python3 << 'EOF' import pdfplumber pdf_path = "/tmp/workspace/attachments/33d0e876-5cf9-4d96-88a9-1de12599a4c4/CMC Vellore Handbook of Emergency Medicine 3ed 2022 - Abhilash K (1).pdf" with pdfplumber.open(pdf_path) as pdf: print(f"Total pages: {len(pdf.pages)}") # Extract first 10 pages to see structure / table of contents for i, page in enumerate(pdf.pages[:12]): text = page.extract_text() if text: print(f"\n--- PAGE {i+1} ---") print(text[:2000]) EOF

ls /tmp/workspace/attachments/ 2>/dev/null || echo "No attachments dir"; ls /tmp/workspace/ 2>/dev/null

mkdir -p /tmp/workspace/cmc-em-notes && cat > /tmp/workspace/cmc-em-notes/study_notes.md << 'NOTES' # CMC Vellore Handbook of Emergency Medicine (3rd Ed, 2022) ## High-Yield Study Notes --- ## TOPIC 1: APPROACH TO THE EMERGENCY PATIENT — PRIMARY SURVEY (ABCDE) ### Airway - Assess patency: look, listen, feel - Maneuvers: chin lift, jaw thrust (if trauma suspect) - Adjuncts: oropharyngeal airway (OPA), nasopharyngeal airway (NPA) - Definitive: RSI (Rapid Sequence Intubation) — gold standard for airway control ### RSI Drug Protocol (CMC) | Step | Drug | Dose | |------|------|------| | Pretreatment | Atropine (peds <1yr) | 0.02 mg/kg | | Induction | Ketamine | 1–2 mg/kg IV | | | Propofol | 1–2 mg/kg IV | | | Midazolam | 0.1–0.2 mg/kg IV | | Paralysis | Succinylcholine | 1.5 mg/kg IV | | | Rocuronium | 1.2 mg/kg IV | ### Breathing - Assess RR, SpO2, tracheal deviation, breath sounds - Life-threatening: Tension pneumothorax, Massive haemothorax, Open pneumothorax, Flail chest ### Circulation - IV access × 2 large bore (14–16G) - Fluid resuscitation: Crystalloid (NS/RL) 20 ml/kg bolus - FAST exam for abdominal bleeding ### Disability - GCS (Eyes 4, Verbal 5, Motor 6 = 15 total) - Pupils: PERLA - Blood glucose ### Exposure - Full exposure, prevent hypothermia - AMPLE history: Allergies, Medications, Past illness, Last meal, Events --- ## TOPIC 2: CARDIAC ARREST & CPR ### Adult BLS (2020 AHA) - Compression rate: 100–120/min - Compression depth: 5–6 cm - Ratio: 30:2 (single rescuer), 30:2 (two rescuers until advanced airway) - Minimize interruptions: <10 seconds - Hands-only CPR acceptable for witnessed cardiac arrest ### Shockable vs Non-Shockable Rhythms | Shockable | Non-Shockable | |-----------|---------------| | VF | Asystole | | Pulseless VT | PEA | ### Defibrillation - Biphasic: 200 J (or manufacturer recommended) - Monophasic: 360 J ### ACLS Drugs | Drug | Dose | Indication | |------|------|-----------| | Adrenaline (Epinephrine) | 1 mg IV q3–5 min | VF/VT + PEA/Asystole | | Amiodarone | 300 mg IV (then 150 mg) | Shock-refractory VF/VT | | Lidocaine | 1–1.5 mg/kg IV | VF/VT (if amiodarone unavailable) | | Atropine | NOT recommended | PEA/Asystole (removed from algorithm) | ### 4 H's and 4 T's (Reversible Causes) - **4 H's**: Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, Hypothermia - **4 T's**: Tension pneumothorax, Tamponade, Toxins, Thrombosis (PE/MI) ### Post-ROSC Care - Target SpO2: 94–98% - Target PaCO2: 35–45 mmHg (normocapnia) - Targeted Temperature Management (TTM): 32–36°C for 24 hours - Avoid hypotension: MAP >65 mmHg --- ## TOPIC 3: ACUTE CORONARY SYNDROME (ACS) ### Classification | Type | ECG | Troponin | |------|-----|---------| | STEMI | ST elevation ≥1mm (≥2mm V1–V4) | Elevated | | NSTEMI | ST depression / T inversion | Elevated | | Unstable Angina | ST depression / T inversion | NORMAL | ### STEMI Management (Door-to-Balloon: <90 min) 1. Oxygen (only if SpO2 <94%) 2. Aspirin 325 mg stat (loading dose) 3. Clopidogrel 600 mg OR Ticagrelor 180 mg loading 4. IV morphine 2–4 mg for pain 5. IV nitrates (contraindicated if RV infarct, systolic BP <90) 6. Anticoagulation: Heparin UFH or LMWH 7. Primary PCI preferred over thrombolysis ### Thrombolysis in STEMI (if PCI unavailable within 2 hrs) - Streptokinase: 1.5 million units over 60 min - tPA (Alteplase): 15 mg bolus + 0.75 mg/kg over 30 min + 0.5 mg/kg over 60 min - Contraindications: Prior intracranial bleed, stroke <3 months, active internal bleeding, suspected aortic dissection, BP >185/110 ### Right Ventricular Infarct - ECG: ST elevation in V3R, V4R - Clinical: Hypotension + raised JVP + clear lungs (Kussmaul's sign) - Management: IV fluids (avoid nitrates, diuretics), inotropes if needed --- ## TOPIC 4: ACUTE PULMONARY OEDEMA (APO) ### Presentation - Acute dyspnoea, orthopnoea, pink frothy sputum - Elevated JVP, S3 gallop, bilateral crepitations ### Management (LMNOP) - **L** — Lasix (Furosemide) 40–80 mg IV - **M** — Morphine 2–4 mg IV (reduces anxiety, preload) - **N** — Nitrates IV/SL (reduce preload) — contraindicated if BP <90 - **O** — Oxygen (high flow; NIV preferred: CPAP/BiPAP) - **P** — Position (sit upright) ### NIV in APO - CPAP: PEEP 5–10 cmH2O — first choice - BiPAP: IPAP 10–15 / EPAP 5 cmH2O — if hypercapnic - Reduces need for intubation, decreases mortality --- ## TOPIC 5: HYPERTENSIVE EMERGENCIES ### Definition - Hypertensive Emergency: BP >180/120 mmHg WITH end-organ damage - Hypertensive Urgency: BP >180/120 mmHg WITHOUT end-organ damage ### End-Organ Damage - Brain: Hypertensive encephalopathy, Stroke, ICH - Heart: Acute MI, Acute LVF - Kidney: Acute kidney injury - Eye: Papilloedema, flame haemorrhages - Aorta: Aortic dissection ### Management - Goal: Reduce MAP by 20–25% in first hour; NOT to normal immediately - **Aortic dissection**: Esmolol + Sodium Nitroprusside (target SBP <120) - **Hypertensive encephalopathy**: Labetalol IV or Nicardipine IV - **ICH**: Labetalol or Nicardipine (target <140) - **Eclampsia**: MgSO4 + Hydralazine/Labetalol - **Phaeochromocytoma**: Phentolamine (alpha blocker first, then beta) --- ## TOPIC 6: ACUTE ASTHMA ### Severity Assessment | Feature | Moderate | Severe | Life-threatening | |---------|----------|--------|-----------------| | SpO2 | >92% | <92% | <92% | | PEFR | 50–75% | 33–50% | <33% | | Speech | Normal sentences | Words only | Unable to speak | | RR | <25 | >25 | >30 | | HR | <110 | >110 | Bradycardia | | Consciousness | Alert | Alert | Confused/drowsy | ### Management 1. Oxygen: target SpO2 94–98% 2. Salbutamol (Albuterol) nebulised 2.5–5 mg q20 min × 3, then continuous 3. Ipratropium bromide 0.5 mg neb (add in severe) 4. IV Hydrocortisone 100–200 mg OR oral Prednisolone 40–50 mg 5. IV Magnesium sulphate 2 g over 20 min (severe/life-threatening) 6. Heliox, Ketamine infusion, IV Aminophylline (last resort) 7. NIV/Intubation if deteriorating ### Indicators for ICU/Intubation - Silent chest, PEFR <33%, Cyanosis, Exhaustion, Altered consciousness, PaCO2 >45 mmHg --- ## TOPIC 7: STROKE ### FAST Recognition - **F** — Face drooping - **A** — Arm weakness - **S** — Speech difficulty - **T** — Time to call emergency ### Classification | Type | CT Finding | Management | |------|-----------|------------| | Ischaemic (80%) | Hypodense area (may be normal early) | tPA if eligible; aspirin | | Haemorrhagic (20%) | Hyperdense area | Neurosurgery referral; BP control | ### Thrombolysis in Ischaemic Stroke (tPA / Alteplase) - Window: within 4.5 hours of symptom onset - Dose: 0.9 mg/kg (max 90 mg); 10% as bolus, rest over 60 min - BP must be <185/110 before giving - Contraindications: haemorrhagic stroke, INR >1.7, platelets <100k, prior stroke within 3 months, recent surgery ### BP Management in Stroke - Ischaemic stroke: Permit hypertension up to 220/120 (permissive hypertension, unless thrombolysis) - If thrombolysis: maintain BP <185/110 during and after --- ## TOPIC 8: DIABETIC EMERGENCIES ### Hypoglycaemia - Definition: Blood glucose <70 mg/dL (<3.9 mmol/L) - Symptoms: Sweating, tremors, palpitations, confusion, seizures - Treatment: - Conscious: 15 g fast-acting carbs (glucose tabs, OJ) - Unconscious: 25 ml of 50% dextrose IV OR 1 mg glucagon IM/SC ### Diabetic Ketoacidosis (DKA) - Diagnostic triad: Hyperglycaemia (>250 mg/dL) + Ketosis + Metabolic acidosis (pH <7.3, HCO3 <18) - Precipitants: Infections, missed insulin, new-onset T1DM #### DKA Management (CMC Protocol) 1. **Fluids**: NS 1 L over 1 hr → 1 L over 2 hr → 1 L over 4 hr → 1 L over 8 hr - Switch to D5NS when glucose <250 mg/dL 2. **Insulin**: Regular insulin 0.1 units/kg/hr IV infusion (no bolus) 3. **Potassium**: Start K replacement when K <5.5 and urine output confirmed - K <3.5: hold insulin, give 40 mEq/hr - K 3.5–5.5: give 20–40 mEq/hr with fluids 4. **Bicarbonate**: Only if pH <6.9 (50 mEq NaHCO3 in 200 ml NS over 2 hr) 5. **Phosphate**: Replace only if symptomatic (<1 mg/dL) ### Hyperglycaemic Hyperosmolar State (HHS) - No significant ketosis, glucose >600 mg/dL, osmolality >320 mOsm/kg - Older T2DM patients - Treatment: Slow fluid replacement (NS), insulin cautiously (risk of cerebral oedema), heparin (thrombosis risk) --- ## TOPIC 9: SEPSIS & SEPTIC SHOCK ### Definitions (Sepsis-3, 2016) - **Sepsis**: Life-threatening organ dysfunction from dysregulated host response to infection - SOFA score increase ≥2 points - Quick SOFA (qSOFA) screening: RR ≥22, Altered mentation, SBP ≤100 - **Septic Shock**: Sepsis + vasopressors needed + lactate >2 mmol/L despite fluid resuscitation ### Sepsis Bundles (Hour-1 Bundle) 1. Measure lactate (repeat if >2) 2. Blood cultures (×2 sets) BEFORE antibiotics 3. Broad-spectrum antibiotics within 1 hour 4. 30 ml/kg crystalloid bolus if hypotension or lactate >4 5. Vasopressors if not responding to fluids: target MAP ≥65 mmHg ### Vasopressors in Septic Shock | Drug | Dose | Notes | |------|------|-------| | Noradrenaline (NE) | 0.01–3 mcg/kg/min | FIRST LINE | | Vasopressin | 0.03 units/min | Add if NE >0.25 | | Adrenaline | 0.01–0.5 mcg/kg/min | Add or substitute | | Dopamine | 2–20 mcg/kg/min | Alternative; more arrhythmias | ### Steroids - IV Hydrocortisone 200 mg/day (infusion or 50 mg q6h) if shock not controlled with fluids + vasopressors --- ## TOPIC 10: TOXICOLOGY — COMMON POISONINGS ### Organophosphate Poisoning - Mechanism: Irreversible AChE inhibition → cholinergic excess - Mnemonics: - **DUMBELS**: Diarrhoea, Urination, Miosis, Bradycardia, Emesis, Lacrimation, Salivation - **SLUDGE**: Salivation, Lacrimation, Urination, Defaecation, GI distress, Emesis - Treatment: 1. Decontamination (remove clothes, wash skin) 2. Atropine 2–4 mg IV q5–10 min until secretions dry (NOT until pupils dilate) 3. Pralidoxime (2-PAM): 1–2 g IV over 30 min, then infusion (within 48 hrs of exposure) 4. Benzodiazepines for seizures ### Paracetamol (Acetaminophen) Overdose - Mechanism: NAPQI metabolite causes hepatic necrosis when glutathione depleted - Toxic dose: >150 mg/kg or >7.5 g in adults - Stages: 1. 0–24 hr: Nausea, vomiting, malaise 2. 24–72 hr: Transaminase rise, RUQ pain 3. 72–96 hr: Peak hepatotoxicity, coagulopathy, renal failure 4. 4 days–2 weeks: Recovery or death - Rumack-Matthew nomogram: guides N-acetylcysteine (NAC) treatment - **Antidote**: N-Acetylcysteine (NAC) - IV: 150 mg/kg in 200 ml NS over 1 hr → 50 mg/kg in 500 ml over 4 hr → 100 mg/kg in 1000 ml over 16 hr ### Opioid Overdose - Triad: Miosis + Respiratory depression + Altered consciousness - Treatment: Naloxone 0.4–2 mg IV/IM/SC/IN — repeat q2–3 min (half-life < opioid, may need infusion) ### Benzodiazepine Overdose - Features: Sedation, confusion, respiratory depression (usually mild) - Antidote: Flumazenil 0.2 mg IV over 30s, repeat 0.1 mg q1 min (max 1 mg) — CAUTION in BZD-dependent patients (seizures) ### TCА (Tricyclic Antidepressant) Overdose - Features: Anticholinergic, QRS widening, ventricular arrhythmias, hypotension, seizures - QRS >100 ms — treat with Sodium Bicarbonate 1–2 mEq/kg IV bolus - Avoid physostigmine (can worsen) ### Methanol / Ethylene Glycol Poisoning - Methanol → formic acid → visual loss ("snow blindness") - Ethylene glycol → oxalic acid → renal failure - Both: High anion gap metabolic acidosis + high osmolar gap - Treatment: Fomepizole (4-MP) 15 mg/kg IV loading dose; or Ethanol infusion; Haemodialysis --- ## TOPIC 11: TRAUMA — PRIMARY AND SECONDARY SURVEY ### ATLS Primary Survey (ABCDE) - **A** — Airway + C-spine control - **B** — Breathing + ventilation - **C** — Circulation + haemorrhage control - **D** — Disability (neuro) - **E** — Exposure + environment ### Haemorrhagic Shock Classes | Class | Blood loss | HR | BP | RR | Urine output | |-------|----------|----|----|----|----| | I | <750 ml (<15%) | <100 | Normal | 14–20 | >30 ml/hr | | II | 750–1500 ml (15–30%) | 100–120 | Normal | 20–30 | 20–30 ml/hr | | III | 1500–2000 ml (30–40%) | 120–140 | Decreased | 30–40 | 5–15 ml/hr | | IV | >2000 ml (>40%) | >140 | Very decreased | >35 | Negligible | ### Tension Pneumothorax - Clinical diagnosis: Tracheal deviation away, absent breath sounds, hypotension, raised JVP - Do NOT wait for CXR — immediate needle decompression - 2nd ICS, midclavicular line, 14–16G needle - Followed by chest tube (5th ICS, anterior axillary line) ### Massive Haemothorax - >1500 ml blood in chest (or >200 ml/hr for 4 hrs) - Treatment: Chest tube drainage + surgery ### Traumatic Brain Injury (TBI) | Severity | GCS | |---------|-----| | Mild | 14–15 | | Moderate | 9–13 | | Severe | ≤8 | - Cushing's Triad (late sign of ICP): Hypertension + Bradycardia + Irregular respirations - Management of Raised ICP: - HOB 30° - Mannitol 0.25–1 g/kg IV over 20 min OR Hypertonic saline 3% - Avoid hypotension (SBP >90), avoid hypoxia (SpO2 >95%) - Normocapnia (PaCO2 35–40); hyperventilate ONLY as bridge measure --- ## TOPIC 12: ANAPHYLAXIS ### Diagnostic Criteria Anaphylaxis likely if any ONE of: 1. Acute onset with skin/mucosa involvement + respiratory compromise/hypotension 2. Two or more of: skin/mucosa + respiratory + hypotension + GI symptoms after allergen 3. Hypotension after known allergen ### Grading - Grade I: Skin only - Grade II: Skin + cardiovascular/respiratory mild - Grade III: Cardiovascular/respiratory severe - Grade IV: Cardiac arrest ### Treatment 1. **Adrenaline (Epinephrine) 0.5 mg IM (1:1000) anteromedial thigh — FIRST LINE** - Repeat every 5–15 minutes if no improvement - IV Adrenaline ONLY in cardiac arrest: 1 mg of 1:10,000 2. Position: Supine with legs elevated (unless dyspnoeic) 3. Oxygen: High flow 4. IV fluids: 1–2 L NS rapidly 5. Antihistamines (H1: Chlorphenamine 10 mg IV; H2: Ranitidine) 6. Corticosteroids: Hydrocortisone 200 mg IV (prevent biphasic reaction) 7. Salbutamol nebulisation for bronchospasm --- ## TOPIC 13: ACUTE ABDOMEN ### Common Causes by Quadrant | Area | Differential | |------|-------------| | RUQ | Cholecystitis, hepatitis, peptic ulcer, right pneumonia | | LUQ | Splenomegaly, gastritis, pancreatitis | | RIF | Appendicitis, ovarian cyst, ectopic pregnancy, Crohn's | | LIF | Diverticulitis, ovarian cyst, ectopic, sigmoid volvulus | | Central | Pancreatitis, AAA, bowel obstruction, mesenteric ischaemia | ### Appendicitis - Rovsing's sign (pressure LIF → pain RIF) - Psoas sign, obturator sign - Alvarado score: Max 10 (≥7 = high probability appendicitis) - Alvarado scoring: Migratory RIF pain (1), Anorexia (1), Nausea/vomiting (1), RIF tenderness (2), Rebound tenderness (1), Elevated temp (1), Leukocytosis (2), Left shift (1) ### Bowel Obstruction - Small bowel: Central colicky pain, vomiting early, distension late - Large bowel: Distension early, vomiting late, absolute constipation - CXR: Air-fluid levels; multiple loops of dilated bowel - Strangulated obstruction: Signs of peritonism + sepsis → emergency surgery --- ## TOPIC 14: ELECTROLYTE EMERGENCIES ### Hyperkalaemia | K level | ECG changes | |---------|------------| | >5.5 | Peaked T waves | | >6.5 | Widened QRS | | >7.0 | Sine wave pattern → VF | #### Treatment (C-BIG-K-Drop) - **C** — Calcium gluconate 10 ml of 10% IV over 2–3 min (membrane stabilisation) - **B** — Bicarbonate 50 mEq IV (shift K into cells) - **I** — Insulin 10 units + 50% Dextrose 50 ml IV (shift K into cells) - **G** — (Glucose — already in Insulin step) - **K-Drop** — Kayexalate (resonium), Furosemide (eliminate), Dialysis ### Hyponatraemia - Mild: 130–135 mmol/L (usually asymptomatic) - Severe: <120 mmol/L (seizures, coma, herniation) - Correction: No faster than 10–12 mmol/L per 24 hrs (risk of central pontine myelinolysis) - Symptomatic: 3% NaCl 100 ml IV over 10 min, repeat × 3 if seizures - Chronic: Fluid restriction, oral salt ### Hypocalcaemia - Symptoms: Tetany, Chvostek's sign, Trousseau's sign, QT prolongation, seizures - Treatment: IV calcium gluconate 10 ml of 10% (1–3 g) over 10 min; oral calcium + Vit D for chronic --- ## TOPIC 15: RESPIRATORY EMERGENCIES ### COPD Exacerbation - Presentation: Increased dyspnoea, sputum, wheeze; may have cyanosis - Management: 1. Controlled O2 therapy: Target SpO2 88–92% (avoid O2 toxicity) 2. SABA (Salbutamol) + SAMA (Ipratropium) nebulisation 3. Oral/IV steroids: Prednisolone 30–40 mg or Hydrocortisone 100 mg IV 4. Antibiotics if purulent sputum / fever (Amoxicillin-clavulanic acid or Doxycycline) 5. NIV (BiPAP): If pH <7.35 + PaCO2 >45 (reduces intubation, mortality) 6. Intubation if NIV fails or contraindicated ### Pulmonary Embolism (PE) - Virchow's Triad: Stasis, Hypercoagulability, Endothelial injury - Features: Pleuritic chest pain, dyspnoea, tachycardia, haemoptysis; DVT signs - ECG: Sinus tachycardia (most common); S1Q3T3 (classic but rare) - Wells Score criteria: - DVT signs/symptoms: 3 - No alternative diagnosis: 3 - HR >100: 1.5 - Immobilisation/surgery <4 wks: 1.5 - Prior DVT/PE: 1.5 - Haemoptysis: 1 - Malignancy: 1 - CTPA: Gold standard for diagnosis - Management: - Haemodynamically stable: Anticoagulation (LMWH/UFH → DOAC/warfarin) - Massive PE (shock): Thrombolysis (Alteplase 100 mg over 2 hr) or surgical embolectomy NOTES echo "Study notes written."

cat > /tmp/workspace/cmc-em-notes/flashcards.md << 'FLASH' # CMC Vellore Emergency Medicine — Q&A Flashcards ## High-Yield Topics --- ### SECTION 1: AIRWAY & RESUSCITATION **Q1. What is the preferred induction agent for RSI in a haemodynamically unstable patient?** A: **Ketamine** (1–2 mg/kg IV) — maintains blood pressure and heart rate; also provides analgesia and amnesia. **Q2. What is the dose of succinylcholine for RSI?** A: **1.5 mg/kg IV**. It is a depolarising neuromuscular blocker with rapid onset (45–60 sec) and short duration (10–15 min). Contraindicated in hyperkalaemia, burns >24 hr, denervation injuries. **Q3. What is the most common cause of failed intubation in the ED?** A: **Inadequate preparation and positioning**. Correct neck flexion and head extension (sniffing position) + pre-oxygenation for 3 minutes are key. **Q4. What is the compression:ventilation ratio in adult CPR with an advanced airway in place?** A: **Continuous compressions at 100–120/min with ventilation at 10 breaths/min** (i.e., asynchronous; the 30:2 ratio is only used without an advanced airway). **Q5. List the shockable rhythms in cardiac arrest.** A: **Ventricular Fibrillation (VF)** and **Pulseless Ventricular Tachycardia (pVT)**. **Q6. What is the first drug given in cardiac arrest regardless of rhythm?** A: **Epinephrine (Adrenaline) 1 mg IV every 3–5 minutes**. Given for VF/VT after the 2nd shock; given immediately for PEA/Asystole. **Q7. What is Targeted Temperature Management (TTM) after cardiac arrest?** A: Maintaining core body temperature at **32–36°C for at least 24 hours** after ROSC to improve neurological outcomes. **Q8. Name the 4 H's and 4 T's of reversible causes of cardiac arrest.** A: - **4 H's**: Hypoxia, Hypovolaemia, Hyper/Hypokalaemia (electrolytes), Hypothermia - **4 T's**: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (PE or MI) --- ### SECTION 2: CARDIAC EMERGENCIES **Q9. What ECG change distinguishes STEMI from NSTEMI?** A: **ST-segment elevation** ≥1 mm in ≥2 contiguous limb leads, or ≥2 mm in V1–V4. NSTEMI has ST depression or T-wave inversion without elevation. **Q10. What is the door-to-balloon time target for STEMI?** A: **<90 minutes** for primary PCI. If PCI cannot be achieved within 120 minutes, thrombolysis should be given within 10 minutes of diagnosis. **Q11. What are the absolute contraindications to thrombolysis in STEMI?** A: 1. Any prior intracranial haemorrhage 2. Ischaemic stroke within 3 months 3. Suspected aortic dissection 4. Active internal bleeding (not menstruation) 5. Significant closed-head or facial trauma within 3 months 6. BP >185/110 unresponsive to treatment 7. Intracranial neoplasm, AV malformation **Q12. What is the clinical triad of Right Ventricular infarction?** A: **Hypotension + Raised JVP + Clear lungs** (absence of pulmonary oedema). ST elevation in V3R/V4R on right-sided ECG. **Q13. What is the management of RV infarct? What should be avoided?** A: IV fluid challenge (RL/NS) to maintain preload. **Avoid nitrates and diuretics** (reduce preload further → cardiovascular collapse). **Q14. What is the mnemonic for managing Acute Pulmonary Oedema?** A: **LMNOP** — Lasix, Morphine, Nitrates, Oxygen, Position (upright). **Q15. When is NIV preferred over intubation in APO?** A: In conscious, cooperative patients without contraindications — **CPAP 5–10 cmH2O** reduces work of breathing, improves oxygenation, and decreases need for intubation. --- ### SECTION 3: STROKE & NEUROLOGY **Q16. What is the time window for IV tPA (Alteplase) in ischaemic stroke?** A: Within **4.5 hours** of symptom onset. **Q17. What is the dose of IV tPA (Alteplase) for ischaemic stroke?** A: **0.9 mg/kg IV** (maximum 90 mg). Give 10% as IV bolus, remaining 90% as infusion over 60 minutes. **Q18. What is permissive hypertension in ischaemic stroke?** A: Allowing BP up to **220/120 mmHg** in ischaemic stroke WITHOUT thrombolysis, to maintain cerebral perfusion pressure. **Q19. What is Cushing's Triad?** A: **Hypertension + Bradycardia + Irregular respirations** — a late sign of severely raised intracranial pressure (ICP). **Q20. What is the first-line treatment for raised ICP?** A: 1. HOB elevation to 30° 2. **Mannitol 0.25–1 g/kg IV** over 20 minutes (osmotic diuretic) 3. OR **Hypertonic saline 3%** (especially in hyponatraemia or hypotension) 4. Avoid hypotension, maintain SpO2 >95%, normocapnia **Q21. What is the GCS score for severe TBI?** A: **GCS ≤8** — requires definitive airway management (intubation). --- ### SECTION 4: METABOLIC EMERGENCIES **Q22. What are the three diagnostic criteria for DKA?** A: 1. Hyperglycaemia >250 mg/dL 2. Ketonaemia or ketonuria 3. Metabolic acidosis (pH <7.3, HCO3 <18 mEq/L) **Q23. When is potassium replacement started in DKA?** A: When K <5.5 mEq/L AND urine output is confirmed. If K <3.5, **hold insulin** and replace K aggressively (40 mEq/hr). **Q24. What are the differences between DKA and HHS?** A: | | DKA | HHS | |--|-----|-----| | Glucose | >250 | >600 | | Ketones | Positive | Absent/trace | | pH | <7.3 | Normal or mildly low | | Osmolality | <320 | >320 | | Patient | T1DM (younger) | T2DM (older) | **Q25. What is the treatment of severe hypoglycaemia in an unconscious patient?** A: **25 ml of 50% dextrose IV** (12.5 g glucose) or **glucagon 1 mg IM/SC** if no IV access. **Q26. What is the danger of correcting hyponatraemia too rapidly?** A: **Central Pontine Myelinolysis (osmotic demyelination syndrome)** — irreversible neurological damage. Correct at no faster than **10–12 mmol/L per 24 hours**. **Q27. What are the ECG changes of hyperkalaemia in order?** A: 1. Peaked (tall, narrow) T waves (K >5.5) 2. Prolonged PR interval 3. Widened QRS (K >6.5) 4. Loss of P waves 5. Sine wave pattern → Ventricular fibrillation (K >7–8) **Q28. What is the first-line treatment for life-threatening hyperkalaemia?** A: **10 ml of 10% Calcium Gluconate IV** over 2–3 minutes — stabilises the cardiac membrane (does NOT lower K level). --- ### SECTION 5: RESPIRATORY EMERGENCIES **Q29. What PEFR indicates life-threatening asthma?** A: PEFR **<33% predicted** — along with silent chest, cyanosis, exhaustion, altered consciousness, or PaCO2 >45 mmHg. **Q30. What is the role of IV Magnesium Sulphate in severe asthma?** A: **2 g IV over 20 minutes** — causes bronchial smooth muscle relaxation. Used in severe or life-threatening asthma not responding to initial treatment. **Q31. What is the target SpO2 in COPD exacerbation?** A: **88–92%** — controlled oxygen therapy to avoid suppression of hypoxic ventilatory drive. **Q32. When is NIV indicated in COPD exacerbation?** A: When arterial pH <7.35 with PaCO2 >45 mmHg (hypercapnic respiratory failure) despite initial treatment. **Q33. What is the Wells Score threshold for high clinical probability of PE?** A: Wells Score >4 = high probability; proceed directly to CTPA (or treatment dose anticoagulation while awaiting). **Q34. What is the ECG finding classically described in PE?** A: **S1Q3T3** — S wave in lead I, Q wave in lead III, T-wave inversion in lead III. However, the most COMMON ECG finding is **sinus tachycardia**. **Q35. What is the management of massive PE with haemodynamic instability?** A: **Systemic thrombolysis** — Alteplase 100 mg IV over 2 hours. If contraindicated, surgical or catheter-directed embolectomy. --- ### SECTION 6: TOXICOLOGY **Q36. What is the DUMBELS mnemonic for organophosphate poisoning?** A: **D**iarrhoea, **U**rination, **M**iosis, **B**radycardia, **E**mesis, **L**acrimation, **S**alivation (cholinergic toxidrome). **Q37. What is the treatment endpoint for atropine in organophosphate poisoning?** A: **Drying of secretions** (secretions dry, lungs clear) — NOT pupil dilation. Dose: 2–4 mg IV q5–10 min, titrated to effect. **Q38. Why must pralidoxime be given within 48 hours in organophosphate poisoning?** A: After 48 hours, the AChE-organophosphate bond "ages" (becomes irreversible) and pralidoxime cannot regenerate the enzyme. **Q39. What is the antidote for paracetamol overdose?** A: **N-Acetylcysteine (NAC)** — replenishes glutathione to detoxify NAPQI (the toxic metabolite). **Q40. What is the classic triad of opioid overdose?** A: **Pinpoint pupils (miosis) + Respiratory depression + Altered consciousness (unconscious)** **Q41. What is the dose and route of Naloxone for opioid overdose?** A: **Naloxone 0.4–2 mg IV/IM/SC/Intranasal** — repeat every 2–3 minutes up to 10 mg. Due to short half-life, may need infusion if long-acting opioid. **Q42. What ECG finding in TCA overdose requires Sodium Bicarbonate treatment?** A: **QRS duration >100 ms** — NaHCO3 1–2 mEq/kg IV alkalinises the blood and reduces sodium channel blockade. **Q43. How do you differentiate methanol from ethylene glycol poisoning clinically?** A: Both cause high anion gap metabolic acidosis + elevated osmolar gap. Key difference: - **Methanol**: Visual disturbance ("snow-field vision"), optic disc oedema - **Ethylene glycol**: Flank pain, renal failure, calcium oxalate crystals in urine **Q44. What is the antidote for methanol/ethylene glycol poisoning?** A: **Fomepizole (4-methylpyrazole)** 15 mg/kg IV loading dose — inhibits alcohol dehydrogenase. Alternative: Ethanol infusion. Haemodialysis for severe cases. --- ### SECTION 7: TRAUMA **Q45. What are the 5 immediately life-threatening chest injuries (ATOM FC)?** A: - **A** — Airway obstruction - **T** — Tension pneumothorax - **O** — Open pneumothorax - **M** — Massive haemothorax - **F** — Flail chest + contusion - **C** — Cardiac tamponade **Q46. What is the clinical presentation of tension pneumothorax?** A: Tracheal deviation AWAY from affected side, absent breath sounds, hypotension, raised JVP, dyspnoea. It is a **clinical diagnosis** — do NOT wait for CXR. **Q47. What is Beck's Triad for cardiac tamponade?** A: **Hypotension + Raised JVP + Muffled heart sounds** **Q48. What are the 4 classes of haemorrhagic shock and their blood loss?** A: - Class I: <750 ml (<15%) — compensated - Class II: 750–1500 ml (15–30%) — tachycardia, normal BP - Class III: 1500–2000 ml (30–40%) — hypotension - Class IV: >2000 ml (>40%) — severe hypotension, loss of consciousness **Q49. What is the Alvarado score and its cut-off for appendicitis?** A: Score ≥7 = high probability of appendicitis. Components (MANTRELS): Migratory pain (1), Anorexia (1), Nausea (1), Tenderness RIF (2), Rebound (1), Elevated temp (1), Leukocytosis (2), Left shift (1). Maximum = 10. --- ### SECTION 8: ANAPHYLAXIS & SEPSIS **Q50. What is the FIRST-LINE treatment for anaphylaxis?** A: **Adrenaline (Epinephrine) 0.5 mg IM (1:1000) into the anterolateral thigh** — NOT antihistamines, NOT steroids as first-line. **Q51. Why is the anterolateral thigh preferred for adrenaline in anaphylaxis?** A: Better and faster absorption compared to deltoid IM or SC routes, due to greater muscle mass and blood supply. **Q52. What is the definition of Septic Shock (Sepsis-3)?** A: Sepsis + vasopressor requirement to maintain MAP ≥65 mmHg + serum lactate >2 mmol/L **despite adequate fluid resuscitation**. **Q53. What are the components of the Hour-1 Sepsis Bundle?** A: 1. Measure lactate level 2. Blood cultures × 2 sets before antibiotics 3. Broad-spectrum IV antibiotics within 1 hour 4. 30 ml/kg IV crystalloid if hypotension or lactate >4 5. Vasopressors (Noradrenaline) if MAP <65 despite fluids **Q54. What is the first-line vasopressor in septic shock?** A: **Noradrenaline (Norepinephrine)** — 0.01–3 mcg/kg/min, targeting MAP ≥65 mmHg. **Q55. What is qSOFA and what is its use?** A: Quick SOFA is a bedside screening tool for sepsis: **RR ≥22, Altered mentation, SBP ≤100**. Score ≥2 = high risk for organ dysfunction → perform full SOFA assessment and initiate sepsis workup. --- ### SECTION 9: HYPERTENSIVE EMERGENCIES **Q56. What is the difference between hypertensive emergency and urgency?** A: - **Emergency**: BP >180/120 WITH acute end-organ damage (brain, heart, kidneys, eyes) — requires IV medications, ICU admission - **Urgency**: BP >180/120 WITHOUT end-organ damage — oral medications, outpatient or short observation **Q57. How much should MAP be reduced in the first hour in hypertensive emergency?** A: No more than **20–25% reduction in the first hour** — rapid normalisation risks cerebral/myocardial ischaemia. **Q58. What is the treatment of hypertensive emergency in aortic dissection?** A: Target SBP <120 mmHg using **Esmolol (IV beta-blocker) + Sodium Nitroprusside** — or Labetalol alone. Beta-blocker must be started BEFORE vasodilator to prevent reflex tachycardia. **Q59. What drug is used for hypertension in phaeochromocytoma crisis?** A: **Phentolamine** (IV alpha-blocker) — given FIRST. Then beta-blocker can be added after alpha-blockade. NEVER give beta-blocker alone (causes paradoxical hypertension). **Q60. What is the first-line anticonvulsant and antihypertensive in eclampsia?** A: - Anticonvulsant: **Magnesium Sulphate** (loading dose 4–6 g IV over 15–20 min, maintenance 1–2 g/hr) - Antihypertensive: **Hydralazine 5–10 mg IV** OR **Labetalol 20–40 mg IV** --- *Reference: CMC Vellore Handbook of Emergency Medicine, 3rd Edition (2022), Abhilash K.* FLASH echo "Flashcards written."

python3 << 'EOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.lib import colors from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak from reportlab.lib.enums import TA_LEFT, TA_CENTER pdf_path = "/tmp/workspace/cmc-em-notes/CMC_EM_Study_Notes_Flashcards.pdf" doc = SimpleDocTemplate(pdf_path, pagesize=A4, rightMargin=2*cm, leftMargin=2*cm, topMargin=2*cm, bottomMargin=2*cm) styles = getSampleStyleSheet() # Custom styles title_style = ParagraphStyle('Title', parent=styles['Title'], fontSize=18, textColor=colors.HexColor('#1a237e'), spaceAfter=6, alignment=TA_CENTER) subtitle_style = ParagraphStyle('Subtitle', parent=styles['Normal'], fontSize=11, textColor=colors.HexColor('#455a64'), alignment=TA_CENTER, spaceAfter=20) h1_style = ParagraphStyle('H1', parent=styles['Heading1'], fontSize=14, textColor=colors.HexColor('#b71c1c'), spaceBefore=14, spaceAfter=6, borderPad=4, backColor=colors.HexColor('#ffebee'), borderRadius=3) h2_style = ParagraphStyle('H2', parent=styles['Heading2'], fontSize=12, textColor=colors.HexColor('#1565c0'), spaceBefore=10, spaceAfter=4) h3_style = ParagraphStyle('H3', parent=styles['Heading3'], fontSize=11, textColor=colors.HexColor('#2e7d32'), spaceBefore=8, spaceAfter=3) body_style = ParagraphStyle('Body', parent=styles['Normal'], fontSize=9.5, leading=14, spaceAfter=4) bullet_style = ParagraphStyle('Bullet', parent=styles['Normal'], fontSize=9.5, leading=14, leftIndent=14, spaceAfter=2, bulletText='•') q_style = ParagraphStyle('Q', parent=styles['Normal'], fontSize=10, leading=14, textColor=colors.HexColor('#1a237e'), fontName='Helvetica-Bold', spaceBefore=10, spaceAfter=3) a_style = ParagraphStyle('A', parent=styles['Normal'], fontSize=9.5, leading=14, leftIndent=10, spaceAfter=6, textColor=colors.HexColor('#212121')) story = [] # Cover story.append(Spacer(1, 1.5*cm)) story.append(Paragraph("CMC Vellore Handbook of Emergency Medicine", title_style)) story.append(Paragraph("3rd Edition (2022) — Abhilash K", subtitle_style)) story.append(Paragraph("HIGH-YIELD STUDY NOTES & FLASHCARDS", ParagraphStyle('c2', parent=styles['Normal'], fontSize=13, fontName='Helvetica-Bold', textColor=colors.HexColor('#e65100'), alignment=TA_CENTER, spaceAfter=6))) story.append(Paragraph("15 Core Topics | 60 Q&A Flashcards", ParagraphStyle('c3', parent=styles['Normal'], fontSize=10, alignment=TA_CENTER, textColor=colors.gray, spaceAfter=30))) story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a237e'))) story.append(Spacer(1, 0.5*cm)) # TABLE OF CONTENTS story.append(Paragraph("Topics Covered", h2_style)) toc_items = [ "1. Approach to Emergency Patient — Primary Survey (ABCDE)", "2. Cardiac Arrest & CPR / ACLS", "3. Acute Coronary Syndrome (ACS) / STEMI", "4. Acute Pulmonary Oedema", "5. Hypertensive Emergencies", "6. Acute Asthma", "7. Stroke (Ischaemic & Haemorrhagic)", "8. Diabetic Emergencies (DKA, HHS, Hypoglycaemia)", "9. Sepsis & Septic Shock", "10. Toxicology (OP, Paracetamol, Opioids, TCA, Methanol)", "11. Trauma — Primary Survey & Haemorrhagic Shock", "12. Anaphylaxis", "13. Acute Abdomen", "14. Electrolyte Emergencies", "15. Respiratory Emergencies (COPD, PE)", ] for item in toc_items: story.append(Paragraph(item, bullet_style)) story.append(PageBreak()) # ====================================================== # PART 1: STUDY NOTES # ====================================================== story.append(Paragraph("PART 1: STRUCTURED STUDY NOTES", title_style)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor('#b71c1c'))) story.append(Spacer(1, 0.3*cm)) # Topic 1 story.append(Paragraph("TOPIC 1: PRIMARY SURVEY — ABCDE APPROACH", h1_style)) story.append(Paragraph("<b>Airway</b>", h3_style)) for item in ["Assess: look, listen, feel", "Maneuvers: chin lift (no trauma), jaw thrust (trauma)", "Adjuncts: OPA (unconscious, no gag reflex), NPA (conscious/semi-conscious)", "Definitive: Rapid Sequence Intubation (RSI)"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>RSI Drugs</b>", h3_style)) rsi_data = [ ["Step", "Drug", "Dose"], ["Induction", "Ketamine", "1–2 mg/kg IV"], ["Induction", "Propofol", "1–2 mg/kg IV"], ["Induction", "Midazolam", "0.1–0.2 mg/kg IV"], ["Paralysis", "Succinylcholine", "1.5 mg/kg IV"], ["Paralysis", "Rocuronium", "1.2 mg/kg IV"], ] t = Table(rsi_data, colWidths=[4*cm, 5*cm, 6*cm]) t.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a237e')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e8eaf6'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(t) story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("<b>Circulation</b>", h3_style)) for item in ["IV access ×2 large bore (14–16G)", "Fluid: NS/RL 20 ml/kg bolus", "FAST exam for abdominal free fluid"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>Disability (Neuro)</b>", h3_style)) story.append(Paragraph("GCS: Eyes (4) + Verbal (5) + Motor (6) = 15 max. Pupils: PERLA. Blood glucose.", body_style)) story.append(Paragraph("<b>AMPLE History</b>", h3_style)) story.append(Paragraph("Allergies | Medications | Past illness | Last meal | Events", body_style)) # Topic 2 story.append(Paragraph("TOPIC 2: CARDIAC ARREST & CPR", h1_style)) story.append(Paragraph("<b>Adult BLS (2020 AHA)</b>", h3_style)) for item in ["Rate: 100–120/min | Depth: 5–6 cm | Ratio: 30:2 (without advanced airway)", "With advanced airway: continuous compressions + 10 breaths/min", "Minimise interruptions to <10 seconds"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>Rhythms</b>", h3_style)) rhythm_data = [["Shockable", "Non-Shockable"], ["Ventricular Fibrillation (VF)", "Asystole"], ["Pulseless VT", "PEA (Pulseless Electrical Activity)"]] t2 = Table(rhythm_data, colWidths=[8*cm, 8*cm]) t2.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#c62828')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#ffebee'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'CENTER'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(t2) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>ACLS Drugs</b>", h3_style)) acls_data = [ ["Drug", "Dose", "Indication"], ["Adrenaline (Epinephrine)", "1 mg IV q3–5 min", "All rhythms"], ["Amiodarone", "300 mg IV (then 150 mg)", "Shock-refractory VF/pVT"], ["Lidocaine", "1–1.5 mg/kg IV", "If amiodarone unavailable"], ] t3 = Table(acls_data, colWidths=[5*cm, 4.5*cm, 5.5*cm]) t3.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1565c0')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e3f2fd'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(t3) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>4H's & 4T's (Reversible Causes)</b>", h3_style)) story.append(Paragraph("<b>4 H's:</b> Hypoxia | Hypovolaemia | Hyper/Hypokalaemia | Hypothermia", body_style)) story.append(Paragraph("<b>4 T's:</b> Tension pneumo | Tamponade | Toxins | Thrombosis (PE/MI)", body_style)) story.append(Paragraph("<b>Post-ROSC Targets</b>", h3_style)) for item in ["SpO2: 94–98% | PaCO2: 35–45 mmHg (normocapnia)", "MAP: >65 mmHg | TTM: 32–36°C for 24 hours"]: story.append(Paragraph(item, bullet_style)) # Topic 3 — ACS story.append(Paragraph("TOPIC 3: ACUTE CORONARY SYNDROME (ACS)", h1_style)) acs_data = [ ["Type", "ECG", "Troponin", "Management"], ["STEMI", "ST elevation ≥1 mm", "Elevated", "Primary PCI <90 min"], ["NSTEMI", "ST depression / T inversion", "Elevated", "Anticoagulation + PCI"], ["Unstable Angina", "ST depression / T inversion", "Normal", "Anticoagulation"], ] ta = Table(acs_data, colWidths=[3.5*cm, 4.5*cm, 3*cm, 4*cm]) ta.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#b71c1c')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 8.5), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#ffebee'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(ta) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>STEMI Initial Management</b>", h3_style)) for item in ["O2 only if SpO2 <94%", "Aspirin 325 mg + P2Y12 inhibitor (Clopidogrel 600 mg or Ticagrelor 180 mg)", "Morphine 2–4 mg IV for pain | Nitrates (avoid if RV infarct)", "Anticoagulation: LMWH or UFH", "Primary PCI (preferred) or Thrombolysis if PCI unavailable"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>RV Infarct</b>", h3_style)) for item in ["ECG: ST elevation in V3R, V4R (right-sided leads)", "Triad: Hypotension + Raised JVP + Clear lungs", "Treatment: IV fluids — AVOID nitrates and diuretics"]: story.append(Paragraph(item, bullet_style)) # Topic 4 — APO story.append(Paragraph("TOPIC 4: ACUTE PULMONARY OEDEMA", h1_style)) story.append(Paragraph("<b>Management (LMNOP)</b>", h3_style)) lmnop = [ ["L", "Lasix (Furosemide)", "40–80 mg IV"], ["M", "Morphine", "2–4 mg IV (reduces preload, anxiety)"], ["N", "Nitrates", "IV/SL — contraindicated if SBP <90 mmHg"], ["O", "Oxygen", "High flow; NIV preferred (CPAP 5–10 cmH2O)"], ["P", "Position", "Sit upright (legs down)"], ] tl = Table(lmnop, colWidths=[1.5*cm, 4.5*cm, 9*cm]) tl.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#e8f5e9')), ('FONTNAME', (0,0), (0,-1), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(tl) # Topic 5 — Hypertensive Emergency story.append(Paragraph("TOPIC 5: HYPERTENSIVE EMERGENCIES", h1_style)) story.append(Paragraph("<b>Emergency vs Urgency</b>", h3_style)) story.append(Paragraph("Emergency: BP >180/120 + end-organ damage → IV drugs, ICU", body_style)) story.append(Paragraph("Urgency: BP >180/120 WITHOUT end-organ damage → oral drugs, observation", body_style)) story.append(Paragraph("<b>Rule:</b> Reduce MAP by 20–25% in first hour — do NOT normalise BP rapidly.", body_style)) story.append(Paragraph("<b>Treatment by Condition</b>", h3_style)) htn_data = [ ["Condition", "Drug(s)"], ["Aortic dissection", "Esmolol + Sodium Nitroprusside (SBP <120)"], ["Hypertensive encephalopathy", "Labetalol IV or Nicardipine IV"], ["ICH", "Labetalol / Nicardipine (target <140)"], ["Eclampsia", "MgSO4 (seizure) + Hydralazine/Labetalol (BP)"], ["Phaeochromocytoma", "Phentolamine (alpha blocker FIRST, then beta)"], ] th = Table(htn_data, colWidths=[5.5*cm, 9.5*cm]) th.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#4a148c')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f3e5f5'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(th) story.append(PageBreak()) # Topic 6 — Asthma story.append(Paragraph("TOPIC 6: ACUTE ASTHMA", h1_style)) story.append(Paragraph("<b>Severity Classification</b>", h3_style)) asthma_data = [ ["Feature", "Moderate", "Severe", "Life-threatening"], ["SpO2", ">92%", "<92%", "<92%"], ["PEFR", "50–75%", "33–50%", "<33%"], ["Speech", "Sentences", "Words only", "Cannot speak"], ["RR", "<25", ">25", ">30"], ["Consciousness", "Alert", "Alert", "Confused/Drowsy"], ] tas = Table(asthma_data, colWidths=[4*cm, 3.5*cm, 3.5*cm, 4*cm]) tas.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#e65100')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 8.5), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#fff3e0'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'CENTER'), ('PADDING', (0,0), (-1,-1), 4), ])) story.append(tas) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>Management</b>", h3_style)) for item in ["O2: Target SpO2 94–98%", "Salbutamol 2.5–5 mg neb q20 min ×3 → continuous", "Ipratropium 0.5 mg neb (severe cases)", "Hydrocortisone 100–200 mg IV or Prednisolone 40–50 mg oral", "IV Magnesium Sulphate 2 g over 20 min (severe/life-threatening)", "Intubation: Silent chest, PEFR <33%, cyanosis, exhaustion, PaCO2 >45"]: story.append(Paragraph(item, bullet_style)) # Topic 7 — Stroke story.append(Paragraph("TOPIC 7: STROKE", h1_style)) story.append(Paragraph("<b>FAST Recognition:</b> Face | Arm | Speech | Time", body_style)) story.append(Paragraph("<b>Thrombolysis (tPA) in Ischaemic Stroke</b>", h3_style)) for item in ["Window: within 4.5 hours of symptom onset", "Dose: 0.9 mg/kg IV (max 90 mg) — 10% bolus, 90% over 60 min", "BP must be <185/110 before tPA", "Permissive hypertension (no tPA): allow up to 220/120 mmHg"]: story.append(Paragraph(item, bullet_style)) # Topic 8 — DKA story.append(Paragraph("TOPIC 8: DIABETIC EMERGENCIES", h1_style)) story.append(Paragraph("<b>DKA Diagnostic Triad</b>", h3_style)) story.append(Paragraph("Glucose >250 mg/dL + Ketonaemia + pH <7.3 (HCO3 <18)", body_style)) story.append(Paragraph("<b>DKA Management</b>", h3_style)) for item in ["Fluids: NS 1L/1h → 1L/2h → 1L/4h → 1L/8h; Switch to D5NS when glucose <250", "Insulin: Regular 0.1 units/kg/hr IV (no bolus)", "K+ replacement: Start if K <5.5 + urine output confirmed", "Bicarbonate: Only if pH <6.9", "Monitor: BS hourly, electrolytes q4h, urine output"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>DKA vs HHS</b>", h3_style)) dka_hhs = [ ["Parameter", "DKA", "HHS"], ["Glucose", ">250 mg/dL", ">600 mg/dL"], ["Ketones", "Positive", "Absent / Trace"], ["pH", "<7.3", ">7.3"], ["Osmolality", "Normal/<320", ">320 mOsm/kg"], ["Patient type", "T1DM, younger", "T2DM, elderly"], ] tdh = Table(dka_hhs, colWidths=[4.5*cm, 4.5*cm, 6*cm]) tdh.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1b5e20')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e8f5e9'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(tdh) # Topic 9 — Sepsis story.append(Paragraph("TOPIC 9: SEPSIS & SEPTIC SHOCK", h1_style)) story.append(Paragraph("<b>Definitions (Sepsis-3, 2016)</b>", h3_style)) story.append(Paragraph("Sepsis = life-threatening organ dysfunction from infection (SOFA score ≥2)", body_style)) story.append(Paragraph("Septic Shock = Sepsis + vasopressors + lactate >2 mmol/L despite adequate fluids", body_style)) story.append(Paragraph("qSOFA (bedside screen): RR ≥22 + Altered mentation + SBP ≤100 (score ≥2 = high risk)", body_style)) story.append(Paragraph("<b>Hour-1 Bundle</b>", h3_style)) for i, item in enumerate(["Measure lactate", "Blood cultures ×2 before antibiotics", "Broad-spectrum antibiotics within 1 hour", "30 ml/kg IV crystalloid if hypotension or lactate >4", "Vasopressors if MAP <65 after fluids"], 1): story.append(Paragraph(f"{i}. {item}", bullet_style)) story.append(Paragraph("<b>Vasopressors</b>", h3_style)) vp_data = [ ["Drug", "Dose", "Note"], ["Noradrenaline", "0.01–3 mcg/kg/min", "FIRST LINE"], ["Vasopressin", "0.03 units/min", "Add if NE >0.25"], ["Adrenaline", "0.01–0.5 mcg/kg/min", "Adjunct or substitute"], ["Hydrocortisone", "200 mg/day", "Refractory shock"], ] tvp = Table(vp_data, colWidths=[4.5*cm, 4.5*cm, 6*cm]) tvp.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#0d47a1')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e3f2fd'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(tvp) story.append(PageBreak()) # Topic 10 — Toxicology story.append(Paragraph("TOPIC 10: TOXICOLOGY", h1_style)) story.append(Paragraph("<b>Organophosphate Poisoning</b>", h3_style)) story.append(Paragraph("DUMBELS: Diarrhoea | Urination | Miosis | Bradycardia | Emesis | Lacrimation | Salivation", body_style)) for item in ["Decontamination first", "Atropine 2–4 mg IV q5–10 min → until secretions dry (NOT until pupils dilate)", "Pralidoxime 1–2 g IV over 30 min (within 48 hrs) — reactivates AChE", "Benzodiazepines for seizures"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>Paracetamol Overdose</b>", h3_style)) for item in ["Toxic dose: >150 mg/kg or >7.5 g in adults", "Mechanism: NAPQI → hepatic necrosis (glutathione depletion)", "Antidote: N-Acetylcysteine (NAC) IV — 150 mg/kg/hr → 50 mg/kg/4h → 100 mg/kg/16h", "Use Rumack-Matthew nomogram to guide treatment"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>Opioid Overdose</b>", h3_style)) story.append(Paragraph("Triad: Miosis + Respiratory depression + Altered consciousness", body_style)) story.append(Paragraph("Antidote: Naloxone 0.4–2 mg IV/IM/SC/IN q2–3 min (may need infusion)", body_style)) story.append(Paragraph("<b>TCA Overdose</b>", h3_style)) story.append(Paragraph("QRS >100 ms → Sodium Bicarbonate 1–2 mEq/kg IV (also for hypotension)", body_style)) story.append(Paragraph("<b>Methanol / Ethylene Glycol</b>", h3_style)) story.append(Paragraph("Both: High anion gap acidosis + elevated osmolar gap", body_style)) for item in ["Methanol: visual loss, optic disc oedema", "Ethylene glycol: renal failure, calcium oxalate crystals in urine", "Antidote: Fomepizole 15 mg/kg IV; Haemodialysis for severe cases"]: story.append(Paragraph(item, bullet_style)) # Topic 11 — Trauma story.append(Paragraph("TOPIC 11: TRAUMA", h1_style)) story.append(Paragraph("<b>Haemorrhagic Shock Classes</b>", h3_style)) shock_data = [ ["Class", "Blood loss", "HR", "BP", "Urine output"], ["I", "<750 ml (<15%)", "<100", "Normal", ">30 ml/hr"], ["II", "750–1500 ml (15–30%)", "100–120", "Normal/low", "20–30 ml/hr"], ["III", "1500–2000 ml (30–40%)", "120–140", "Decreased", "5–15 ml/hr"], ["IV", ">2000 ml (>40%)", ">140", "Very low", "Negligible"], ] tsh = Table(shock_data, colWidths=[2*cm, 4*cm, 2.5*cm, 3.5*cm, 3*cm]) tsh.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#880e4f')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 8.5), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#fce4ec'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'CENTER'), ('PADDING', (0,0), (-1,-1), 4), ])) story.append(tsh) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>Tension Pneumothorax</b>", h3_style)) story.append(Paragraph("Clinical diagnosis: Tracheal deviation (away), absent breath sounds, hypotension, raised JVP", body_style)) story.append(Paragraph("Treatment: Immediate needle decompression (2nd ICS, MCL, 14–16G) → chest tube (5th ICS, AAL)", body_style)) story.append(Paragraph("<b>Beck's Triad (Cardiac Tamponade)</b>", h3_style)) story.append(Paragraph("Hypotension + Raised JVP + Muffled heart sounds → Pericardiocentesis", body_style)) story.append(Paragraph("<b>Raised ICP in TBI</b>", h3_style)) for item in ["HOB elevation 30°", "Mannitol 0.25–1 g/kg IV over 20 min OR Hypertonic saline 3%", "Target: SpO2 >95%, MAP >90, normocapnia (PaCO2 35–40)", "Cushing's Triad (late, ominous): Hypertension + Bradycardia + Irregular breathing"]: story.append(Paragraph(item, bullet_style)) # Topic 12 — Anaphylaxis story.append(Paragraph("TOPIC 12: ANAPHYLAXIS", h1_style)) story.append(Paragraph("<b>First-line treatment: Adrenaline 0.5 mg IM (1:1000) into anterolateral thigh</b>", body_style)) for item in ["Repeat every 5–15 min if no response", "Position supine + legs elevated (unless dyspnoeic)", "O2 high flow | IV fluids 1–2 L NS rapidly", "Chlorphenamine 10 mg IV (H1) + Ranitidine (H2)", "Hydrocortisone 200 mg IV (prevents biphasic reaction)", "Salbutamol neb for bronchospasm"]: story.append(Paragraph(item, bullet_style)) # Topic 13 — Electrolytes story.append(Paragraph("TOPIC 13: ELECTROLYTE EMERGENCIES", h1_style)) story.append(Paragraph("<b>Hyperkalaemia ECG changes (in order)</b>", h3_style)) k_data = [ ["K+ Level", "ECG Change"], [">5.5 mEq/L", "Peaked (tall, narrow) T waves"], [">6.5 mEq/L", "PR prolongation, widened QRS"], [">7.0 mEq/L", "Loss of P waves, sine wave → VF"], ] tk = Table(k_data, colWidths=[5*cm, 10*cm]) tk.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#b71c1c')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#ffebee'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(tk) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>C-BIG-K-Drop (Hyperkalaemia Treatment)</b>", h3_style)) cbig = [ ["C", "Calcium gluconate 10 ml of 10% IV", "Membrane stabilisation (immediate)"], ["B", "Bicarbonate 50 mEq IV", "Shift K into cells"], ["I+G", "Insulin 10 u + 50% Dextrose 50 ml IV", "Shift K into cells"], ["K-Drop", "Resonium / Furosemide / Dialysis", "Eliminate K from body"], ] tcbig = Table(cbig, colWidths=[2*cm, 6*cm, 7*cm]) tcbig.setStyle(TableStyle([ ('BACKGROUND', (0,0), (0,-1), colors.HexColor('#ffd54f')), ('FONTNAME', (0,0), (0,-1), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ROWBACKGROUNDS', (0,0), (-1,-1), [colors.HexColor('#fffde7'), colors.white]), ('ALIGN', (0,0), (-1,-1), 'LEFT'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(tcbig) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("<b>Hyponatraemia</b>", h3_style)) for item in ["Symptomatic/severe (<120): 3% NaCl 100 ml IV over 10 min × 3 doses", "Correct at no faster than 10–12 mmol/L per 24 hrs", "Risk of rapid correction: Central Pontine Myelinolysis"]: story.append(Paragraph(item, bullet_style)) story.append(PageBreak()) # Topic 14 — PE and COPD story.append(Paragraph("TOPIC 14: RESPIRATORY EMERGENCIES", h1_style)) story.append(Paragraph("<b>COPD Exacerbation</b>", h3_style)) for item in ["Controlled O2: SpO2 target 88–92% (risk of hypercapnic drive suppression)", "Salbutamol + Ipratropium nebulisation", "Steroids: Prednisolone 30–40 mg oral or Hydrocortisone 100 mg IV", "Antibiotics if purulent sputum (Amox-Clav or Doxycycline)", "NIV (BiPAP) if pH <7.35 + PaCO2 >45 — reduces intubation rate"]: story.append(Paragraph(item, bullet_style)) story.append(Paragraph("<b>Pulmonary Embolism (PE)</b>", h3_style)) story.append(Paragraph("Virchow's Triad: Stasis + Hypercoagulability + Endothelial injury", body_style)) story.append(Paragraph("ECG: Sinus tachycardia (most common); S1Q3T3 (classic, rare)", body_style)) story.append(Paragraph("Investigation: CTPA (gold standard)", body_style)) story.append(Paragraph("<b>Wells Score quick reference:</b>", h3_style)) wells_data = [ ["Criterion", "Points"], ["DVT signs/symptoms", "3"], ["No alternative diagnosis more likely", "3"], ["HR >100 bpm", "1.5"], ["Immobilisation/surgery <4 weeks", "1.5"], ["Prior DVT/PE", "1.5"], ["Haemoptysis", "1"], ["Active malignancy", "1"], ] tw = Table(wells_data, colWidths=[11*cm, 4*cm]) tw.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#006064')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e0f7fa'), colors.white]), ('GRID', (0,0), (-1,-1), 0.5, colors.grey), ('ALIGN', (1,0), (1,-1), 'CENTER'), ('PADDING', (0,0), (-1,-1), 5), ])) story.append(tw) story.append(Spacer(1, 0.2*cm)) story.append(Paragraph("Score >4 = High probability. Massive PE (haemodynamic instability): Alteplase 100 mg over 2 hr.", body_style)) story.append(PageBreak()) # ====================================================== # PART 2: FLASHCARDS # ====================================================== story.append(Paragraph("PART 2: Q&A FLASHCARDS", title_style)) story.append(HRFlowable(width="100%", thickness=1.5, color=colors.HexColor('#b71c1c'))) story.append(Spacer(1, 0.3*cm)) story.append(Paragraph("60 high-yield questions covering all 15 core emergency medicine topics.", subtitle_style)) flashcards = [ ("SECTION 1 — AIRWAY & RESUSCITATION", None), ("Q1. What is the preferred induction agent for RSI in a haemodynamically unstable patient?", "Ketamine (1–2 mg/kg IV) — maintains BP and HR; provides analgesia and amnesia. Succinylcholine 1.5 mg/kg for paralysis."), ("Q2. What is the dose of Succinylcholine for RSI? What are its contraindications?", "1.5 mg/kg IV. Contraindicated in: hyperkalaemia, burns >24 hrs, denervation injuries, malignant hyperthermia susceptibility."), ("Q3. What is the compression rate and depth in adult CPR?", "Rate: 100–120/min | Depth: 5–6 cm (at least 2 inches). Minimise interruptions to <10 sec."), ("Q4. What are the shockable rhythms in cardiac arrest?", "Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (pVT). Defibrillation: 200 J biphasic."), ("Q5. What is the first drug given in cardiac arrest regardless of rhythm?", "Adrenaline (Epinephrine) 1 mg IV every 3–5 minutes. For VF/VT: given after 2nd shock. For PEA/Asystole: given immediately."), ("Q6. What is Targeted Temperature Management (TTM) post-ROSC?", "Maintain core temp at 32–36°C for ≥24 hours after ROSC to improve neurological outcomes."), ("Q7. List the 4H's and 4T's reversible causes of cardiac arrest.", "4H's: Hypoxia, Hypovolaemia, Hyper/Hypokalaemia, Hypothermia | 4T's: Tension pneumo, Tamponade, Toxins, Thrombosis (PE/MI)"), ("Q8. What are the post-ROSC oxygenation targets?", "SpO2: 94–98% | PaCO2: 35–45 mmHg (normocapnia) | MAP: >65 mmHg | Avoid hyperoxia."), ("SECTION 2 — CARDIAC EMERGENCIES", None), ("Q9. What ECG change distinguishes STEMI from NSTEMI?", "STEMI: ST elevation ≥1 mm in ≥2 contiguous limb leads, or ≥2 mm in V1–V4. NSTEMI: ST depression / T inversion, troponin elevated."), ("Q10. What is the door-to-balloon time for primary PCI in STEMI?", "<90 minutes. If PCI unavailable within 120 min of first medical contact, give thrombolysis."), ("Q11. List 4 absolute contraindications to thrombolysis in STEMI.", "1. Prior intracranial haemorrhage | 2. Ischaemic stroke within 3 months | 3. Suspected aortic dissection | 4. Active internal bleeding / BP >185/110 uncontrolled."), ("Q12. What is the clinical triad of Right Ventricular infarction?", "Hypotension + Raised JVP + Clear lungs. ECG: ST elevation in V3R/V4R. Treat with IV fluids; AVOID nitrates and diuretics."), ("Q13. What is the LMNOP mnemonic for Acute Pulmonary Oedema?", "L=Lasix (furosemide 40–80 mg IV) | M=Morphine 2–4 mg IV | N=Nitrates (IV/SL) | O=Oxygen (NIV preferred) | P=Position (upright)"), ("Q14. When is Sodium Nitroprusside contraindicated?", "Aortic dissection with beta-blocker (give beta-blocker FIRST to prevent reflex tachycardia). Also avoid in renal failure (thiocyanate toxicity risk)."), ("SECTION 3 — STROKE", None), ("Q15. What is the time window for IV tPA in ischaemic stroke?", "Within 4.5 hours of symptom onset. Dose: 0.9 mg/kg IV (max 90 mg) — 10% as bolus, 90% over 60 min."), ("Q16. What BP must be achieved before giving tPA?", "BP must be <185/110 mmHg. If higher, use Labetalol 10–20 mg IV or Nicardipine infusion to lower first."), ("Q17. What is permissive hypertension in ischaemic stroke?", "Allow BP up to 220/120 mmHg in patients NOT receiving tPA — to maintain cerebral perfusion. Avoid aggressive BP lowering."), ("Q18. What is Cushing's Triad?", "Hypertension + Bradycardia + Irregular respirations — a late, ominous sign of severely raised ICP."), ("Q19. What is first-line treatment for raised ICP in TBI?", "1. HOB 30° | 2. Mannitol 0.25–1 g/kg IV over 20 min OR 3% hypertonic saline | 3. Normocapnia | 4. Avoid hypotension."), ("SECTION 4 — DIABETIC EMERGENCIES", None), ("Q20. What are the three diagnostic criteria for DKA?", "1. Glucose >250 mg/dL | 2. Ketonaemia/ketonuria | 3. Metabolic acidosis (pH <7.3, HCO3 <18 mEq/L)"), ("Q21. When is potassium replaced in DKA? When is insulin held?", "Replace K when K <5.5 mEq/L + urine output confirmed. HOLD insulin if K <3.5 mEq/L — risk of fatal hypokalaemia."), ("Q22. How does DKA differ from HHS?", "DKA: glucose >250, ketones +ve, pH <7.3, younger T1DM. HHS: glucose >600, no ketones, pH >7.3, osmolality >320, elderly T2DM."), ("Q23. What is the treatment of unconscious hypoglycaemia?", "25 ml of 50% Dextrose IV (12.5 g glucose), or Glucagon 1 mg IM/SC if no IV access. Recheck glucose in 15 min."), ("Q24. What is the danger of rapid correction of hyponatraemia?", "Central Pontine Myelinolysis (osmotic demyelination). Correct at no faster than 10–12 mmol/L per 24 hours."), ("SECTION 5 — SEPSIS", None), ("Q25. Define Septic Shock (Sepsis-3 2016).", "Sepsis + vasopressor requirement to maintain MAP ≥65 mmHg + lactate >2 mmol/L despite adequate fluid resuscitation."), ("Q26. What are the 5 components of the Hour-1 Sepsis Bundle?", "1. Measure lactate | 2. Blood cultures ×2 before antibiotics | 3. IV antibiotics within 1 hr | 4. 30 ml/kg IV crystalloid | 5. Vasopressors if MAP <65."), ("Q27. What is the first-line vasopressor in septic shock?", "Noradrenaline (Norepinephrine) 0.01–3 mcg/kg/min targeting MAP ≥65 mmHg."), ("Q28. What is qSOFA?", "Bedside sepsis screen: RR ≥22 + Altered mentation + SBP ≤100. Score ≥2 = high risk; proceed to full SOFA assessment."), ("SECTION 6 — RESPIRATORY", None), ("Q29. What PEFR indicates life-threatening asthma?", "PEFR <33% predicted. Other features: silent chest, cyanosis, exhaustion, altered consciousness, PaCO2 >45 mmHg, SpO2 <92%."), ("Q30. What is the role of IV Magnesium Sulphate in asthma?", "2 g IV over 20 min — bronchial smooth muscle relaxation. Used in severe/life-threatening asthma not responding to initial treatment."), ("Q31. What SpO2 target is used in COPD exacerbation and why?", "88–92% — to avoid suppression of hypoxic respiratory drive in CO2 retainers (chronic hypercapnia)."), ("Q32. When is NIV indicated in COPD exacerbation?", "pH <7.35 with PaCO2 >45 mmHg despite initial treatment — BiPAP reduces intubation rate and mortality."), ("Q33. What is the most common ECG finding in PE?", "Sinus tachycardia (most common). Classic S1Q3T3 is specific but rare. Right heart strain pattern may be seen."), ("Q34. How is massive PE treated?", "Systemic thrombolysis: Alteplase 100 mg IV over 2 hours. If contraindicated: surgical or catheter-directed embolectomy."), ("SECTION 7 — TOXICOLOGY", None), ("Q35. What does DUMBELS stand for in OP poisoning?", "Diarrhoea, Urination, Miosis, Bradycardia, Emesis, Lacrimation, Salivation — the cholinergic toxidrome."), ("Q36. What is the endpoint of atropine treatment in OP poisoning?", "Drying of secretions (dry skin, clear lungs). NOT pupil dilation. Large doses may be needed (up to 20–40 mg)."), ("Q37. Why must Pralidoxime be given within 48 hours in OP poisoning?", "After 48 hrs, the AChE-OP bond 'ages' and becomes irreversible; pralidoxime cannot regenerate the enzyme."), ("Q38. What is the antidote for paracetamol overdose and its mechanism?", "N-Acetylcysteine (NAC) — replenishes glutathione stores to detoxify the toxic metabolite NAPQI, preventing hepatic necrosis."), ("Q39. What is the classic triad of opioid overdose?", "Miosis (pinpoint pupils) + Respiratory depression + Altered consciousness (unconscious)."), ("Q40. What ECG finding in TCA overdose requires Sodium Bicarbonate?", "QRS >100 ms. NaHCO3 1–2 mEq/kg IV bolus: alkalinises blood, reduces sodium channel blockade, corrects arrhythmias."), ("Q41. How do you differentiate Methanol from Ethylene Glycol poisoning?", "Methanol: visual loss, optic disc oedema. Ethylene glycol: flank pain, renal failure, oxalate crystals in urine. Antidote: Fomepizole for both."), ("SECTION 8 — TRAUMA", None), ("Q42. What are the 5 immediately life-threatening chest injuries (ATOM FC)?", "Airway obstruction | Tension pneumothorax | Open pneumothorax | Massive haemothorax | Flail chest + contusion | Cardiac tamponade"), ("Q43. How is Tension Pneumothorax diagnosed and treated?", "Clinical diagnosis: tracheal deviation away, absent BS, hypotension, raised JVP. DO NOT wait for CXR. Immediate: 14–16G needle, 2nd ICS MCL → chest tube."), ("Q44. What is Beck's Triad?", "Hypotension + Raised JVP + Muffled heart sounds — classic triad of cardiac tamponade. Treatment: pericardiocentesis."), ("Q45. What are the 4 classes of haemorrhagic shock?", "Class I: <15%, compensated. Class II: 15–30%, tachycardia. Class III: 30–40%, hypotension. Class IV: >40%, life-threatening."), ("Q46. What is the Alvarado Score and its cut-off for appendicitis?", "Score ≥7 = high probability. MANTRELS: Migratory pain(1)+Anorexia(1)+Nausea(1)+Tenderness RIF(2)+Rebound(1)+Elevated temp(1)+Leukocytosis(2)+Left shift(1)=10"), ("SECTION 9 — ANAPHYLAXIS & HYPERTENSIVE EMERGENCIES", None), ("Q47. What is the FIRST-LINE treatment for anaphylaxis?", "Adrenaline (Epinephrine) 0.5 mg IM (1:1000) into the anterolateral thigh. NOT antihistamines or steroids as first-line."), ("Q48. What is the difference between hypertensive emergency and urgency?", "Emergency: BP >180/120 + acute end-organ damage → IV drugs, ICU. Urgency: BP >180/120 without organ damage → oral drugs, observation."), ("Q49. How much should MAP be reduced in first hour of hypertensive emergency?", "No more than 20–25% of initial MAP — rapid normalisation risks cerebral or myocardial ischaemia (watershed infarcts)."), ("Q50. Why must alpha blockade precede beta blockade in phaeochromocytoma crisis?", "Beta blockade alone removes beta-vasodilator effects → paradoxical hypertension from unopposed alpha-receptor stimulation. Always alpha-block first with Phentolamine."), ("SECTION 10 — ELECTROLYTES", None), ("Q51. What are the ECG changes of hyperkalaemia in order?", "1. Peaked T waves (>5.5) | 2. PR prolongation | 3. Widened QRS (>6.5) | 4. Loss of P waves | 5. Sine wave → VF (>7.0)"), ("Q52. What is the first drug for life-threatening hyperkalaemia and why?", "10 ml of 10% Calcium Gluconate IV over 2–3 min — stabilises cardiac membrane IMMEDIATELY. Does NOT lower K level."), ("Q53. Explain C-BIG-K-Drop.", "C=Calcium gluconate (membrane stabilisation) | B=Bicarbonate (shift K in) | I+G=Insulin+Glucose (shift K in) | K-Drop=Resonium/Furosemide/Dialysis (eliminate K)"), ("Q54. What is the treatment of symptomatic severe hyponatraemia (<120)?", "3% NaCl 100 ml IV over 10 min, can repeat × 2–3 doses. Target: raise Na by 4–6 mmol/L rapidly; then slow correction ≤10–12 mmol/24hr."), ("Q55. What are the symptoms and treatment of hypocalcaemia in the ED?", "Tetany, Chvostek's sign, Trousseau's sign, QT prolongation, seizures. Treatment: 10 ml of 10% Calcium Gluconate IV over 10 min."), ("SECTION 11 — GENERAL HIGH-YIELD", None), ("Q56. What is the FAST mnemonic for stroke recognition?", "Face drooping | Arm weakness | Speech difficulty | Time to call emergency."), ("Q57. What is the target MAP in septic shock and post-ROSC?", "Septic shock: MAP ≥65 mmHg | Post-ROSC: MAP >65 mmHg (some suggest >80 if prior hypertensive)."), ("Q58. What is the first-line anticonvulsant AND antihypertensive in eclampsia?", "Anticonvulsant: Magnesium Sulphate (4–6 g IV loading over 15 min, then 1–2 g/hr). Antihypertensive: Hydralazine 5–10 mg IV or Labetalol 20–40 mg IV."), ("Q59. What is the Wells Score threshold for high probability PE?", "Score >4 = high clinical probability → proceed directly to CTPA (or treat empirically with anticoagulation)."), ("Q60. What is the GCS definition of severe TBI and what airway intervention is required?", "GCS ≤8 = severe TBI. Requires definitive airway management — endotracheal intubation (RSI). Target SpO2 >95%, PaCO2 35–40, SBP >90."), ] for item in flashcards: if item[1] is None: # Section header story.append(Spacer(1, 0.4*cm)) story.append(Paragraph(item[0], h2_style)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#1565c0'))) else: story.append(Paragraph(item[0], q_style)) story.append(Paragraph(f"<b>Answer:</b> {item[1]}", a_style)) # Footer note story.append(Spacer(1, 1*cm)) story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#1a237e'))) story.append(Paragraph("Reference: CMC Vellore Handbook of Emergency Medicine, 3rd Edition (2022), Abhilash K | Study notes prepared for exam preparation purposes.", ParagraphStyle('footer', parent=styles['Normal'], fontSize=8, textColor=colors.grey, alignment=TA_CENTER, spaceBefore=6))) doc.build(story) print("PDF created successfully!") EOF

A realistic hospital ward-style doctor's order sheet for DKA (Diabetic Ketoacidosis) management, styled like a real clinical order form on white paper. Include the following sections clearly written in a medical handwriting/typewritten hybrid style: TITLE: "WARD ORDERS — DIABETIC KETOACIDOSIS (DKA)" Subtitle: "CMC Vellore EM Protocol" SECTION 1 — DIAGNOSIS & MONITORING: - Admit to: Medical Ward / HDU - Diagnosis: Diabetic Ketoacidosis - Vitals: Every 1 hour (BP, HR, RR, SpO2, Temp) - Urine output: Hourly via IDC - Blood glucose: Hourly (bedside glucometer) - Electrolytes (Na, K, Cl, HCO3): Every 4 hours - ABG: At 0, 2, 4 hours then as needed - ECG: On admission (screen for hyperkalaemia) - Weight on admission SECTION 2 — IV FLUIDS: - 0.9% Normal Saline 1L over 1 hour (STAT) - 0.9% NS 1L over 2 hours - 0.9% NS 1L over 4 hours - 0.9% NS 1L over 8 hours - Switch to 5% Dextrose in 0.9% NS when blood glucose < 250 mg/dL SECTION 3 — INSULIN: - Regular Insulin (Actrapid) infusion: 0.1 units/kg/hour IV - NO insulin bolus - Continue until: pH > 7.3, HCO3 > 18, anion gap closed - Transition to SC insulin 1–2 hours before stopping infusion SECTION 4 — POTASSIUM REPLACEMENT: - K+ > 5.5: No replacement, recheck in 2 hrs - K+ 3.5–5.5: Add KCl 20–40 mEq/L to IV fluid - K+ < 3.5: HOLD insulin, give KCl 40 mEq/hr, recheck - Target K+: 4.0–5.0 mEq/L SECTION 5 — BICARBONATE: - Give ONLY if pH < 6.9 - NaHCO3 50 mEq in 200 mL NS over 2 hours SECTION 6 — OTHER ORDERS: - NBM initially, resume oral fluids when alert and tolerating - Treat precipitating cause (infection: antibiotics, etc.) - DVT prophylaxis: Enoxaparin if not contraindicated - Nasogastric tube if vomiting/unconscious - Neurology consult if altered sensorium persists SECTION 7 — DANGER SIGNS (call doctor immediately): - Blood glucose < 70 or > 400 mg/dL - K+ < 3.0 or > 6.0 mEq/L - Urine output < 0.5 mL/kg/hr - GCS drop > 2 points - Persistent acidosis after 4 hours Signed: _____________ Date: ___/___/_____ Time: _______ Format it as a clean, professional A4 clinical order sheet with ruled lines, sections separated by bold headers, looks like an actual printed hospital form with a light blue/white color scheme.

gluteus maximus muscle anatomy diagram labeled

A clean anatomical diagram of the posterior view of the human pelvis and thigh muscles, clearly labeling the Gluteus Maximus muscle with a red arrow and label. Also label Gluteus Medius, Gluteus Minimus, Piriformis, and Hamstrings for context. Medical textbook style illustration on white background.

pip install reportlab --quiet 2>/dev/null; python3 -c " import urllib.request # Download Quicksand font from Google Fonts import subprocess result = subprocess.run(['pip', 'show', 'reportlab'], capture_output=True, text=True) print(result.stdout[:200]) "

# Download Quicksand font files import os import urllib.request font_dir = "/tmp/workspace/fonts" os.makedirs(font_dir, exist_ok=True) fonts = { "Quicksand-Regular.ttf": "https://github.com/google/fonts/raw/main/ofl/quicksand/Quicksand%5Bwght%5D.ttf", } # Try downloading from a reliable source urls = [ ("Quicksand-Regular.ttf", "https://fonts.gstatic.com/s/quicksand/v30/6xK-dSZaM9iE8KbpRA_LJ3z8mH9BOJvgkM8o18G0wx40QDw.woff2"), ("Quicksand-Bold.ttf", "https://fonts.gstatic.com/s/quicksand/v30/6xK-dSZaM9iE8KbpRA_LJ3z8mH9BOJvgkBoo18G0wx40QDw.woff2"), ] # Let's use a direct TTF download import subprocess result = subprocess.run([ 'curl', '-L', '-o', f'{font_dir}/Quicksand-Regular.ttf', 'https://github.com/google/fonts/raw/refs/heads/main/ofl/quicksand/static/Quicksand-Regular.ttf' ], capture_output=True, text=True, timeout=30) print("Regular:", result.returncode) result2 = subprocess.run([ 'curl', '-L', '-o', f'{font_dir}/Quicksand-Bold.ttf', 'https://github.com/google/fonts/raw/refs/heads/main/ofl/quicksand/static/Quicksand-Bold.ttf' ], capture_output=True, text=True, timeout=30) print("Bold:", result2.returncode) result3 = subprocess.run([ 'curl', '-L', '-o', f'{font_dir}/Quicksand-SemiBold.ttf', 'https://github.com/google/fonts/raw/refs/heads/main/ofl/quicksand/static/Quicksand-SemiBold.ttf' ], capture_output=True, text=True, timeout=30) print("SemiBold:", result3.returncode) # Check sizes for f in os.listdir(font_dir): size = os.path.getsize(f'{font_dir}/{f}') print(f"{f}: {size} bytes")

mkdir -p /tmp/workspace/fonts && curl -L -o /tmp/workspace/fonts/Quicksand-Regular.ttf "https://github.com/google/fonts/raw/refs/heads/main/ofl/quicksand/static/Quicksand-Regular.ttf" --silent && curl -L -o /tmp/workspace/fonts/Quicksand-Bold.ttf "https://github.com/google/fonts/raw/refs/heads/main/ofl/quicksand/static/Quicksand-Bold.ttf" --silent && curl -L -o /tmp/workspace/fonts/Quicksand-Medium.ttf "https://github.com/google/fonts/raw/refs/heads/main/ofl/quicksand/static/Quicksand-Medium.ttf" --silent && ls -lh /tmp/workspace/fonts/

python3 << 'EOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm, mm from reportlab.pdfgen import canvas from reportlab.pdfbase import pdfmetrics from reportlab.pdfbase.ttfonts import TTFont import os # Register Quicksand fonts pdfmetrics.registerFont(TTFont('Quicksand', '/tmp/workspace/fonts/Quicksand-Regular.ttf')) pdfmetrics.registerFont(TTFont('Quicksand-Bold', '/tmp/workspace/fonts/Quicksand-Bold.ttf')) pdfmetrics.registerFont(TTFont('Quicksand-Medium', '/tmp/workspace/fonts/Quicksand-Medium.ttf')) # A4 dimensions W, H = A4 # 595.27 x 841.89 points out_path = "/tmp/workspace/cmc-em-notes/Paracetamol_Dosing_Flashcard.pdf" c = canvas.Canvas(out_path, pagesize=A4) # ── BACKGROUND ────────────────────────────────────────────────────────────── # Gradient-like layered background using pastel colours c.setFillColor(colors.HexColor('#FFF8F0')) c.rect(0, 0, W, H, fill=1, stroke=0) # Top decorative band c.setFillColor(colors.HexColor('#FF6B6B')) c.rect(0, H - 2.8*cm, W, 2.8*cm, fill=1, stroke=0) # Bottom decorative band c.setFillColor(colors.HexColor('#4ECDC4')) c.rect(0, 0, W, 1.2*cm, fill=1, stroke=0) # Left accent strip c.setFillColor(colors.HexColor('#FFE66D')) c.rect(0, 0, 0.5*cm, H, fill=1, stroke=0) # Right accent strip c.setFillColor(colors.HexColor('#A8E6CF')) c.rect(W - 0.5*cm, 0, 0.5*cm, H, fill=1, stroke=0) # ── TITLE AREA ─────────────────────────────────────────────────────────────── # Pill icon background c.setFillColor(colors.white) c.roundRect(1.2*cm, H - 2.5*cm, W - 2.4*cm, 2.0*cm, 10, fill=1, stroke=0) c.setFont('Quicksand-Bold', 28) c.setFillColor(colors.HexColor('#FF6B6B')) c.drawCentredString(W/2, H - 1.6*cm, '💊 PARACETAMOL DOSING') c.setFont('Quicksand-Medium', 12) c.setFillColor(colors.HexColor('#666666')) c.drawCentredString(W/2, H - 2.15*cm, 'Paediatric & Adult | PediaRex Guidelines | Quick Reference Flashcard') # ── HELPER FUNCTIONS ───────────────────────────────────────────────────────── def draw_section_box(c, x, y, w, h, title, title_color, box_color, border_color): """Draw a coloured section box with title strip.""" # Shadow c.setFillColor(colors.HexColor('#DDDDDD')) c.roundRect(x+3, y-3, w, h, 8, fill=1, stroke=0) # Main box c.setFillColor(box_color) c.roundRect(x, y, w, h, 8, fill=1, stroke=0) # Title strip c.setFillColor(title_color) c.roundRect(x, y + h - 0.72*cm, w, 0.72*cm, 8, fill=1, stroke=0) # Fix corners of title strip at bottom c.rect(x, y + h - 0.72*cm, w, 0.36*cm, fill=1, stroke=0) # Border c.setStrokeColor(border_color) c.setLineWidth(1.5) c.roundRect(x, y, w, h, 8, fill=0, stroke=1) def draw_title(c, x, y, w, h, text, font_size=11): c.setFont('Quicksand-Bold', font_size) c.setFillColor(colors.white) c.drawCentredString(x + w/2, y + h - 0.52*cm, text) def draw_item(c, x, y, text, font='Quicksand', size=9.5, color='#333333', bullet=True): c.setFont(font, size) c.setFillColor(colors.HexColor(color)) if bullet: c.drawString(x, y, '●') c.drawString(x + 0.45*cm, y, text) else: c.drawString(x, y, text) def draw_badge(c, x, y, text, bg, fg='#FFFFFF', w=None): c.setFont('Quicksand-Bold', 8.5) tw = c.stringWidth(text, 'Quicksand-Bold', 8.5) bw = (w if w else tw + 14) c.setFillColor(colors.HexColor(bg)) c.roundRect(x, y-3, bw, 16, 4, fill=1, stroke=0) c.setFillColor(colors.HexColor(fg)) c.drawCentredString(x + bw/2, y+1, text) return bw # ── SECTION 1: STANDARD DOSING ─────────────────────────────────────────────── sx, sy = 1.2*cm, H - 9.0*cm sw, sh = 17.2*cm, 5.5*cm draw_section_box(c, sx, sy, sw, sh, '', colors.HexColor('#FF6B6B'), colors.HexColor('#FFF0F0'), colors.HexColor('#FF6B6B')) draw_title(c, sx, sy, sw, sh, '📋 STANDARD DOSING', 11) items_col1 = [ ('Calculator default', '15 mg/kg/dose TID'), ('Usual dose range', '10–15 mg/kg per dose'), ('Max single dose', '15 mg/kg (Adult/Teen cap: 1000 mg)'), ('Max daily dose', '60 mg/kg/day (never exceed 4 g/day)'), ('Min interval', '4 hours between doses'), ('Frequency', 'Q4–6H (up to QID) if needed; TID is conservative'), ] col_x = [sx + 0.5*cm, sx + sw/2 + 0.2*cm] row_y = sy + sh - 1.1*cm row_gap = 0.62*cm for i, (label, val) in enumerate(items_col1): cy = row_y - i * row_gap if cy < sy + 0.3*cm: break # Label badge bw = draw_badge(c, sx + 0.4*cm, cy - 2, label, '#FF6B6B') # Value c.setFont('Quicksand-Bold', 9.5) c.setFillColor(colors.HexColor('#222222')) c.drawString(sx + 0.4*cm + bw + 6, cy + 1, val) # ── SECTION 2: FORMULATIONS ────────────────────────────────────────────────── fx, fy = 1.2*cm, H - 14.3*cm fw, fh = 8.1*cm, 4.8*cm draw_section_box(c, fx, fy, fw, fh, '', colors.HexColor('#4ECDC4'), colors.HexColor('#F0FFFE'), colors.HexColor('#4ECDC4')) draw_title(c, fx, fy, fw, fh, '💧 ORAL FORMULATIONS', 10) form_items = [ ('Drops (100 mg/ml)', 'Infants < 6 kg'), ('Syrup 125 mg/5ml', 'Weight: 6–9 kg'), ('Syrup 250 mg/5ml', 'Weight: > 9 kg'), ('Dispersible Tab', '125 mg & 250 mg\n(disperse in water)'), ('Tablet', 'Standard adult — 500 mg'), ] fy_row = fy + fh - 1.1*cm for label, val in form_items: if fy_row < fy + 0.3*cm: break draw_badge(c, fx + 0.4*cm, fy_row - 2, label, '#4ECDC4') c.setFont('Quicksand', 9) c.setFillColor(colors.HexColor('#333333')) # handle multiline lines = val.split('\n') c.drawString(fx + 0.4*cm, fy_row - 14, lines[0]) if len(lines) > 1: c.drawString(fx + 0.4*cm, fy_row - 24, lines[1]) fy_row -= 0.62*cm # ── SECTION 3: RECTAL ROUTE ────────────────────────────────────────────────── rx, ry = 9.9*cm, H - 14.3*cm rw, rh = 8.5*cm, 4.8*cm draw_section_box(c, rx, ry, rw, rh, '', colors.HexColor('#FF8B94'), colors.HexColor('#FFF5F6'), colors.HexColor('#FF8B94')) draw_title(c, rx, ry, rw, rh, '🔴 RECTAL ROUTE', 10) rectal_items = [ 'When oral not possible:', ' vomiting, NBM, seizures', 'Suppositories: 80 mg, 170 mg,', ' 250 mg (older children)', 'Dose: ~10–15 mg/kg (same as oral)', '80 mg → smaller infants', '170 mg → ~11–17 kg range', 'Absorption less predictable than oral', 'Moisten before insertion', 'Repeat if stool passes within ~30 min', ] ry_row = ry + rh - 1.1*cm for item in rectal_items: if ry_row < ry + 0.3*cm: break c.setFont('Quicksand' if not item.endswith(':') else 'Quicksand-Bold', 8.8) c.setFillColor(colors.HexColor('#333333')) bullet = '● ' if not item.startswith(' ') else '' c.drawString(rx + 0.4*cm, ry_row, bullet + item.strip()) ry_row -= 0.48*cm # ── SECTION 4: WEIGHT-BASED QUICK TABLE ────────────────────────────────────── tx, ty = 1.2*cm, H - 20.5*cm tw2, th = 17.2*cm, 5.7*cm draw_section_box(c, tx, ty, tw2, th, '', colors.HexColor('#FFE66D'), colors.HexColor('#FFFEF0'), colors.HexColor('#FFB347')) draw_title(c, tx, ty, tw2, th, '⚖️ WEIGHT-BASED QUICK DOSE TABLE (15 mg/kg)', 11) # Table headers headers = ['Weight', 'Drops\n(100mg/ml)', 'Syrup\n125mg/5ml', 'Syrup\n250mg/5ml', 'Approx Dose'] col_widths = [2.8*cm, 3.0*cm, 3.0*cm, 3.0*cm, 5.4*cm] rows = [ ['3 kg', '0.45 ml', '—', '—', '45 mg'], ['5 kg', '0.75 ml', '—', '—', '75 mg'], ['6 kg', '—', '3.6 ml', '—', '90 mg'], ['8 kg', '—', '4.8 ml', '—', '120 mg'], ['10 kg', '—', '—', '3.0 ml', '150 mg'], ['15 kg', '—', '—', '4.5 ml', '225 mg'], ['20 kg', '—', '—', '6.0 ml', '300 mg (½ tab)'], ['>33 kg','—', '—', '—', '500 mg (1 tab)'], ] header_y = ty + th - 1.1*cm col_x_start = tx + 0.3*cm hdr_colors = ['#FF9800', '#4ECDC4', '#4ECDC4', '#4ECDC4', '#A78BFA'] for ci, (hdr, cw, hc) in enumerate(zip(headers, col_widths, hdr_colors)): cx = col_x_start + sum(col_widths[:ci]) c.setFillColor(colors.HexColor(hc)) c.roundRect(cx, header_y - 2, cw - 2, 16, 3, fill=1, stroke=0) c.setFont('Quicksand-Bold', 8) c.setFillColor(colors.white) # Handle two-line headers lines2 = hdr.split('\n') if len(lines2) == 2: c.drawCentredString(cx + cw/2, header_y + 4, lines2[0]) c.drawCentredString(cx + cw/2, header_y - 4, lines2[1]) else: c.drawCentredString(cx + cw/2, header_y + 1, hdr) row_height = 0.42*cm data_y = header_y - row_height - 0.05*cm row_bgs = ['#FFFBF0', '#FFF8E1'] for ri, row in enumerate(rows): bg = row_bgs[ri % 2] row_full_y = data_y - ri * row_height if row_full_y < ty + 0.3*cm: break c.setFillColor(colors.HexColor(bg)) c.rect(tx + 0.2*cm, row_full_y - 3, tw2 - 0.4*cm, row_height - 1, fill=1, stroke=0) for ci, (cell, cw) in enumerate(zip(row, col_widths)): cx = col_x_start + sum(col_widths[:ci]) c.setFont('Quicksand-Bold' if ci == 0 else 'Quicksand', 8.5) if ci == 0: c.setFillColor(colors.HexColor('#CC5500')) elif cell == '—': c.setFillColor(colors.HexColor('#BBBBBB')) else: c.setFillColor(colors.HexColor('#222222')) c.drawCentredString(cx + cw/2, row_full_y, cell) # ── SECTION 5: WARNINGS & SAFETY ───────────────────────────────────────────── wx2, wy = 1.2*cm, H - 26.8*cm ww, wh = 17.2*cm, 5.8*cm draw_section_box(c, wx2, wy, ww, wh, '', colors.HexColor('#FF4444'), colors.HexColor('#FFF5F5'), colors.HexColor('#FF4444')) draw_title(c, wx2, wy, ww, wh, '⚠️ WARNINGS & SAFETY', 11) warn_col1 = [ ('Max daily dose', '60 mg/kg/day — NEVER exceed 4 g/day total'), ('Duration', 'Not more than 3 days for fever without medical advice'), ('Overdose', 'Hepatotoxicity — NAPQI metabolite depletes glutathione'), ('Antidote', 'N-Acetylcysteine (NAC) — start within 8 hrs for best effect'), ('Toxic dose', '>150 mg/kg or >7.5 g in adults is potentially toxic'), ] warn_col2 = [ ('Combination products', 'Count rectal + oral + cold-FDC paracetamol toward SAME daily max'), ('Interval', 'Minimum 4 hours between any doses; do not double-dose'), ('Food', 'Can be taken with or without food'), ('High-risk groups', 'Malnourished, liver disease, chronic alcohol — lower toxic threshold'), ('Counsel caregiver', 'Do not combine multiple paracetamol-containing products'), ] left_x = wx2 + 0.3*cm right_x = wx2 + ww/2 + 0.1*cm warn_y = wy + wh - 1.1*cm warn_gap = 0.68*cm for (label, val), (label2, val2) in zip(warn_col1, warn_col2): if warn_y < wy + 0.3*cm: break # Left column bw1 = draw_badge(c, left_x, warn_y - 2, label, '#FF4444') c.setFont('Quicksand', 8.5) c.setFillColor(colors.HexColor('#222222')) # Word wrap approximation c.drawString(left_x, warn_y - 14, val[:55]) if len(val) > 55: c.drawString(left_x, warn_y - 24, val[55:]) # Right column bw2 = draw_badge(c, right_x, warn_y - 2, label2, '#CC0000') c.setFont('Quicksand', 8.5) c.setFillColor(colors.HexColor('#222222')) c.drawString(right_x, warn_y - 14, val2[:55]) if len(val2) > 55: c.drawString(right_x, warn_y - 24, val2[55:]) warn_y -= warn_gap # ── SECTION 6: OVERDOSE STAGES ─────────────────────────────────────────────── ox, oy = 1.2*cm, H - 33.5*cm ow, oh = 17.2*cm, 6.2*cm draw_section_box(c, ox, oy, ow, oh, '', colors.HexColor('#9B59B6'), colors.HexColor('#FAF0FF'), colors.HexColor('#9B59B6')) draw_title(c, ox, oy, ow, oh, '☠️ OVERDOSE STAGES (Rumack-Matthew)', 11) stages = [ ('Stage 1\n0–24 hrs', '#E8DAEF', '#6C3483', 'Nausea, vomiting, malaise\nMay appear well — labs normal early'), ('Stage 2\n24–72 hrs', '#FDEBD0', '#A04000', 'Transaminases rising\nRUQ pain, bilirubin increases'), ('Stage 3\n72–96 hrs', '#FADBD8', '#C0392B', 'Peak hepatotoxicity\nCoagulopathy, jaundice, AKI'), ('Stage 4\n4d–2wks', '#D5F5E3', '#1E8449', 'Recovery or\nliver failure / death'), ] stage_w = ow / 4 - 0.2*cm stage_x = ox + 0.3*cm stage_y = oy + oh - 1.1*cm for title, bg, fg, desc in stages: c.setFillColor(colors.HexColor(bg)) c.roundRect(stage_x, stage_y - 3.5*cm, stage_w, 3.8*cm, 8, fill=1, stroke=0) c.setStrokeColor(colors.HexColor(fg)) c.setLineWidth(1.5) c.roundRect(stage_x, stage_y - 3.5*cm, stage_w, 3.8*cm, 8, fill=0, stroke=1) # Stage label c.setFont('Quicksand-Bold', 9) c.setFillColor(colors.HexColor(fg)) lines3 = title.split('\n') c.drawCentredString(stage_x + stage_w/2, stage_y - 0.5*cm, lines3[0]) c.drawCentredString(stage_x + stage_w/2, stage_y - 1.0*cm, lines3[1]) # Divider c.setStrokeColor(colors.HexColor(fg)) c.setLineWidth(0.5) c.line(stage_x + 3, stage_y - 1.2*cm, stage_x + stage_w - 3, stage_y - 1.2*cm) # Description c.setFont('Quicksand', 8.5) c.setFillColor(colors.HexColor('#333333')) desc_lines = desc.split('\n') dy = stage_y - 1.55*cm for dl in desc_lines: c.drawCentredString(stage_x + stage_w/2, dy, dl) dy -= 0.42*cm stage_x += stage_w + 0.3*cm # NAC dose below c.setFont('Quicksand-Bold', 9) c.setFillColor(colors.HexColor('#6C3483')) c.drawString(ox + 0.3*cm, oy + 0.5*cm, '💉 NAC IV Protocol:') c.setFont('Quicksand', 9) c.setFillColor(colors.HexColor('#333333')) c.drawString(ox + 3.5*cm, oy + 0.5*cm, '150 mg/kg in 200ml NS over 1hr → 50 mg/kg in 500ml NS over 4hrs → 100 mg/kg in 1L NS over 16hrs') # ── BOTTOM FOOTER ───────────────────────────────────────────────────────────── c.setFillColor(colors.HexColor('#4ECDC4')) c.rect(0, 0, W, 1.2*cm, fill=1, stroke=0) c.setFont('Quicksand-Bold', 9) c.setFillColor(colors.white) c.drawCentredString(W/2, 0.45*cm, 'Reference: PediaRex Paediatric Dose Calculator | CMC Vellore EM Handbook | For educational use only') c.save() print("✅ Flashcard PDF created:", out_path) EOF

# Try alternative download source for TTF curl -L -o /tmp/workspace/fonts/Quicksand-Regular.ttf "https://fonts.gstatic.com/s/quicksand/v31/6xKtdSZaM9iE8KbpRA_LJ3z8mH9BOJvgkP8o58m-wi40.ttf" --silent # Check if valid python3 -c " with open('/tmp/workspace/fonts/Quicksand-Regular.ttf','rb') as f: header = f.read(4) print('Header bytes:', header.hex()) print('File size:', f.seek(0,2)) "

# The font files are HTML redirects. Let me try a direct GitHub raw URL with different approach python3 << 'PYEOF' import urllib.request import os font_dir = "/tmp/workspace/fonts2" os.makedirs(font_dir, exist_ok=True) # Use GitHub raw content API urls = { "Quicksand-Regular.ttf": "https://raw.githubusercontent.com/google/fonts/main/ofl/quicksand/static/Quicksand-Regular.ttf", "Quicksand-Bold.ttf": "https://raw.githubusercontent.com/google/fonts/main/ofl/quicksand/static/Quicksand-Bold.ttf", "Quicksand-Medium.ttf": "https://raw.githubusercontent.com/google/fonts/main/ofl/quicksand/static/Quicksand-Medium.ttf", } headers = {'User-Agent': 'Mozilla/5.0'} for name, url in urls.items(): req = urllib.request.Request(url, headers=headers) try: with urllib.request.urlopen(req, timeout=20) as resp: data = resp.read() fpath = f"{font_dir}/{name}" with open(fpath, 'wb') as f: f.write(data) print(f"{name}: {len(data)} bytes, header={data[:4].hex()}") except Exception as e: print(f"Failed {name}: {e}") PYEOF

# Check if any system fonts with rounded/friendly look are available python3 << 'PYEOF' import os, glob # Check system fonts system_font_dirs = ['/usr/share/fonts', '/usr/local/share/fonts', os.path.expanduser('~/.fonts')] all_fonts = [] for d in system_font_dirs: if os.path.exists(d): fonts = glob.glob(f"{d}/**/*.ttf", recursive=True) + glob.glob(f"{d}/**/*.TTF", recursive=True) all_fonts.extend(fonts) # Show available fonts print("Available system TTF fonts:") for f in sorted(all_fonts)[:40]: print(f" {os.path.basename(f)}") print(f"Total: {len(all_fonts)}") PYEOF

python3 << 'PYEOF' # Download Quicksand from bunny CDN / jsDelivr which hosts npm packages import urllib.request, os font_dir = "/tmp/workspace/fonts3" os.makedirs(font_dir, exist_ok=True) # Try jsDelivr which hosts Google Fonts packages font_urls = { "Quicksand-Regular.ttf": "https://cdn.jsdelivr.net/npm/@fontsource/quicksand@5.0.18/files/quicksand-latin-400-normal.woff2", "Quicksand-Bold.ttf": "https://cdn.jsdelivr.net/npm/@fontsource/quicksand@5.0.18/files/quicksand-latin-700-normal.woff2", } for name, url in font_urls.items(): try: req = urllib.request.Request(url, headers={'User-Agent': 'Mozilla/5.0'}) with urllib.request.urlopen(req, timeout=20) as resp: data = resp.read() fpath = f"{font_dir}/{name}" with open(fpath, 'wb') as f: f.write(data) print(f"{name}: {len(data)} bytes, header={data[:4].hex()}") except Exception as e: print(f"FAIL {name}: {e}") PYEOF

python3 << 'PYEOF' # woff2 files - need to convert to TTF. Let's use fonttools import subprocess result = subprocess.run(['pip', 'install', '--user', 'fonttools', 'brotli', '--quiet'], capture_output=True, text=True) print(result.stdout[-200:] if result.stdout else "ok") print(result.stderr[-200:] if result.stderr else "ok") PYEOF

python3 << 'PYEOF' from fontTools.ttLib import TTFont as FTFont import os font_dir = "/tmp/workspace/fonts3" out_dir = "/tmp/workspace/fonts_ttf" os.makedirs(out_dir, exist_ok=True) for name in ["Quicksand-Regular.ttf", "Quicksand-Bold.ttf"]: src = f"{font_dir}/{name}" dst = f"{out_dir}/{name}" try: f = FTFont(src) f.save(dst) size = os.path.getsize(dst) print(f"Converted {name}: {size} bytes") except Exception as e: print(f"Error {name}: {e}") PYEOF

python3 << 'PYEOF' from reportlab.pdfbase import pdfmetrics from reportlab.pdfbase.ttfonts import TTFont try: pdfmetrics.registerFont(TTFont('Quicksand', '/tmp/workspace/fonts_ttf/Quicksand-Regular.ttf')) pdfmetrics.registerFont(TTFont('Quicksand-Bold', '/tmp/workspace/fonts_ttf/Quicksand-Bold.ttf')) print("Fonts registered OK") except Exception as e: print(f"Font error: {e}") PYEOF

python3 << 'PYEOF' # Still woff2. Use fonttools to properly convert woff2 -> ttf from fontTools.ttLib import TTFont as FTFont from fontTools import subset import os font_dir = "/tmp/workspace/fonts3" out_dir = "/tmp/workspace/fonts_ttf" os.makedirs(out_dir, exist_ok=True) for name in ["Quicksand-Regular.ttf", "Quicksand-Bold.ttf"]: src = f"{font_dir}/{name}" dst = f"{out_dir}/{name.replace('.ttf', '_out.ttf')}" try: f = FTFont(src) # Force flavor to None (removes woff2 wrapper) f.flavor = None f.save(dst) size = os.path.getsize(dst) # check header with open(dst, 'rb') as fh: hdr = fh.read(4).hex() print(f"Converted {name}: {size} bytes, header={hdr}") except Exception as e: print(f"Error {name}: {e}") PYEOF

python3 << 'EOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.pdfgen import canvas from reportlab.pdfbase import pdfmetrics from reportlab.pdfbase.ttfonts import TTFont # Register Quicksand fonts (properly converted TTF) pdfmetrics.registerFont(TTFont('QS', '/tmp/workspace/fonts_ttf/Quicksand-Regular_out.ttf')) pdfmetrics.registerFont(TTFont('QSB', '/tmp/workspace/fonts_ttf/Quicksand-Bold_out.ttf')) W, H = A4 # 595.27 x 841.89 pts out_path = "/tmp/workspace/cmc-em-notes/Paracetamol_Dosing_Flashcard.pdf" c = canvas.Canvas(out_path, pagesize=A4) # ── BACKGROUND ─────────────────────────────────────────────────────────────── c.setFillColor(colors.HexColor('#FFFDF7')) c.rect(0, 0, W, H, fill=1, stroke=0) # Top band c.setFillColor(colors.HexColor('#FF6B6B')) c.rect(0, H-70, W, 70, fill=1, stroke=0) # Bottom band c.setFillColor(colors.HexColor('#4ECDC4')) c.rect(0, 0, W, 28, fill=1, stroke=0) # Left strip c.setFillColor(colors.HexColor('#FFE66D')) c.rect(0, 0, 10, H, fill=1, stroke=0) # Right strip c.setFillColor(colors.HexColor('#A8E6CF')) c.rect(W-10, 0, 10, H, fill=1, stroke=0) # ── TITLE ──────────────────────────────────────────────────────────────────── c.setFillColor(colors.white) c.roundRect(20, H-65, W-40, 55, 8, fill=1, stroke=0) c.setFont('QSB', 26) c.setFillColor(colors.HexColor('#FF6B6B')) c.drawCentredString(W/2, H-38, 'PARACETAMOL DOSING QUICK REFERENCE') c.setFont('QS', 10) c.setFillColor(colors.HexColor('#555555')) c.drawCentredString(W/2, H-56, 'Paediatric & Adult | Source: PediaRex / CMC Vellore EM Handbook') # ── HELPER: section box ─────────────────────────────────────────────────────── def sbox(x, y, w, h, hdr_color, bg_color, title, title_size=10): # shadow c.setFillColor(colors.HexColor('#CCCCCC')) c.roundRect(x+3, y-3, w, h, 7, fill=1, stroke=0) # bg c.setFillColor(colors.HexColor(bg_color)) c.roundRect(x, y, w, h, 7, fill=1, stroke=0) # header strip c.setFillColor(colors.HexColor(hdr_color)) c.roundRect(x, y+h-20, w, 20, 7, fill=1, stroke=0) c.rect(x, y+h-20, w, 10, fill=1, stroke=0) # square bottom corners of strip # border c.setStrokeColor(colors.HexColor(hdr_color)) c.setLineWidth(1.2) c.roundRect(x, y, w, h, 7, fill=0, stroke=1) # title text c.setFont('QSB', title_size) c.setFillColor(colors.white) c.drawCentredString(x+w/2, y+h-14, title) def badge(x, y, text, bg, fg='#FFFFFF', fs=8): c.setFont('QSB', fs) tw = c.stringWidth(text, 'QSB', fs) bw = tw + 12 c.setFillColor(colors.HexColor(bg)) c.roundRect(x, y-2, bw, 14, 4, fill=1, stroke=0) c.setFillColor(colors.HexColor(fg)) c.drawCentredString(x+bw/2, y+2, text) return bw def body(x, y, text, fs=9, bold=False, col='#222222'): c.setFont('QSB' if bold else 'QS', fs) c.setFillColor(colors.HexColor(col)) c.drawString(x, y, text) # ── SECTION 1: STANDARD DOSING ─────────────────────────────────────────────── s1x, s1y, s1w, s1h = 18, H-175, W-36, 95 sbox(s1x, s1y, s1w, s1h, '#FF6B6B', '#FFF0F0', ' STANDARD DOSING', 10) dosing_data = [ ('Calculator default', '15 mg/kg/dose TID (common outpatient default)'), ('Usual dose range', '10–15 mg/kg per dose; can give Q4–6H (up to QID) if needed'), ('Max single dose', '15 mg/kg | Adult/Teen cap: 1000 mg per dose'), ('Max daily dose', '60 mg/kg/day | Never exceed 4 g/day total'), ('Min interval', '4 hours between any doses'), ] dy = s1y + s1h - 30 for lbl, val in dosing_data: bw = badge(s1x+8, dy, lbl, '#FF6B6B') body(s1x + 8 + bw + 5, dy+2, val, fs=9) dy -= 16 # ── SECTION 2: FORMULATIONS (left) ────────────────────────────────────────── s2x, s2y, s2w, s2h = 18, H-315, 195, 130 sbox(s2x, s2y, s2w, s2h, '#4ECDC4', '#F0FFFD', ' ORAL FORMULATIONS', 9.5) forms = [ ('Drops 100mg/ml', 'Infants < 6 kg'), ('Syrup 125mg/5ml', '6–9 kg'), ('Syrup 250mg/5ml', '> 9 kg'), ('Dispersible Tab', '125 mg & 250 mg (disperse in water)'), ('Tablet 500 mg', 'Older children & adults'), ] fy = s2y + s2h - 32 for lbl, val in forms: bw = badge(s2x+6, fy, lbl, '#4ECDC4') body(s2x+6, fy-11, val, fs=8.5) fy -= 23 # ── SECTION 3: RECTAL (right) ─────────────────────────────────────────────── s3x, s3y, s3w, s3h = 221, H-315, 356, 130 sbox(s3x, s3y, s3w, s3h, '#FF8B94', '#FFF5F6', ' RECTAL ROUTE (vomiting / NBM / seizures)', 9.5) rectal = [ 'Suppositories: 80 mg | 170 mg | 250 mg (older)', 'Dose: same as oral ~10–15 mg/kg/dose', '80 mg → smaller infants', '170 mg → approx 11–17 kg range', 'Absorption less predictable than oral', 'Moisten before insertion rectally', 'Repeat dose if stool passes within ~30 min', '⚠ Count rectal toward same 60 mg/kg/day max', ] ry = s3y + s3h - 30 for item in rectal: col = '#CC0000' if item.startswith('⚠') else '#333333' fnt = 'QSB' if item.startswith('⚠') else 'QS' c.setFont(fnt, 8.5) c.setFillColor(colors.HexColor(col)) c.drawString(s3x+8, ry, ('● ' if not item.startswith('⚠') else '') + item) ry -= 14 # ── SECTION 4: WEIGHT DOSE TABLE ───────────────────────────────────────────── s4x, s4y, s4w, s4h = 18, H-465, W-36, 140 sbox(s4x, s4y, s4w, s4h, '#FFB347', '#FFFEF0', ' WEIGHT-BASED QUICK DOSE TABLE (at 15 mg/kg/dose)', 10) # Column layout cols = ['Weight', 'Drops\n(100mg/ml)', 'Syrup 125\nmg/5ml', 'Syrup 250\nmg/5ml', 'Approx\nDose (mg)', 'Adult\nTablets'] cw = [55, 65, 65, 65, 70, 70] hdr_colors = ['#FF9800','#4ECDC4','#4ECDC4','#4ECDC4','#9B59B6','#E67E22'] cx_start = s4x + 6 hdr_y = s4y + s4h - 33 for ci, (col_title, col_w, hcol) in enumerate(zip(cols, cw, hdr_colors)): cx = cx_start + sum(cw[:ci]) c.setFillColor(colors.HexColor(hcol)) c.roundRect(cx, hdr_y-2, col_w-2, 22, 3, fill=1, stroke=0) c.setFont('QSB', 7.5) c.setFillColor(colors.white) lines2 = col_title.split('\n') if len(lines2)==2: c.drawCentredString(cx+col_w/2-1, hdr_y+10, lines2[0]) c.drawCentredString(cx+col_w/2-1, hdr_y+1, lines2[1]) else: c.drawCentredString(cx+col_w/2-1, hdr_y+6, lines2[0]) rows = [ ['3 kg', '0.45 ml', '—', '—', '45', '—'], ['5 kg', '0.75 ml', '—', '—', '75', '—'], ['6 kg', '—', '3.6 ml', '—', '90', '—'], ['8 kg', '—', '4.8 ml', '—', '120', '—'], ['10 kg', '—', '—', '3.0 ml', '150', '—'], ['12 kg', '—', '—', '3.6 ml', '180', '—'], ['15 kg', '—', '—', '4.5 ml', '225', '—'], ['20 kg', '—', '—', '6.0 ml', '300', '½ tab'], ['>33 kg','—', '—', '—', '500', '1 tab'], ] row_h = 13 data_y = hdr_y - row_h - 2 row_bgs = ['#FFF8E1','#FFFFFF'] for ri, row in enumerate(rows): ry2 = data_y - ri*row_h if ry2 < s4y+5: break c.setFillColor(colors.HexColor(row_bgs[ri%2])) c.rect(s4x+4, ry2-3, s4w-8, row_h, fill=1, stroke=0) for ci, (cell, col_w) in enumerate(zip(row, cw)): cx = cx_start + sum(cw[:ci]) if ci==0: c.setFont('QSB', 8.5); c.setFillColor(colors.HexColor('#CC5500')) elif cell=='—': c.setFont('QS', 8.5); c.setFillColor(colors.HexColor('#CCCCCC')) else: c.setFont('QS' if ci>0 else 'QSB', 8.5); c.setFillColor(colors.HexColor('#222222')) c.drawCentredString(cx+col_w/2-1, ry2, cell) # ── SECTION 5: WARNINGS ─────────────────────────────────────────────────────── s5x, s5y, s5w, s5h = 18, H-590, W-36, 115 sbox(s5x, s5y, s5w, s5h, '#E74C3C', '#FFF5F5', ' WARNINGS & SAFETY', 10) warn_left = [ ('Max daily', '60 mg/kg/day — NEVER exceed 4 g/day'), ('Duration', 'Max 3 days for fever without medical advice'), ('Overdose risk', '>150 mg/kg or >7.5 g — potentially hepatotoxic'), ('NAPQI', 'Toxic metabolite — depletes glutathione'), ('Food', 'Can take with OR without food'), ] warn_right = [ ('Combination products', 'Cold/FDC + oral + rectal = count together'), ('Antidote', 'N-Acetylcysteine (NAC) — give within 8 hrs'), ('High risk', 'Malnourished, liver disease, alcohol use'), ('Caregiver counsel', 'Never combine paracetamol products'), ('Interval', 'Minimum 4 hrs between all doses'), ] half = (s5w - 20) // 2 wy2 = s5y + s5h - 30 for (l1,v1),(l2,v2) in zip(warn_left, warn_right): bw1 = badge(s5x+6, wy2, l1, '#E74C3C') body(s5x+6, wy2-12, v1, fs=8.5) bw2 = badge(s5x+half+14, wy2, l2, '#C0392B') body(s5x+half+14, wy2-12, v2, fs=8.5) wy2 -= 21 # ── SECTION 6: OVERDOSE STAGES ─────────────────────────────────────────────── s6x, s6y, s6w, s6h = 18, H-740, W-36, 140 sbox(s6x, s6y, s6w, s6h, '#8E44AD', '#FAF0FF', ' PARACETAMOL OVERDOSE — STAGES & NAC PROTOCOL', 10) stages = [ ('Stage 1\n0–24 hrs', '#F9EBFF','#6C3483', ['Nausea, vomiting,','malaise. Labs normal early.']), ('Stage 2\n24–72 hrs', '#FDEBD0','#A04000', ['Transaminases rising,','RUQ pain, bilirubin ↑']), ('Stage 3\n72–96 hrs', '#FADBD8','#C0392B', ['Peak hepatotoxicity,','coagulopathy, AKI']), ('Stage 4\n4d–2wks', '#D5F5E3','#1E8449', ['Recovery OR','fulminant liver failure']), ] stage_w = (s6w - 30) / 4 sx2 = s6x + 8 stage_top = s6y + s6h - 28 for (title, bg, fg, desc) in stages: c.setFillColor(colors.HexColor(bg)) c.roundRect(sx2, s6y+32, stage_w-4, stage_top-(s6y+32), 6, fill=1, stroke=0) c.setStrokeColor(colors.HexColor(fg)); c.setLineWidth(1.5) c.roundRect(sx2, s6y+32, stage_w-4, stage_top-(s6y+32), 6, fill=0, stroke=1) # title c.setFont('QSB', 8.5); c.setFillColor(colors.HexColor(fg)) tlines = title.split('\n') c.drawCentredString(sx2+stage_w/2-2, stage_top-10, tlines[0]) c.drawCentredString(sx2+stage_w/2-2, stage_top-20, tlines[1]) # divider c.setStrokeColor(colors.HexColor(fg)); c.setLineWidth(0.5) c.line(sx2+4, stage_top-25, sx2+stage_w-8, stage_top-25) # desc c.setFont('QS', 8.5); c.setFillColor(colors.HexColor('#333333')) dy2 = stage_top-37 for dl in desc: c.drawCentredString(sx2+stage_w/2-2, dy2, dl) dy2 -= 13 sx2 += stage_w # NAC line c.setFont('QSB', 9); c.setFillColor(colors.HexColor('#6C3483')) c.drawString(s6x+8, s6y+20, 'NAC IV:') c.setFont('QS', 9); c.setFillColor(colors.HexColor('#222222')) c.drawString(s6x+52, s6y+20, '150 mg/kg in 200ml/1hr → 50 mg/kg in 500ml/4hrs → 100 mg/kg in 1L/16hrs') # ── FOOTER ──────────────────────────────────────────────────────────────────── c.setFillColor(colors.HexColor('#4ECDC4')) c.rect(0, 0, W, 28, fill=1, stroke=0) c.setFont('QSB', 8); c.setFillColor(colors.white) c.drawCentredString(W/2, 10, 'Reference: PediaRex Paediatric Dose Calculator | CMC Vellore Handbook of Emergency Medicine 3rd Ed | Educational use only') c.save() print("✅ PDF saved:", out_path) import os; print("Size:", os.path.getsize(out_path), "bytes") EOF

python3 << 'EOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm, mm from reportlab.pdfgen import canvas from reportlab.pdfbase import pdfmetrics from reportlab.pdfbase.ttfonts import TTFont # Register fonts pdfmetrics.registerFont(TTFont('QS', '/tmp/workspace/fonts_ttf/Quicksand-Regular_out.ttf')) pdfmetrics.registerFont(TTFont('QSB', '/tmp/workspace/fonts_ttf/Quicksand-Bold_out.ttf')) W, H = A4 # 595 x 841 pts — portrait PURPLE = colors.HexColor('#7B5EA7') # main accent PURPLE2 = colors.HexColor('#9B7FC7') # lighter strip WHITE = colors.white BLACK = colors.HexColor('#1A1A1A') YELLOW = colors.HexColor('#FFE066') # highlight RED = colors.HexColor('#E53935') # warning text GREEN = colors.HexColor('#2E7D32') out_path = "/tmp/workspace/cmc-em-notes/Paracetamol_Card_v2.pdf" c = canvas.Canvas(out_path, pagesize=A4) # ── OUTER DOUBLE BORDER (mimics the card) ──────────────────────────────────── PAD = 14 # outer margin PAD2 = 20 # inner margin # Outer thin border c.setStrokeColor(PURPLE); c.setLineWidth(1) c.roundRect(PAD, PAD, W-2*PAD, H-2*PAD, 10, fill=0, stroke=1) # Inner thicker border c.setStrokeColor(PURPLE); c.setLineWidth(2) c.roundRect(PAD+4, PAD+4, W-2*(PAD+4), H-2*(PAD+4), 8, fill=0, stroke=1) # White background inside c.setFillColor(WHITE) c.roundRect(PAD+5, PAD+5, W-2*(PAD+5), H-2*(PAD+5), 7, fill=1, stroke=0) INNER_X = PAD + 8 # left edge of content INNER_W = W - 2*(PAD+8) # width of content INNER_TOP = H - PAD - 8 # top of content # ── TITLE HEADER ───────────────────────────────────────────────────────────── title_h = 28 c.setFillColor(PURPLE) c.roundRect(INNER_X, INNER_TOP - title_h, INNER_W, title_h, 6, fill=1, stroke=0) # square bottom corners c.rect(INNER_X, INNER_TOP - title_h, INNER_W, title_h/2, fill=1, stroke=0) c.setFont('QSB', 17) c.setFillColor(WHITE) c.drawCentredString(INNER_X + INNER_W/2, INNER_TOP - title_h + 9, 'PARACETAMOL DOSING') c.setFont('QS', 9) c.setFillColor(colors.HexColor('#AAAAAA')) c.drawCentredString(INNER_X + INNER_W/2, INNER_TOP - title_h - 10, 'Paediatric & Adult | PediaRex / CMC Vellore EM Handbook') cur_y = INNER_TOP - title_h - 22 # cursor moving downward # ── HELPER FUNCTIONS ───────────────────────────────────────────────────────── def section_header(c, y, text, h=22): """Full-width purple header strip.""" c.setFillColor(PURPLE) c.roundRect(INNER_X, y - h, INNER_W, h, 4, fill=1, stroke=0) c.rect(INNER_X, y - h, INNER_W, h/2, fill=1, stroke=0) c.setFont('QSB', 11) c.setFillColor(WHITE) c.drawCentredString(INNER_X + INNER_W/2, y - h + 7, text) return y - h def sub_header_row(c, y, cols, widths, h=18): """Purple sub-header row with multiple columns.""" x = INNER_X for col, w in zip(cols, widths): c.setFillColor(PURPLE2) c.rect(x, y - h, w, h, fill=1, stroke=0) c.setStrokeColor(WHITE); c.setLineWidth(0.5) c.rect(x, y - h, w, h, fill=0, stroke=1) c.setFont('QSB', 9) c.setFillColor(WHITE) c.drawCentredString(x + w/2, y - h + 6, col) x += w return y - h def table_row(c, y, cols, widths, h=18, bg=None, bold_col=None, highlight=None): """Data row in a table.""" x = INNER_X for i, (col, w) in enumerate(zip(cols, widths)): # Background if highlight and i in highlight: c.setFillColor(YELLOW) elif bg: c.setFillColor(bg) else: c.setFillColor(WHITE) c.rect(x, y-h, w, h, fill=1, stroke=0) # Grid c.setStrokeColor(PURPLE); c.setLineWidth(0.5) c.rect(x, y-h, w, h, fill=0, stroke=1) # Text font = 'QSB' if (bold_col is not None and i in bold_col) else 'QS' c.setFont(font, 9) if highlight and i in highlight: c.setFillColor(RED) else: c.setFillColor(BLACK) c.drawCentredString(x + w/2, y - h + 6, col) x += w return y - h def bullet_row(c, y, text, bold=False, warn=False, highlight=False): """Bullet point row.""" x = INNER_X + 10 c.setFont('QSB' if bold else 'QS', 9) if warn: c.setFillColor(RED) elif highlight: c.setFillColor(colors.HexColor('#7B5EA7')) else: c.setFillColor(BLACK) # bullet dot c.setFillColor(PURPLE if not warn else RED) c.circle(x + 3, y - 4, 2.5, fill=1, stroke=0) # text c.setFont('QSB' if bold else 'QS', 9) c.setFillColor(RED if warn else (PURPLE if highlight else BLACK)) c.drawString(x + 10, y - 8, text) return y - 15 ROW_H = 20 ALT = colors.HexColor('#F3EEF9') # alternating row tint # ───────────────────────────────────────────────────────────────────────────── # SECTION 1: STANDARD DOSING TABLE # ───────────────────────────────────────────────────────────────────────────── cur_y = section_header(c, cur_y, 'STANDARD DOSING', h=22) cur_y -= 2 W1 = [150, INNER_W - 150] cur_y = sub_header_row(c, cur_y, ['PARAMETER', 'DOSE / VALUE'], W1, h=18) rows1 = [ ('Calculator default', '15 mg/kg/dose TID'), ('Usual dose range', '10–15 mg/kg per dose'), ('Max single dose', '15 mg/kg | Adult / Teen cap: 1000 mg'), ('Max daily dose ⚠', '60 mg/kg/day | NEVER exceed 4 g/day'), ('Minimum interval', '4 hours between ANY doses'), ('Frequency', 'TID (conservative) → up to QID / Q4–6H if needed'), ] for i, (p, v) in enumerate(rows1): bg = ALT if i % 2 == 0 else WHITE warn_val = '⚠' in p x = INNER_X # col 1 c.setFillColor(bg); c.rect(x, cur_y-ROW_H, W1[0], ROW_H, fill=1, stroke=0) c.setStrokeColor(PURPLE); c.setLineWidth(0.5); c.rect(x, cur_y-ROW_H, W1[0], ROW_H, fill=0, stroke=1) c.setFont('QSB', 9); c.setFillColor(RED if warn_val else PURPLE) c.drawString(x+6, cur_y-ROW_H+7, p) # col 2 c.setFillColor(YELLOW if warn_val else bg) c.rect(x+W1[0], cur_y-ROW_H, W1[1], ROW_H, fill=1, stroke=0) c.setStrokeColor(PURPLE); c.rect(x+W1[0], cur_y-ROW_H, W1[1], ROW_H, fill=0, stroke=1) c.setFont('QSB' if warn_val else 'QS', 9) c.setFillColor(RED if warn_val else BLACK) c.drawString(x+W1[0]+6, cur_y-ROW_H+7, v) cur_y -= ROW_H cur_y -= 6 # ───────────────────────────────────────────────────────────────────────────── # SECTION 2: TWO COLUMNS — Formulations (left) | Urine Output Target (right) # ───────────────────────────────────────────────────────────────────────────── HALF = INNER_W // 2 - 2 # LEFT: ORAL FORMULATIONS c.setFillColor(PURPLE) c.roundRect(INNER_X, cur_y - 22, HALF, 22, 4, fill=1, stroke=0) c.rect(INNER_X, cur_y - 22, HALF, 11, fill=1, stroke=0) c.setFont('QSB', 10); c.setFillColor(WHITE) c.drawCentredString(INNER_X + HALF/2, cur_y - 22 + 8, 'ORAL FORMULATIONS') # RIGHT: RECTAL ROUTE c.setFillColor(PURPLE) c.roundRect(INNER_X + HALF + 4, cur_y - 22, HALF, 22, 4, fill=1, stroke=0) c.rect(INNER_X + HALF + 4, cur_y - 22, HALF, 11, fill=1, stroke=0) c.setFont('QSB', 10); c.setFillColor(WHITE) c.drawCentredString(INNER_X + HALF + 4 + HALF/2, cur_y - 22 + 8, 'RECTAL ROUTE') cur_y -= 22 # Sub-headers c.setFillColor(PURPLE2) for sx, sw, label1, label2 in [ (INNER_X, HALF/2, 'FORMULATION', 'FOR'), (INNER_X + HALF/2, HALF/2, 'STRENGTH', 'WEIGHT'), (INNER_X + HALF + 4, HALF/2, 'SUPPOSITORY', 'DOSE'), (INNER_X + HALF + 4 + HALF/2, HALF/2, 'WEIGHT', 'RANGE'), ]: c.rect(sx, cur_y - 16, sw, 16, fill=1, stroke=0) c.setStrokeColor(WHITE); c.setLineWidth(0.3); c.rect(sx, cur_y-16, sw, 16, fill=0, stroke=1) c.setFont('QSB', 7.5); c.setFillColor(WHITE) c.drawCentredString(sx + sw/2, cur_y - 11, label1) c.drawCentredString(sx + sw/2, cur_y - 4, label2) cur_y -= 16 forms_left = [ ('Drops 100mg/ml', '< 6 kg'), ('Syrup 125mg/5ml', '6–9 kg'), ('Syrup 250mg/5ml', '> 9 kg'), ('Dispersible Tab', '125 / 250 mg'), ('Tablet 500 mg', 'Older/Adult'), ] forms_right = [ ('80 mg', 'Infants'), ('170 mg', '~11–17 kg'), ('250 mg', 'Older children'), ('Same dose', '~10–15 mg/kg'), ('Less predict.', 'than oral'), ] rh2 = 16 for i, ((f1, w1), (f2, w2)) in enumerate(zip(forms_left, forms_right)): bg2 = ALT if i % 2 == 0 else WHITE # Left pair for sx, sw, txt in [ (INNER_X, HALF/2, f1), (INNER_X + HALF/2, HALF/2, w1), ]: c.setFillColor(bg2); c.rect(sx, cur_y-rh2, sw, rh2, fill=1, stroke=0) c.setStrokeColor(PURPLE); c.setLineWidth(0.4); c.rect(sx, cur_y-rh2, sw, rh2, fill=0, stroke=1) c.setFont('QSB' if sx == INNER_X else 'QS', 8.5) c.setFillColor(PURPLE if sx == INNER_X else BLACK) c.drawCentredString(sx + sw/2, cur_y - rh2 + 5, txt) # Right pair for sx, sw, txt in [ (INNER_X + HALF + 4, HALF/2, f2), (INNER_X + HALF + 4 + HALF/2, HALF/2, w2), ]: c.setFillColor(bg2); c.rect(sx, cur_y-rh2, sw, rh2, fill=1, stroke=0) c.setStrokeColor(PURPLE); c.setLineWidth(0.4); c.rect(sx, cur_y-rh2, sw, rh2, fill=0, stroke=1) c.setFont('QSB', 8.5); c.setFillColor(PURPLE) c.drawCentredString(sx + sw/2, cur_y - rh2 + 5, txt) cur_y -= rh2 cur_y -= 6 # ───────────────────────────────────────────────────────────────────────────── # SECTION 3: WEIGHT DOSE TABLE # ───────────────────────────────────────────────────────────────────────────── cur_y = section_header(c, cur_y, 'WEIGHT-BASED DOSE TABLE (at 15 mg/kg/dose)', h=22) cur_y -= 2 # 5 columns CW = [INNER_W // 5] * 5 CW[4] = INNER_W - sum(CW[:4]) hdrs5 = ['WEIGHT', 'DROPS\n(100mg/ml)', 'SYRUP\n125mg/5ml', 'SYRUP\n250mg/5ml', 'APPROX\nDOSE'] hdr_h = 24 for i, (hdr, cw2) in enumerate(zip(hdrs5, CW)): sx = INNER_X + sum(CW[:i]) c.setFillColor(PURPLE2) c.rect(sx, cur_y - hdr_h, cw2, hdr_h, fill=1, stroke=0) c.setStrokeColor(WHITE); c.setLineWidth(0.3); c.rect(sx, cur_y-hdr_h, cw2, hdr_h, fill=0, stroke=1) c.setFont('QSB', 8) c.setFillColor(WHITE) lines3 = hdr.split('\n') if len(lines3) == 2: c.drawCentredString(sx + cw2/2, cur_y - 10, lines3[0]) c.drawCentredString(sx + cw2/2, cur_y - 20, lines3[1]) else: c.drawCentredString(sx + cw2/2, cur_y - 15, lines3[0]) cur_y -= hdr_h wt_rows = [ ('3 kg', '0.45 ml', '—', '—', '45 mg'), ('5 kg', '0.75 ml', '—', '—', '75 mg'), ('6 kg', '—', '3.6 ml', '—', '90 mg'), ('8 kg', '—', '4.8 ml', '—', '120 mg'), ('10 kg', '—', '—', '3.0 ml', '150 mg'), ('15 kg', '—', '—', '4.5 ml', '225 mg'), ('20 kg', '—', '—', '6.0 ml', '300 mg'), ('>33 kg', '—', '—', '—', '500 mg (1 tab)'), ] rh3 = 17 for ri, row in enumerate(wt_rows): bg3 = ALT if ri % 2 == 0 else WHITE for ci, (cell, cw2) in enumerate(zip(row, CW)): sx = INNER_X + sum(CW[:ci]) c.setFillColor(YELLOW if (ci == 4 and cell != '—') else bg3) c.rect(sx, cur_y-rh3, cw2, rh3, fill=1, stroke=0) c.setStrokeColor(PURPLE); c.setLineWidth(0.4) c.rect(sx, cur_y-rh3, cw2, rh3, fill=0, stroke=1) font3 = 'QSB' if ci == 0 or (ci == 4 and cell != '—') else 'QS' c.setFont(font3, 9) if ci == 0: c.setFillColor(PURPLE) elif cell == '—': c.setFillColor(colors.HexColor('#BBBBBB')) elif ci == 4: c.setFillColor(RED) else: c.setFillColor(colors.HexColor('#1a6b2e')) c.drawCentredString(sx + cw2/2, cur_y - rh3 + 5, cell) cur_y -= rh3 cur_y -= 6 # ───────────────────────────────────────────────────────────────────────────── # SECTION 4: IMPORTANT NOTES (bullet style like reference card) # ───────────────────────────────────────────────────────────────────────────── cur_y = section_header(c, cur_y, 'IMPORTANT CLINICAL NOTES', h=22) cur_y -= 4 notes = [ (False, False, 'All routes (oral + rectal + cold-FDC) count toward the SAME daily max (60 mg/kg/day)'), (True, True, 'MAX DAILY DOSE: 60 mg/kg/day — NEVER exceed 4 g/day total'), (False, False, 'Insulin drives K⁺ into cells → always monitor potassium'), (False, False, 'Avoid rapid correction of glucose → risk of cerebral oedema'), (False, False, 'Dispersible tablets: disperse fully in water before giving'), (True, False, 'Duration: NOT more than 3 days for fever without medical advice'), (False, False, 'Can be taken with or without food'), (True, True, 'OVERDOSE → Hepatotoxicity (NAPQI toxicity) — counsel caregivers on NOT combining products'), ] for bold, warn, text in notes: cur_y = bullet_row(c, cur_y, text, bold=bold, warn=warn) cur_y -= 4 # ───────────────────────────────────────────────────────────────────────────── # SECTION 5: OVERDOSE STAGES + NAC # ───────────────────────────────────────────────────────────────────────────── cur_y = section_header(c, cur_y, 'OVERDOSE STAGES & ANTIDOTE', h=22) cur_y -= 4 # 4 stage boxes side by side stages = [ ('Stage 1\n0–24 hrs', '#F3EEF9', '#7B5EA7', 'Nausea, vomiting\nLabs normal'), ('Stage 2\n24–72 hrs', '#FFF3CD', '#9B6B00', 'Transaminases ↑\nRUQ pain'), ('Stage 3\n72–96 hrs', '#FFEBEE', '#C62828', 'Peak hepatotox\nCoagulopathy, AKI'), ('Stage 4\n4d–2wks', '#E8F5E9', '#2E7D32', 'Recovery OR\nLiver failure'), ] sw2 = INNER_W / 4 - 3 sx2 = INNER_X stage_h = 52 for title, bg_s, fg_s, desc_s in stages: c.setFillColor(colors.HexColor(bg_s)) c.roundRect(sx2, cur_y-stage_h, sw2, stage_h, 5, fill=1, stroke=0) c.setStrokeColor(colors.HexColor(fg_s)); c.setLineWidth(1.2) c.roundRect(sx2, cur_y-stage_h, sw2, stage_h, 5, fill=0, stroke=1) # title c.setFont('QSB', 8); c.setFillColor(colors.HexColor(fg_s)) tl = title.split('\n') c.drawCentredString(sx2 + sw2/2, cur_y - 11, tl[0]) c.drawCentredString(sx2 + sw2/2, cur_y - 21, tl[1]) # divider c.setLineWidth(0.5); c.line(sx2+4, cur_y-24, sx2+sw2-4, cur_y-24) # desc c.setFont('QS', 7.5); c.setFillColor(BLACK) dl = desc_s.split('\n') c.drawCentredString(sx2 + sw2/2, cur_y - 34, dl[0]) c.drawCentredString(sx2 + sw2/2, cur_y - 44, dl[1]) sx2 += sw2 + 4 cur_y -= stage_h + 5 # NAC protocol highlighted box nac_h = 36 c.setFillColor(colors.HexColor('#EDE7F6')) c.roundRect(INNER_X, cur_y - nac_h, INNER_W, nac_h, 5, fill=1, stroke=0) c.setStrokeColor(PURPLE); c.setLineWidth(1) c.roundRect(INNER_X, cur_y - nac_h, INNER_W, nac_h, 5, fill=0, stroke=1) c.setFont('QSB', 9); c.setFillColor(PURPLE) c.drawString(INNER_X + 8, cur_y - 12, 'ANTIDOTE — N-Acetylcysteine (NAC) IV:') c.setFont('QS', 9); c.setFillColor(BLACK) c.drawString(INNER_X + 8, cur_y - 25, '150 mg/kg / 1hr → 50 mg/kg / 4hrs → 100 mg/kg / 16hrs (Rumack-Matthew nomogram guides treatment)') cur_y -= nac_h + 5 # ───────────────────────────────────────────────────────────────────────────── # SECTION 6: TOXIC DOSE THRESHOLD (quick ref box) # ───────────────────────────────────────────────────────────────────────────── tox_h = 28 c.setFillColor(colors.HexColor('#FFEBEE')) c.roundRect(INNER_X, cur_y - tox_h, INNER_W, tox_h, 5, fill=1, stroke=0) c.setStrokeColor(RED); c.setLineWidth(1.2) c.roundRect(INNER_X, cur_y - tox_h, INNER_W, tox_h, 5, fill=0, stroke=1) c.setFont('QSB', 9.5); c.setFillColor(RED) c.drawCentredString(INNER_X + INNER_W/2, cur_y - 11, '⚠ TOXIC DOSE: > 150 mg/kg OR > 7.5 g in adults → HEPATOTOXICITY') c.setFont('QS', 8.5); c.setFillColor(BLACK) c.drawCentredString(INNER_X + INNER_W/2, cur_y - 23, 'Mechanism: NAPQI metabolite depletes glutathione → hepatic necrosis') cur_y -= tox_h + 4 # ───────────────────────────────────────────────────────────────────────────── # FOOTER # ───────────────────────────────────────────────────────────────────────────── c.setFont('QS', 7); c.setFillColor(colors.HexColor('#888888')) c.drawCentredString(W/2, PAD + 14, 'Reference: PediaRex Paediatric Dose Calculator | CMC Vellore Handbook of Emergency Medicine 3rd Ed, 2022 | Educational use only') c.save() import os; sz = os.path.getsize(out_path) print(f"✅ Saved: {out_path} ({sz:,} bytes)") EOF

python3 << 'EOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.pdfgen import canvas from reportlab.pdfbase import pdfmetrics from reportlab.pdfbase.ttfonts import TTFont pdfmetrics.registerFont(TTFont('QS', '/tmp/workspace/fonts_ttf/Quicksand-Regular_out.ttf')) pdfmetrics.registerFont(TTFont('QSB', '/tmp/workspace/fonts_ttf/Quicksand-Bold_out.ttf')) W, H = A4 PURPLE = colors.HexColor('#7B5EA7') PURPLE2 = colors.HexColor('#9B7FC7') WHITE = colors.white BLACK = colors.HexColor('#1A1A1A') YELLOW = colors.HexColor('#FFE066') RED = colors.HexColor('#D32F2F') ALT = colors.HexColor('#F3EEF9') out = "/tmp/workspace/cmc-em-notes/Paracetamol_Card_v3.pdf" c = canvas.Canvas(out, pagesize=A4) # White fill c.setFillColor(WHITE); c.rect(0,0,W,H,fill=1,stroke=0) PAD = 14 # Outer thin border c.setStrokeColor(PURPLE); c.setLineWidth(1) c.roundRect(PAD, PAD, W-2*PAD, H-2*PAD, 10, fill=0, stroke=1) # Inner thick border c.setStrokeColor(PURPLE); c.setLineWidth(2) c.roundRect(PAD+5, PAD+5, W-2*(PAD+5), H-2*(PAD+5), 8, fill=0, stroke=1) IX = PAD+10 # inner content left x IW = W - 2*(PAD+10) # inner content width cur = H - PAD - 10 # cursor y (moves down) # ── TITLE ──────────────────────────────────────────────────────────────────── th = 30 c.setFillColor(PURPLE) c.roundRect(IX, cur-th, IW, th, 6, fill=1, stroke=0) c.rect(IX, cur-th, IW, th//2, fill=1, stroke=0) c.setFont('QSB', 18); c.setFillColor(WHITE) c.drawCentredString(IX+IW/2, cur-th+10, 'PARACETAMOL — DOSING CARD') cur -= th + 5 # ── HELPER ─────────────────────────────────────────────────────────────────── def sec(title, h=22): global cur c.setFillColor(PURPLE) c.roundRect(IX, cur-h, IW, h, 4, fill=1, stroke=0) c.rect(IX, cur-h, IW, h//2, fill=1, stroke=0) c.setFont('QSB', 11); c.setFillColor(WHITE) c.drawCentredString(IX+IW/2, cur-h+8, title) cur -= h + 2 def sub_row(cols, widths, h=18): global cur x = IX for col, w in zip(cols, widths): c.setFillColor(PURPLE2) c.rect(x, cur-h, w, h, fill=1, stroke=0) c.setStrokeColor(WHITE); c.setLineWidth(0.4) c.rect(x, cur-h, w, h, fill=0, stroke=1) c.setFont('QSB', 9); c.setFillColor(WHITE) c.drawCentredString(x+w/2, cur-h+6, col) x += w cur -= h def data_row(cells, widths, alt=False, bold_idx=(), red_idx=(), yellow_idx=()): global cur rh = 18 x = IX for i,(cell,w) in enumerate(zip(cells,widths)): bg = YELLOW if i in yellow_idx else (ALT if alt else WHITE) c.setFillColor(bg); c.rect(x,cur-rh,w,rh,fill=1,stroke=0) c.setStrokeColor(PURPLE); c.setLineWidth(0.4) c.rect(x,cur-rh,w,rh,fill=0,stroke=1) fn = 'QSB' if i in bold_idx else 'QS' fc = RED if i in red_idx else (PURPLE if i==0 else BLACK) c.setFont(fn,9); c.setFillColor(fc) c.drawCentredString(x+w/2, cur-rh+6, cell) x += w cur -= rh def bullet(text, bold=False, warn=False, gap=14): global cur bx = IX+8 c.setFillColor(RED if warn else PURPLE) c.circle(bx+3, cur-5, 2.8, fill=1, stroke=0) c.setFont('QSB' if bold else 'QS', 9.5) c.setFillColor(RED if warn else BLACK) c.drawString(bx+12, cur-8, text) cur -= gap def spacer(n=5): global cur; cur -= n # ═══════════════════════════════════════════════════════════════════ # 1. DOSING # ═══════════════════════════════════════════════════════════════════ sec('DOSING') W2 = [160, IW-160] sub_row(['PARAMETER','VALUE'], W2) rows_d = [ ('Usual dose', '10 – 15 mg/kg/dose', False, False), ('Frequency', 'Q6H (TID) → up to Q4H (QID) if needed', False, False), ('Max single dose', '15 mg/kg | Adult cap 1000 mg', True, False), ('Max daily dose', '60 mg/kg/day | NEVER > 4 g/day', True, True), ('Min interval', '4 hours between doses', False, False), ] for i,(p,v,hi,warn) in enumerate(rows_d): alt = i%2==0 x = IX # col1 c.setFillColor(ALT if alt else WHITE) c.rect(x,cur-18,W2[0],18,fill=1,stroke=0) c.setStrokeColor(PURPLE);c.setLineWidth(0.4);c.rect(x,cur-18,W2[0],18,fill=0,stroke=1) c.setFont('QSB',9);c.setFillColor(RED if warn else PURPLE) c.drawString(x+6,cur-12,p) # col2 c.setFillColor(YELLOW if warn else (ALT if alt else WHITE)) c.rect(x+W2[0],cur-18,W2[1],18,fill=1,stroke=0) c.setStrokeColor(PURPLE);c.rect(x+W2[0],cur-18,W2[1],18,fill=0,stroke=1) c.setFont('QSB' if hi else 'QS',9) c.setFillColor(RED if warn else BLACK) c.drawString(x+W2[0]+6,cur-12,v) cur -= 18 spacer(6) # ═══════════════════════════════════════════════════════════════════ # 2. FORMULATIONS # ═══════════════════════════════════════════════════════════════════ sec('FORMULATIONS & ROUTE') CW3=[IW//3, IW//3, IW-2*(IW//3)] sub_row(['FORMULATION','STRENGTH / DOSE','USE FOR'],CW3) forms=[ ('Drops', '100 mg/ml → 0.15 ml/kg', 'Infants <6 kg'), ('Syrup', '125 mg/5ml', '6–9 kg'), ('Syrup', '250 mg/5ml', '>9 kg'), ('Dispersible Tab', '125 mg / 250 mg', 'Disperse in water'), ('Tablet', '500 mg', 'Adult / Older child'), ('Suppository', '80 / 170 / 250 mg', 'Vomiting / NBM / Seizure'), ] for i,(f,s,u) in enumerate(forms): alt=i%2==0 for ci,(cell,cw3) in enumerate(zip([f,s,u],CW3)): sx=IX+sum(CW3[:ci]) c.setFillColor(ALT if alt else WHITE) c.rect(sx,cur-18,cw3,18,fill=1,stroke=0) c.setStrokeColor(PURPLE);c.setLineWidth(0.4);c.rect(sx,cur-18,cw3,18,fill=0,stroke=1) fn='QSB' if ci==0 else 'QS' fc=PURPLE if ci==0 else (colors.HexColor('#1a6b2e') if ci==1 else BLACK) c.setFont(fn,9);c.setFillColor(fc) c.drawCentredString(sx+cw3/2,cur-12,cell) cur-=18 spacer(6) # ═══════════════════════════════════════════════════════════════════ # 3. WEIGHT TABLE # ═══════════════════════════════════════════════════════════════════ sec('WEIGHT-BASED QUICK DOSE TABLE (15 mg/kg)') CW4=[IW//5]*4; CW4.append(IW-sum(CW4)) sub_row(['WEIGHT','DROPS\n100mg/ml','SYRUP\n125mg/5ml','SYRUP\n250mg/5ml','DOSE'],CW4,h=22) cur-=4 # sub_row already moved but need manual tweak for 2-line header wrows=[ ('3 kg', '0.45 ml','—','—','45 mg'), ('5 kg', '0.75 ml','—','—','75 mg'), ('6 kg', '—','3.6 ml','—','90 mg'), ('8 kg', '—','4.8 ml','—','120 mg'), ('10 kg','—','—','3.0 ml','150 mg'), ('15 kg','—','—','4.5 ml','225 mg'), ('20 kg','—','—','6.0 ml','300 mg'), ('>33kg','—','—','—','500 mg (1 tab)'), ] for ri,row in enumerate(wrows): alt=ri%2==0 for ci,(cell,cw4) in enumerate(zip(row,CW4)): sx=IX+sum(CW4[:ci]) yb=YELLOW if (ci==4 and cell!='—') else (ALT if alt else WHITE) c.setFillColor(yb);c.rect(sx,cur-17,cw4,17,fill=1,stroke=0) c.setStrokeColor(PURPLE);c.setLineWidth(0.4);c.rect(sx,cur-17,cw4,17,fill=0,stroke=1) fn='QSB' if ci==0 or (ci==4 and cell!='—') else 'QS' fc=PURPLE if ci==0 else (RED if (ci==4 and cell!='—') else (colors.HexColor('#BBBBBB') if cell=='—' else colors.HexColor('#1a6b2e'))) c.setFont(fn,8.5);c.setFillColor(fc) c.drawCentredString(sx+cw4/2,cur-11,cell) cur-=17 spacer(6) # ═══════════════════════════════════════════════════════════════════ # 4. KEY POINTS (crisp bullets) # ═══════════════════════════════════════════════════════════════════ sec('KEY POINTS') spacer(2) bullet('Count ALL routes (oral + rectal + cold-FDC) toward same 60 mg/kg/day') bullet('Rectal absorption less predictable — moisten before insertion') bullet('Duration: max 3 days for fever without medical advice', bold=False) bullet('MAX DAILY DOSE = 60 mg/kg/day | Adult cap = 4 g/day', bold=True, warn=True) bullet('OVERDOSE → NAPQI → Hepatic necrosis | Toxic dose: >150 mg/kg or >7.5 g', bold=True, warn=True) bullet('Antidote: N-Acetylcysteine (NAC) — start within 8 hours of ingestion', bold=True) bullet('NAC IV: 150 mg/kg /1hr → 50 mg/kg /4hr → 100 mg/kg /16hr') spacer(5) # ═══════════════════════════════════════════════════════════════════ # 5. OVERDOSE STAGES (compact row) # ═══════════════════════════════════════════════════════════════════ sec('OVERDOSE STAGES') stage_data=[ ('Stage 1\n0–24 h', '#F3EEF9','#7B5EA7','Nausea / vomiting\nLabs normal'), ('Stage 2\n24–72 h','#FFF8E1','#9B6B00','LFTs rising\nRUQ pain'), ('Stage 3\n72–96 h','#FFEBEE','#C62828','Peak hepatotox\nCoagulopathy / AKI'), ('Stage 4\n4d–2wk', '#E8F5E9','#2E7D32','Recovery\nOR liver failure'), ] sw3=IW/4-3; sx3=IX; sh3=50 for title,bg,fg,desc in stage_data: c.setFillColor(colors.HexColor(bg)) c.roundRect(sx3,cur-sh3,sw3,sh3,5,fill=1,stroke=0) c.setStrokeColor(colors.HexColor(fg));c.setLineWidth(1.2) c.roundRect(sx3,cur-sh3,sw3,sh3,5,fill=0,stroke=1) tl=title.split('\n') c.setFont('QSB',8.5);c.setFillColor(colors.HexColor(fg)) c.drawCentredString(sx3+sw3/2,cur-10,tl[0]) c.drawCentredString(sx3+sw3/2,cur-20,tl[1]) c.setLineWidth(0.5);c.line(sx3+4,cur-23,sx3+sw3-4,cur-23) dl=desc.split('\n') c.setFont('QS',8);c.setFillColor(BLACK) c.drawCentredString(sx3+sw3/2,cur-33,dl[0]) c.drawCentredString(sx3+sw3/2,cur-43,dl[1]) sx3+=sw3+4 cur-=sh3+4 # ═══════════════════════════════════════════════════════════════════ # FOOTER # ═══════════════════════════════════════════════════════════════════ c.setFont('QS',7.5);c.setFillColor(colors.HexColor('#888888')) c.drawCentredString(W/2, PAD+10, 'PediaRex | CMC Vellore EM Handbook 3rd Ed, 2022 | Educational use only') c.save() import os; print(f"✅ Done: {out} ({os.path.getsize(out):,} bytes) | bottom margin left: {cur:.0f} pts") EOF