Airway Fire Protocol in Laser Surgery

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Laser Airway Surgery - Anaesthesia";
pres.author = "MD Anaesthesiology Revision";

// ── Colour Palette ──────────────────────────────────────────────
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};

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// ── Helper: footer ────────────────────────────────────────────────
function addFooter(slide, text = "MD Anaesthesiology Revision  |  Laser Airway Surgery") {
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// ═══════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════
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  // subtitle
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  // tagline
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  // bullet topics at bottom
  const topics = [
    "Fire Triad & Pathophysiology",
    "Laser Types & Properties",
    "ETT Selection",
    "Prevention Protocol",
    "Airway Fire Management",
    "Post-Fire Care"
  ];
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW / CONTENTS
// ═══════════════════════════════════════════════════════════════
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    { n: "1", title: "Fire Triad", sub: "Fuel · Oxidiser · Ignition" },
    { n: "2", title: "Laser Types", sub: "CO₂, KTP, Nd:YAG" },
    { n: "3", title: "ETT Selection", sub: "PVC vs laser-safe tubes" },
    { n: "4", title: "Prevention", sub: "FiO₂, N₂O, cuff management" },
    { n: "5", title: "Ventilation Strategies", sub: "Jet, apnoea, HFJV" },
    { n: "6", title: "Airway Fire Protocol", sub: "Step-by-step algorithm" },
    { n: "7", title: "Post-Fire Management", sub: "ICU, bronchoscopy, steroids" },
    { n: "8", title: "Key Exam Points", sub: "High-yield facts" },
  ];

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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 3 — FIRE TRIAD
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addHeader(s, "The Fire Triad (Fire Tetrahedron)", C.red);

  // Central concept box
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  s.addText("ALL THREE must be present", {
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  const triad = [
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      items: ["PVC / rubber ETT", "Dry gauze / pledgets", "Surgical drapes", "Charred tissue", "Airway mucosa"]
    },
    {
      label: "OXIDISER", color: C.red, x: 3.5,
      items: ["Oxygen > 21%", "Nitrous oxide (oxidiser)", "PVC ETT ignites at 25% O₂", "O₂ + N₂O = greatest risk"]
    },
    {
      label: "IGNITION", color: C.navy, x: 6.75,
      items: ["CO₂ laser", "Nd:YAG laser", "KTP laser", "Electrocautery (ESU)", "Electrosurgery unit"]
    }
  ];

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    x: 0.35, y: 5.05, w: 9.3, h: 0.36,
    fontSize: 10, bold: true, color: C.red,
    valign: "middle", margin: 0
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 4 — LASER TYPES
// ═══════════════════════════════════════════════════════════════
{
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  s.background = { color: C.offWhite };
  addHeader(s, "Types of Lasers Used in Airway Surgery", C.teal);

  const lasers = [
    {
      name: "CO₂ Laser",
      wl: "10,600 nm",
      color: C.teal,
      props: ["Interacts with water & any surface", "Used for airway resection / papilloma", "Clear glass safety goggles sufficient", "Cannot be fibre-optic guided", "Most common cause of airway fire"],
      use: "Microlaryngoscopy, papillomatosis"
    },
    {
      name: "KTP Laser",
      wl: "532 nm",
      color: C.green,
      props: ["Potassium titanyl phosphate", "Interacts with tissue pigment", "Tinted/wavelength-specific goggles", "Delivered via flexible glass fibre", "Through bronchoscope — distal to ETT"],
      use: "Vascular lesions, haemangioma"
    },
    {
      name: "Nd:YAG Laser",
      wl: "1,064 nm",
      color: C.mid,
      props: ["Neodymium:yttrium aluminium garnet", "Deep tissue penetration", "Tinted/wavelength-specific goggles", "Fibre-optic delivery via bronchoscope", "Compatible tubes not in half-sizes"],
      use: "Tracheal/bronchial tumours"
    }
  ];

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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 5 — ETT SELECTION
// ═══════════════════════════════════════════════════════════════
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  s.background = { color: C.offWhite };
  addHeader(s, "ETT Selection for Laser Airway Surgery", C.teal);

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      { text: "Advantages", options: { bold: true, color: C.white, fill: { color: C.navy }, align: "center" } },
      { text: "Disadvantages", options: { bold: true, color: C.white, fill: { color: C.navy }, align: "center" } },
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      { text: "PVC", options: { bold: true, color: C.red } },
      "Inexpensive; nonreflective",
      { text: "Ignites at 25% O₂; highly combustible", options: { color: C.red } }
    ],
    [
      { text: "Red Rubber", options: { bold: true, color: C.orange } },
      "Puncture-resistant; nonreflective",
      { text: "Highly combustible", options: { color: C.orange } }
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    [
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      "Nonreflective",
      { text: "Combustible; burns to toxic ash", options: { color: C.orange } }
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    [
      { text: "Metal (Norton/Laser-Flex)", options: { bold: true, color: C.green } },
      { text: "Combustion-resistant; kink-resistant", options: { color: C.green } },
      "Flammable cuff; reflects laser; bulky; transfers heat"
    ],
    [
      { text: "Laser-Safe (Lasertubus/Sheridan)", options: { bold: true, color: C.teal } },
      { text: "Double-cuffed; indicator dye; purpose-made", options: { color: C.teal } },
      "Large OD; not for small infants; expensive"
    ],
  ];

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    valign: "middle", margin: 0
  });

  // Foil wrapping warning
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  s.addText("✗  Metallic foil wrapping of PVC tubes is OBSOLETE & NOT FDA-approved — adhesive ignites; laser can penetrate; edges damage mucosa.", {
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    fontSize: 10, bold: false, color: C.red,
    valign: "middle", margin: 0
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  addFooter(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 6 — PREVENTION (2 columns)
// ═══════════════════════════════════════════════════════════════
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  s.background = { color: C.offWhite };
  addHeader(s, "Prevention of Airway Fire — Anaesthesiologist's Checklist", C.green);

  const left = [
    { head: "Surgical Time-Out", items: ["Discuss fire risk with entire team", "Assign roles: who stops laser, removes ETT, pours saline", "Post laser warning signs on OR doors", "Ensure correct wavelength eye protection for all"] },
    { head: "Gas Management", items: ["Target FiO₂ < 0.30 (30%) — use air as carrier", "Avoid N₂O entirely (oxidiser)", "Many patients tolerate FiO₂ = 21%", "Confirm FiO₂ on end-tidal analyser before laser fires", "Use TIVA (propofol) — avoids volatile agents"] },
  ];

  const right = [
    { head: "ETT Cuff Management", items: ["Fill cuffs with saline (not air)", "Add methylene blue dye — visible indicator of cuff puncture", "Use double-cuffed laser-safe ETT", "Position cuff well below vocal cords"] },
    { head: "Surgical Technique", items: ["Laser in STANDBY when not in use", "Surgeon gives notice before firing", "Pulsed mode, minimum power", "Saline-soaked pledgets around ETT", "Avoid lasing charred / adipose tissue", "Limit continuous lasing to < 5 seconds", "60 mL saline syringe at field immediately available"] },
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      yOff += 0.1;
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  renderSection(right, 5.0);

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  addFooter(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 7 — VENTILATION STRATEGIES
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addHeader(s, "Ventilation Strategies for Laser Airway Surgery", C.teal);

  const strategies = [
    {
      name: "Intubation\n(Laser-Safe ETT)",
      color: C.mid,
      pros: "Standard; familiar; controlled ventilation",
      cons: "ETT = fuel source in field; limits posterior view",
      note: "TIVA + laser-safe ETT + FiO₂ <0.3"
    },
    {
      name: "Intermittent\nApnoea & Mask",
      color: C.teal,
      pros: "ETT-free during lasing; high FiO₂ tolerated",
      cons: "Limited operative time; repeated handling",
      note: "SpO₂-guided; re-oxygenate between bursts"
    },
    {
      name: "Jet Ventilation\n(Sanders)",
      color: C.green,
      pros: "ETT-free; excellent laryngeal view",
      cons: "Pneumothorax risk; gastric distension; drying; HPV spread",
      note: "Via rigid bronchoscope above/below cords"
    },
    {
      name: "HFJV",
      color: C.navy,
      pros: "Continuous gas exchange; ETT-free",
      cons: "Barotrauma risk; specialised equipment",
      note: "High frequency jet ventilation; 60-150 breaths/min"
    },
    {
      name: "Spontaneous\nVentilation",
      color: C.orange,
      pros: "Unobstructed view; no ETT",
      cons: "Deep anaesthesia needed; laryngospasm; hypoventilation",
      note: "Propofol + sevoflurane via side port"
    },
  ];

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      { text: st.pros + "\n\n", options: { fontSize: 9, color: C.text, breakLine: false } },
      { text: "CONS\n", options: { bold: true, color: C.red, fontSize: 8.5, breakLine: false } },
      { text: st.cons + "\n\n", options: { fontSize: 9, color: C.text, breakLine: false } },
      { text: "NOTE: ", options: { bold: true, color: st.color, fontSize: 8, breakLine: false } },
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      valign: "top", margin: 2
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 8 — AIRWAY FIRE PROTOCOL (step-by-step)
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "1A0A00" };  // very dark warm bg for urgency

  // Header — full red
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.75,
    fill: { color: C.red }, line: { color: C.red }
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  s.addText("🔥  AIRWAY FIRE PROTOCOL — IMMEDIATE MANAGEMENT", {
    x: 0.2, y: 0, w: 9.6, h: 0.75,
    fontSize: 17, bold: true, color: C.white,
    valign: "middle", margin: 0
  });

  // Mnemonic badge
  addCard(s, 7.45, 0.88, 2.4, 0.52, C.amber, C.orange);
  s.addText("STOP · DROP · POUR · SCOPE", {
    x: 7.45, y: 0.88, w: 2.4, h: 0.52,
    fontSize: 9, bold: true, color: C.navy,
    align: "center", valign: "middle", margin: 0
  });

  const steps = [
    { n: "1", action: "STOP VENTILATION", detail: "Cease all ventilation immediately\nStop the laser / ESU", color: C.red },
    { n: "2", action: "REMOVE THE ETT", detail: "Remove burning ETT from the airway\nSubmerge ETT in water/saline", color: C.red },
    { n: "3", action: "DISCONNECT ALL GASES", detail: "Turn off O₂ at the machine\nDisconnect breathing circuit\nStop N₂O and all volatiles", color: C.orange },
    { n: "4", action: "POUR SALINE INTO AIRWAY", detail: "Pour 60 mL saline directly into trachea\nRemove all flammable pledgets/gauze", color: C.orange },
    { n: "5", action: "REVENTILATE", detail: "Mask ventilate once fire extinguished\nAvoid supplemental O₂ initially\nReintubate before oedema develops", color: C.amber },
    { n: "6", action: "BRONCHOSCOPY + ASSESS", detail: "Mandatory: confirm fire out, remove debris\nAssess thermal injury extent\nSerial CXR + ABG monitoring\nConsider ICU transfer, steroids", color: C.teal },
  ];

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    const row = Math.floor(i / 2);
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    const y = 1.52 + row * 1.26;

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    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 4.65, h: 1.12,
      fill: { color: "2A1500" },
      line: { color: step.color, pt: 1.5 }
    });
    // step number
    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 0.48, h: 1.12,
      fill: { color: step.color }, line: { color: step.color }
    });
    s.addText("STEP\n" + step.n, {
      x, y, w: 0.48, h: 1.12,
      fontSize: 11, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
    s.addText(step.action, {
      x: x + 0.58, y: y + 0.06, w: 3.95, h: 0.36,
      fontSize: 12, bold: true, color: step.color,
      valign: "middle", margin: 0
    });
    s.addText(step.detail, {
      x: x + 0.58, y: y + 0.42, w: 3.95, h: 0.65,
      fontSize: 9.5, color: "D0C0A0",
      valign: "top", margin: 0
    });
  });

  // Bottom mnemonic
  s.addText("Memory Aid:  STOP – DISCONNECT – POUR – REASSESS – SCOPE", {
    x: 0.2, y: 5.28, w: 9.6, h: 0.3,
    fontSize: 9.5, bold: true, color: C.amber,
    align: "center", valign: "middle", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 9 — POST-FIRE MANAGEMENT
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addHeader(s, "Post-Fire Management & Complications", C.red);

  // Immediate actions (left column)
  addCard(s, 0.25, 0.88, 4.55, 4.45, C.white, C.teal);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.25, y: 0.88, w: 4.55, h: 0.38,
    fill: { color: C.teal }, line: { color: C.teal }
  });
  s.addText("IMMEDIATE ACTIONS", {
    x: 0.25, y: 0.88, w: 4.55, h: 0.38,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", margin: 0
  });
  const immediateItems = [
    "Transfer to ICU for monitoring",
    "Prolonged intubation or tracheostomy if severe oedema",
    "IV corticosteroids (dexamethasone) — reduce airway oedema",
    "Humidified O₂ + bronchodilators (nebulised salbutamol)",
    "Nebulised N-acetylcysteine — mucosal protection",
    "Broad-spectrum antibiotics if aspiration/infection risk",
    "Repeated bronchoscopy to remove debris / assess progress",
    "Medicolegal notification and incident documentation",
  ];
  s.addText(immediateItems.map((item, i) => ({
    text: item + (i < immediateItems.length - 1 ? "\n" : ""),
    options: { bullet: { code: "25B8" }, fontSize: 10, color: C.text, breakLine: i < immediateItems.length - 1 }
  })), {
    x: 0.4, y: 1.34, w: 4.25, h: 3.85,
    valign: "top", margin: 2
  });

  // Complications (right column)
  addCard(s, 5.1, 0.88, 4.65, 4.45, C.white, C.red);
  s.addShape(pres.shapes.RECTANGLE, {
    x: 5.1, y: 0.88, w: 4.65, h: 0.38,
    fill: { color: C.red }, line: { color: C.red }
  });
  s.addText("COMPLICATIONS TO MONITOR", {
    x: 5.1, y: 0.88, w: 4.65, h: 0.38,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", margin: 0
  });

  const compGroups = [
    { timing: "Immediate", items: ["Acute airway oedema & obstruction", "Thermal/chemical tracheobronchitis", "Retained foreign body (ETT debris)"] },
    { timing: "Early (24–72 hr)", items: ["ARDS from inhalation injury", "Aspiration pneumonia", "Respiratory failure"] },
    { timing: "Late (weeks–months)", items: ["Tracheal/subglottic stenosis", "Tracheomalacia", "Bronchiectasis"] },
  ];

  let yComp = 1.34;
  compGroups.forEach(grp => {
    s.addText(grp.timing, {
      x: 5.25, y: yComp, w: 4.3, h: 0.28,
      fontSize: 10, bold: true, color: C.red,
      valign: "middle", margin: 0
    });
    yComp += 0.28;
    grp.items.forEach(item => {
      s.addText([{ text: item, options: { bullet: { code: "2022" }, fontSize: 10, color: C.text } }], {
        x: 5.35, y: yComp, w: 4.25, h: 0.28,
        valign: "middle", margin: 0
      });
      yComp += 0.28;
    });
    yComp += 0.08;
  });

  addFooter(s);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 10 — HIGH-YIELD EXAM POINTS
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };

  // Header
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.72,
    fill: { color: C.amber }, line: { color: C.amber }
  });
  s.addText("HIGH-YIELD EXAM POINTS  — Laser Airway Surgery", {
    x: 0.2, y: 0, w: 9.6, h: 0.72,
    fontSize: 17, bold: true, color: C.navy,
    valign: "middle", margin: 0
  });

  const points = [
    { n: "1", text: "Fire triad: Fuel + Oxidiser + Ignition. All three must be present for fire." },
    { n: "2", text: "PVC ETT ignites at as low as 25% O₂ — it is NEVER safe in laser surgery." },
    { n: "3", text: "No ETT is completely laser-proof — precautions reduce but do not eliminate risk." },
    { n: "4", text: "Methylene blue in cuff saline = visual indicator of cuff rupture by laser." },
    { n: "5", text: "N₂O is an oxidiser — absolutely contraindicated in all laser airway procedures." },
    { n: "6", text: "First step in airway fire: STOP ventilation AND remove ETT simultaneously." },
    { n: "7", text: "Pour saline into the airway — do NOT use CO₂ extinguisher inside the trachea." },
    { n: "8", text: "Bronchoscopy is MANDATORY after every airway fire — remove debris, assess injury." },
    { n: "9", text: "Continuous lasing > 5 seconds raises fire risk ×72 (Barash). Avoid charred tissue (×98)." },
    { n: "10", text: "TIVA + FiO₂ < 0.3 + laser-safe double-cuffed ETT = standard prevention triad." },
  ];

  // Two columns
  points.forEach((p, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.2 + col * 5.0;
    const y = 0.88 + row * 0.92;
    const highlightColor = i < 3 ? C.red : i < 7 ? C.amber : C.teal;

    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 4.72, h: 0.78,
      fill: { color: "1A2840" }, line: { color: highlightColor, pt: 1 }
    });
    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 0.44, h: 0.78,
      fill: { color: highlightColor }, line: { color: highlightColor }
    });
    s.addText(p.n, {
      x, y, w: 0.44, h: 0.78,
      fontSize: 15, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
    s.addText(p.text, {
      x: x + 0.54, y, w: 4.08, h: 0.78,
      fontSize: 9.5, color: C.light,
      valign: "middle", margin: [0, 4, 0, 0]
    });
  });

  // Bottom source line
  s.addText("Sources: Miller's Anesthesia 10e  |  Barash Clinical Anesthesia 9e  |  Morgan & Mikhail 7e  |  ASA Practice Advisory on OR Fires", {
    x: 0.2, y: 5.3, w: 9.6, h: 0.28,
    fontSize: 8, color: C.muted, align: "center", valign: "middle", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/laser-airway-pptx/Laser_Airway_Surgery_Anaesthesia.pptx" })
  .then(() => console.log("DONE: Laser_Airway_Surgery_Anaesthesia.pptx written"))
  .catch(err => { console.error(err); process.exit(1); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/laser-airway-pptx/generate.js'