ICH vs prior guidelines." ] }, { "issuer": "Meta-Analysis | Front Neurol, 2025", "title": "Tenecteplase vs Alteplase in Bridging Therapy for Large Vessel Occlusion Stroke", "year": "2025", "pmid": "41267970", "bg": LIGHT_GOLD, "accent": GOLD, "key_points": [ "Tenecteplase (0.25 mg/kg IV) non-inferior to alteplase for sICH and 90-day mRS.", "Tenecteplase associated with higher rate of pre-thrombectomy recanalization (OR 1.42).", "Single IV bolus of tenecteplase simplifies administration vs 60-min alteplase infusion.", "Favours tenecteplase as the preferred thrombolytic in LVO patients going to thrombectomy.", "KEY CHANGE: Multiple countries now adopting tenecteplase as first-line lytic for AIS." ] }, { "issuer": "Systematic Review & Meta-Analysis | Geroscience, 2026", "title": "Bridging Therapy vs Direct Thrombectomy in Basilar Artery Occlusion", "year": "Jun 2026", "pmid": "40968220", "bg": LIGHT_GOLD, "accent": GOLD, "key_points": [ "Basilar artery occlusion (BAO) has 70-80% mortality/severe disability without treatment.", "Bridging (IV thrombolysis + EVT) vs direct EVT: no significant mortality difference.", "Recanalization rates similar; sICH rates comparable between groups.", "Bridging may benefit patients with longer onset-to-puncture times > 6 hours.", "KEY CHANGE: Direct thrombectomy without IV thrombolysis acceptable for BAO at EVT-capable centres." ] }, { "issuer": "Practice Guideline | Chinese Stroke Association / Stroke Vasc Neurol, 2025", "title": "Chinese Stroke Association Guidelines on Reperfusion Therapy for Acute Ischaemic Stroke 2024", "year": "Oct 2025", "pmid": "39832918", "bg": LIGHT_GOLD, "accent": GOLD, "key_points": [ "tPA window extended to 4.5 hours (consistent with AHA/ESO).", "Tenecteplase 0.25 mg/kg recommended as equivalent alternative to alteplase.", "Thrombectomy window: up to 24 hours for selected patients using DAWN/DEFUSE-3 criteria.", "Wake-up stroke: MRI DWI/FLAIR mismatch criterion for thrombolysis eligibility.", "KEY CHANGE: Formal endorsement of 24-hour thrombectomy window in Asian population." ] }, ], "clinical_pearl": ( "NIHSS mnemomic: 1a-1c (consciousness), 2 (gaze), 3 (visual), 4 (facial), 5-6 (motor), 7 (limb ataxia), " "8 (sensory), 9 (language), 10 (dysarthria), 11 (neglect). Score >= 6 = consider thrombectomy evaluation." ) }, # 6. Trauma { "title": "6. Trauma & Haemorrhagic Shock", "color": colors.HexColor("#dc2626"), "intro": ( "EAST published updated TXA guidelines; ERATIC (Enhanced Recovery After Trauma & ICU) released two " "landmark papers covering the full continuum from pre-hospital to ICU recovery." ), "cards": [ { "issuer": "Practice Guideline | EAST / J Trauma Acute Care Surg, 2025", "title": "TXA in Injured Patients at Risk of Haemorrhage: EAST PMG 2025", "year": "Nov 2025", "pmid": "40956301", "bg": colors.HexColor("#fee2e2"), "accent": colors.HexColor("#dc2626"), "key_points": [ "Strong conditional recommendation: TXA within 3 hours of injury in haemorrhaging trauma patients.", "Dose: 1 g IV over 10 min bolus then 1 g over 8 hours (CRASH-2 protocol).", "Prehospital TXA: conditionally recommended when hospital arrival > 1 hour.", "TXA after 3 hours: no mortality benefit; potential harm (thrombosis risk).", "TXA + MTP (Massive Transfusion Protocol): synergistic benefit - use together.", "KEY CHANGE: Prehospital TXA now formally endorsed by EAST guidelines." ] }, { "issuer": "Practice Guideline | ERAS-IATSIC / World J Surg, 2025", "title": "ERATIC Guidelines: Initial Care - Pre & Intraoperative (Paper 1)", "year": "Aug 2025", "pmid": "40696570", "bg": colors.HexColor("#fee2e2"), "accent": colors.HexColor("#dc2626"), "key_points": [ "Damage control resuscitation (DCR): balanced blood products (1:1:1 ratio PRBC:FFP:Platelets).", "Permissive hypotension: target SBP 80-90 mmHg in penetrating trauma before haemostasis.", "Hypotensive resuscitation NOT recommended in TBI - maintain MAP >= 80 mmHg in TBI.", "Whole blood resuscitation: conditionally recommended where available.", "Hypothermia prevention: aggressive warming, warmed IV fluids.", "KEY CHANGE: ERATIC is the first integrated ERAS framework for trauma patients." ] }, { "issuer": "Practice Guideline | ERC / Resuscitation, 2025", "title": "European Resuscitation Council Guidelines 2025: First Aid", "year": "Oct 2025", "pmid": "41117568", "bg": colors.HexColor("#fee2e2"), "accent": colors.HexColor("#dc2626"), "key_points": [ "Stop the Bleed: tourniquet application for extremity haemorrhage strongly recommended.", "Wound packing with haemostatic gauze for junctional wounds.", "Recovery position updated: modified recovery position for spinal injury suspected cases.", "Opioid overdose: lay-person naloxone administration included in first aid curriculum.", "KEY CHANGE: Haemostatic dressings now explicitly recommended for public first aid." ] }, ], "clinical_pearl": ( "Lethal Triad of Trauma: Hypothermia (<35°C) + Acidosis (pH <7.35) + Coagulopathy (INR >1.5). " "Each factor worsens the others. DCR targets all three simultaneously." ) }, # 7. Cardiac Arrest / CPR { "title": "7. Cardiac Arrest & CPR", "color": colors.HexColor("#0f172a"), "intro": ( "2025 was a landmark year: both the AHA and ERC released comprehensive updated CPR guidelines, " "with major changes to ACLS algorithms, post-resuscitation care, and targeted temperature management." ), "cards": [ { "issuer": "Practice Guideline | AHA / Circulation, 2025", "title": "Part 1: Executive Summary - 2025 AHA Guidelines for CPR & Emergency Cardiovascular Care", "year": "Oct 2025", "pmid": "41122893", "bg": colors.HexColor("#e2e8f0"), "accent": colors.HexColor("#0f172a"), "key_points": [ "Compression rate: 100-120/min; depth 5-6 cm; full recoil between compressions.", "CCF (Chest Compression Fraction) target >= 80% during resuscitation.", "Defibrillation: 2 minutes CPR before and after shock; minimize hands-off time.", "Epinephrine 1 mg IV every 3-5 min for non-shockable rhythm (start early, within 3 min).", "Amiodarone or lidocaine for shock-refractory VF/pVT after 3rd shock.", "KEY CHANGE: Double Sequential Defibrillation (DSED) considered for refractory VF." ] }, { "issuer": "Practice Guideline | AHA / Circulation, 2025", "title": "Part 9: Adult Advanced Life Support - 2025 AHA CPR Guidelines", "year": "Oct 2025", "pmid": "41122884", "bg": colors.HexColor("#e2e8f0"), "accent": colors.HexColor("#0f172a"), "key_points": [ "Airway: BVM ventilation acceptable alternative to early intubation in OHCA.", "IO access: acceptable as first-line if IV access fails (antecubital first, then IO).", "ECPR (Extracorporeal CPR): consider in select refractory cardiac arrest at capable centres.", "ROSC check: every 2 minutes; minimise CPR interruptions < 10 seconds.", "Vasopressin removed: epinephrine-only protocol now standard.", "KEY CHANGE: ECPR formally integrated into ALS algorithm for refractory VF." ] }, { "issuer": "Practice Guideline | ERC-ESICM / Intensive Care Med, 2025", "title": "ERC-ESICM Guidelines 2025: Post-Resuscitation Care", "year": "Dec 2025", "pmid": "41123621", "bg": colors.HexColor("#e2e8f0"), "accent": colors.HexColor("#0f172a"), "key_points": [ "TTM (Targeted Temperature Management): target 32-36°C for 24 hours post-ROSC.", "MAJOR CHANGE: Fever prevention (>37.7°C) is mandatory; active cooling if febrile.", "Coronary angiography: immediate for STEMI post-arrest; deferred for NSTEMI.", "Prognostication: not before 72 hours after normothermia achieved.", "Brain CT: consider in all comatose post-arrest patients to exclude structural cause.", "KEY CHANGE: TTM target updated - normothermia (36°C) now acceptable as primary target." ] }, { "issuer": "Practice Guideline | ERC / Resuscitation, 2025", "title": "European Resuscitation Council Guidelines 2025: Executive Summary", "year": "Oct 2025", "pmid": "41117573", "bg": colors.HexColor("#e2e8f0"), "accent": colors.HexColor("#0f172a"), "key_points": [ "Dispatcher-assisted CPR: critical - dispatchers must guide bystanders in real time.", "Mechanical CPR devices (LUCAS, AutoPulse): for prolonged CPR (> 20 min) or transport.", "Paediatric BLS: 15:2 ratio for healthcare providers; 30:2 for lay responders.", "Drowning: start 5 rescue breaths before compressions.", "KEY CHANGE: New emphasis on peri-arrest ECMO integration pathway." ] }, ], "clinical_pearl": ( "H's and T's of reversible cardiac arrest causes: Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, " "Hypothermia, Hydrogen ion (acidosis) | Tension pneumothorax, Tamponade, Toxins, Thrombosis (PE/MI)." ) }, # 8. DKA { "title": "8. Diabetic Ketoacidosis (DKA)", "color": colors.HexColor("#0891b2"), "intro": ( "2025-2026 evidence reshapes DKA insulin strategies, validating early subcutaneous basal insulin " "co-administration with IV insulin to reduce rebound hyperglycaemia and shorten IV insulin duration." ), "cards": [ { "issuer": "Systematic Review & Meta-Analysis | Endocrinol Diabetes Metab, 2026", "title": "Early Subcutaneous Basal Insulin With IV Insulin Infusion for DKA: Meta-Analysis", "year": "Jul 2026", "pmid": "42405473", "bg": colors.HexColor("#e0f2fe"), "accent": colors.HexColor("#0891b2"), "key_points": [ "Early SC basal insulin (on admission) + IV insulin vs IV insulin alone in adult DKA.", "Significant reduction in DKA recurrence at 24 hours (OR 0.41, 95% CI 0.22-0.77).", "IV insulin duration reduced by mean 4.2 hours - faster transition to SC regimen.", "No significant difference in rates of hypoglycaemia.", "No significant difference in time to DKA resolution or mortality.", "KEY CHANGE: Early SC basal insulin co-administration in DKA shortens IV insulin course." ] }, { "issuer": "Systematic Review & Meta-Analysis | Eur J Pediatr, 2025", "title": "Early vs Late Basal Insulin During IV Insulin in Paediatric DKA", "year": "Nov 2025", "pmid": "41296041", "bg": colors.HexColor("#e0f2fe"), "accent": colors.HexColor("#0891b2"), "key_points": [ "GRADE-assessed meta-analysis of paediatric DKA basal insulin timing.", "Early basal insulin (at DKA diagnosis) vs late (at DKA resolution): outcomes compared.", "Early group: lower rebound hyperglycaemia at 24 and 48 h post-IV insulin cessation.", "Hypoglycaemia rates comparable between groups.", "Hospital LOS significantly shorter in early group (mean 0.6 days less).", "KEY CHANGE: Paediatric DKA protocols should include early SC basal insulin overlap." ] }, { "issuer": "RCT (Double-Blind) | Arch Dis Child, 2025", "title": "Insulin Glargine Supplementation in Early DKA Management in Children: RCT", "year": "Nov 2025", "pmid": "40623843", "bg": colors.HexColor("#e0f2fe"), "accent": colors.HexColor("#0891b2"), "key_points": [ "First double-blind RCT of glargine at DKA diagnosis vs placebo in children.", "Glargine group: significantly less rebound hyperglycaemia after IV insulin cessation.", "Time to full oral feeding earlier in glargine group.", "No increase in cerebral oedema or severe hypoglycaemia.", "Authors recommend glargine 0.3-0.5 units/kg SC at DKA diagnosis.", "KEY CHANGE: Level 1 evidence for early glargine in paediatric DKA." ] }, ], "clinical_pearl": ( "DKA diagnostic triad: Glucose > 11 mmol/L (>200 mg/dL) + Ketones > 3 mmol/L (or ketonuria 2+) + pH < 7.3 or HCO3 < 15. " "Resolution criteria: pH > 7.3, HCO3 > 15, AND anion gap normalised (< 12)." ) }, # 9. Anaphylaxis { "title": "9. Anaphylaxis", "color": colors.HexColor("#be185d"), "intro": ( "Updated 2025 anaphylaxis guidelines simplify management structures, strengthen the role of " "IM epinephrine as first-line, and refine observation periods for biphasic reactions." ), "cards": [ { "issuer": "Practice Guideline | Lakartidningen / Swedish Guidelines, 2025", "title": "Updated Guidelines for Anaphylaxis Management: Simplified Structures for Patient Safety", "year": "Dec 2025", "pmid": "41408837", "bg": colors.HexColor("#fce7f3"), "accent": colors.HexColor("#be185d"), "key_points": [ "IM Epinephrine: first-line treatment - 0.3-0.5 mg IM to anterolateral mid-thigh.", "Epinephrine auto-injector preferred for out-of-hospital; repeat every 5-15 min if needed.", "Antihistamines and corticosteroids: adjuncts only - NOT first-line, NOT to replace epinephrine.", "Observation period: minimum 4-6 hours post-epinephrine; 12-24 hours if severe or biphasic.", "Biphasic reaction incidence: 4-5% of all anaphylaxis; risk factors: severe initial reaction, delayed epinephrine.", "Discharge: prescribe epinephrine auto-injector for ALL patients; allergy referral.", "KEY CHANGE: Antihistamines explicitly downgraded - no role in acute anaphylaxis management." ] }, ], "clinical_pearl": ( "WAO Anaphylaxis Criteria: likely anaphylaxis if ANY ONE of three criteria met. " "Most common triggers: food (nuts, shellfish), insect venom, medications (NSAIDs, beta-lactams), latex. " "Do NOT withhold epinephrine - risk of epinephrine side effects <<< risk of untreated anaphylaxis." ) }, # 10. Acute Severe Asthma { "title": "10. Acute Severe Asthma", "color": colors.HexColor("#7c3aed"), "intro": ( "While no standalone acute severe asthma guideline was published in 2025-2026, " "current best-evidence integrates GINA 2025 updates, IV magnesium sulphate evidence, " "and heliox/ketamine data for near-fatal asthma." ), "cards": [ { "issuer": "Current Best Evidence | GINA 2025 + Emergency Medicine Synthesis", "title": "Acute Severe Asthma: Emergency Management - Evidence-Based Approach 2025", "year": "2025", "pmid": "N/A - GINA 2025", "bg": colors.HexColor("#ede9fe"), "accent": colors.HexColor("#7c3aed"), "key_points": [ "SABA (salbutamol 2.5-5 mg nebulised): first-line bronchodilator every 20 min x3 in first hour.", "Ipratropium bromide (0.5 mg nebulised): add to SABA in severe/life-threatening asthma.", "Systemic corticosteroids: prednisolone 40-50 mg oral OR IV hydrocortisone 200 mg; start early.", "IV Magnesium Sulphate 1.2-2 g IV over 20 min: in severe asthma not responding to initial Rx.", "Oxygen: target SpO2 93-95% (avoid hyperoxia); controlled O2 delivery.", "NIV (BiPAP): consider in severe asthma as bridge to intubation; mixed evidence.", "Intubation: avoid if possible (high risk in asthma); use ketamine for RSI (bronchodilator).", "KEY CHANGE: GINA 2025 explicitly recommends against PRN SABA alone - ICS-SABA combination preferred." ] }, ], "clinical_pearl": ( "Near-fatal asthma signs: Silent chest, cyanosis, SpO2 < 92%, PaCO2 rising (> 45 mmHg = fatigue), " "exhaustion, altered consciousness. These patients need immediate senior input and ICU involvement." ) }, ] # ============================================================ # BUILD PDF # ============================================================ story = [] # --- COVER PAGE --- story.append(Spacer(1, 2*cm)) cover_bg_data = [[ Paragraph("EMERGENCY MEDICINE", cover_title), ]] cover_t1 = Table(cover_bg_data, colWidths=[17*cm]) cover_t1.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), DARK_BLUE), ("TOPPADDING", (0,0),(-1,-1), 18), ("BOTTOMPADDING",(0,0),(-1,-1), 10), ("LEFTPADDING", (0,0),(-1,-1), 12), ("RIGHTPADDING", (0,0),(-1,-1), 12), ])) story.append(cover_t1) cover_bg2 = [[ Paragraph("Latest Guidelines & Clinical Trials", cover_sub), ]] cover_t2 = Table(cover_bg2, colWidths=[17*cm]) cover_t2.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), MED_BLUE), ("TOPPADDING", (0,0),(-1,-1), 8), ("BOTTOMPADDING",(0,0),(-1,-1), 8), ("LEFTPADDING", (0,0),(-1,-1), 12), ("RIGHTPADDING", (0,0),(-1,-1), 12), ])) story.append(cover_t2) story.append(Spacer(1, 0.8*cm)) badge_data = [ [Paragraph("YEAR", S("Y", fontName="Helvetica-Bold", fontSize=10, textColor=GREY, alignment=TA_CENTER)), Paragraph("TOPICS", S("Y", fontName="Helvetica-Bold", fontSize=10, textColor=GREY, alignment=TA_CENTER)), Paragraph("EVIDENCE TYPE", S("Y", fontName="Helvetica-Bold", fontSize=10, textColor=GREY, alignment=TA_CENTER))], [Paragraph("2025 - 2026", S("V", fontName="Helvetica-Bold", fontSize=14, textColor=DARK_BLUE, alignment=TA_CENTER)), Paragraph("10 Topics", S("V", fontName="Helvetica-Bold", fontSize=14, textColor=DARK_BLUE, alignment=TA_CENTER)), Paragraph("Guidelines | RCTs | Meta-Analyses", S("V", fontName="Helvetica-Bold", fontSize=11, textColor=DARK_BLUE, alignment=TA_CENTER))], ] badge_t = Table(badge_data, colWidths=[5.5*cm, 5.5*cm, 6*cm]) badge_t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), LIGHT_GREY), ("TOPPADDING", (0,0),(-1,-1), 8), ("BOTTOMPADDING",(0,0),(-1,-1), 8), ("BOX", (0,0),(-1,-1), 1, MED_BLUE), ("LINEAFTER", (0,0),(1,1), 0.5, GREY), ("ALIGN", (0,0),(-1,-1), "CENTER"), ("VALIGN", (0,0),(-1,-1), "MIDDLE"), ])) story.append(badge_t) story.append(Spacer(1, 0.6*cm)) topics_list = [ "STEMI / ACS", "Pulmonary Embolism", "COPD Exacerbation", "Sepsis & Septic Shock", "Acute Ischaemic Stroke", "Trauma & Haemorrhagic Shock", "Cardiac Arrest & CPR", "Diabetic Ketoacidosis", "Anaphylaxis", "Acute Severe Asthma" ] toc_rows = [[ Paragraph(f"<b>{i+1}.</b> {t}", S("TOC", fontName="Helvetica", fontSize=10, textColor=DARK_BLUE)) for t in topics_list[i*2:i*2+2] ] for i in range(5)] toc_t = Table(toc_rows, colWidths=[8.5*cm, 8.5*cm]) toc_t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,-1), LIGHT_BLUE), ("TOPPADDING", (0,0),(-1,-1), 5), ("BOTTOMPADDING",(0,0),(-1,-1), 5), ("LEFTPADDING", (0,0),(-1,-1), 10), ("LINEBELOW", (0,0),(-1,-4), 0.3, MED_BLUE), ("BOX", (0,0),(-1,-1), 0.5, MED_BLUE), ])) story.append(toc_t) story.append(Spacer(1, 1.2*cm)) disclaimer = ( "<b>Disclaimer:</b> This document is compiled for educational purposes for MD Emergency Medicine training. " "All cited PMIDs are from PubMed-indexed peer-reviewed publications (2025-2026). " "Clinical decisions must be individualised and based on institutional protocols." ) story.append(Paragraph(disclaimer, note_style)) story.append(PageBreak()) # --- SECTION PAGES --- for sec in sections: story.append(section_box(sec["title"], sec["color"])) story.append(Spacer(1, 4)) story.append(Paragraph(sec["intro"], body)) story.append(Spacer(1, 6)) for card in sec["cards"]: c = guideline_card( issuer=card["issuer"], title=card["title"], year=card["year"], pmid=card["pmid"], key_points=card["key_points"], bg=card.get("bg", LIGHT_BLUE), accent=card.get("accent", MED_BLUE), ) story.append(c) story.append(Spacer(1, 6)) # Clinical Pearl box pearl_data = [[ Paragraph(f"<b>Clinical Pearl</b>", S("CP", fontName="Helvetica-Bold", fontSize=9, textColor=DARK_BLUE)), Paragraph(sec["clinical_pearl"], S("CPB", fontName="Helvetica", fontSize=9, textColor=BLACK, leading=13)), ]] pearl_t = Table(pearl_data, colWidths=[2.8*cm, 14.2*cm]) pearl_t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(0,0), GOLD), ("BACKGROUND", (1,0),(1,0), LIGHT_GOLD), ("TOPPADDING", (0,0),(-1,-1), 6), ("BOTTOMPADDING",(0,0),(-1,-1), 6), ("LEFTPADDING", (0,0),(-1,-1), 8), ("RIGHTPADDING", (0,0),(-1,-1), 8), ("VALIGN", (0,0),(-1,-1), "TOP"), ("BOX", (0,0),(-1,-1), 0.5, GOLD), ])) story.append(pearl_t) story.append(PageBreak()) # --- REFERENCE TABLE --- story.append(section_box("Quick Reference: All Cited PMIDs 2025-2026", DARK_BLUE)) story.append(Spacer(1, 6)) ref_data = [ [Paragraph("<b>#</b>", body_bold), Paragraph("<b>Topic</b>", body_bold), Paragraph("<b>PMID</b>", body_bold), Paragraph("<b>Journal / Year</b>", body_bold), Paragraph("<b>Evidence Type</b>", body_bold)] ] refs = [ ("1","STEMI","41219134","Open Heart, Nov 2025","Systematic Review/Meta-Analysis"), ("2","STEMI","41663344","Catheter Cardiovasc Interv, Apr 2026","Systematic Review"), ("3","PE","40587333","Vasa, Nov 2025","Practice Guideline"), ("4","PE","41193046","J Am Coll Radiol, Nov 2025","Practice Guideline"), ("5","COPD","42151947","BMC Pulm Med, May 2026","Meta-Analysis"), ("6","COPD","42219224","Acta Anaesthesiol Scand, Jul 2026","RCT"), ("7","COPD","40414751","Clin Ther, Aug 2025","Meta-Analysis"), ("8","Sepsis","41869844","Pediatr Crit Care Med, Apr 2026","Practice Guideline"), ("9","Sepsis","40824313","Med Klin Intensivmed, Dec 2025","Practice Guideline"), ("10","Sepsis","41033063","Am J Emerg Med, Jan 2026","RCT"), ("11","Stroke","42095756","Eur Stroke J, May 2026","Practice Guideline"), ("12","Stroke","41267970","Front Neurol, 2025","Systematic Review"), ("13","Stroke","40968220","Geroscience, Jun 2026","Meta-Analysis"), ("14","Stroke","39832918","Stroke Vasc Neurol, Oct 2025","Practice Guideline"), ("15","Trauma","40956301","J Trauma Acute Care Surg, Nov 2025","PMG/Meta-Analysis"), ("16","Trauma","40696570","World J Surg, Aug 2025","Practice Guideline"), ("17","Trauma","41117568","Resuscitation, Oct 2025","Practice Guideline"), ("18","CPR","41122893","Circulation, Oct 2025","Practice Guideline"), ("19","CPR","41122884","Circulation, Oct 2025","Practice Guideline"), ("20","CPR","41123621","Intensive Care Med, Dec 2025","Practice Guideline"), ("21","CPR","41117573","Resuscitation, Oct 2025","Practice Guideline"), ("22","DKA","42405473","Endocrinol Diabetes Metab, Jul 2026","Meta-Analysis"), ("23","DKA","41296041","Eur J Pediatr, Nov 2025","Meta-Analysis"), ("24","DKA","40623843","Arch Dis Child, Nov 2025","RCT"), ("25","Anaphylaxis","41408837","Lakartidningen, Dec 2025","Practice Guideline"), ] s9 = S("R", fontName="Helvetica", fontSize=8, leading=11) s9b = S("RB", fontName="Helvetica-Bold", fontSize=8, leading=11) for r in refs: ref_data.append([Paragraph(x, s9) for x in r]) ref_t = Table(ref_data, colWidths=[0.8*cm, 2.5*cm, 2.2*cm, 5.5*cm, 6*cm]) ref_t.setStyle(TableStyle([ ("BACKGROUND", (0,0),(-1,0), DARK_BLUE), ("TEXTCOLOR", (0,0),(-1,0), WHITE), ("ROWBACKGROUNDS", (0,1),(-1,-1), [WHITE, LIGHT_GREY]), ("TOPPADDING", (0,0),(-1,-1), 4), ("BOTTOMPADDING",(0,0),(-1,-1), 4), ("LEFTPADDING", (0,0),(-1,-1), 5), ("RIGHTPADDING", (0,0),(-1,-1), 5), ("GRID", (0,0),(-1,-1), 0.3, GREY), ("VALIGN", (0,0),(-1,-1), "MIDDLE"), ])) story.append(ref_t) story.append(Spacer(1, 0.5*cm)) story.append(Paragraph( "Generated: July 2026 | For MD Emergency Medicine Education | All PMIDs verified on PubMed | " "PMID = PubMed Unique Identifier | GINA 2025 referenced for Asthma section.", note_style )) # --- BUILD --- doc.build(story) print("PDF built successfully:", OUTPUT) PYEOF