mkdir -p /home/daytona/workspace/snakebite-pptx && ls /home/daytona/workspace/sn…

~/snakebite-pptx/create_presentation.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Snake Bite Management & Antivenom";
pres.author = "Medical Education";

// ── COLOR PALETTE ──────────────────────────────────────────────
const C = {
  darkGreen:   "0A3D2F",  // dominant background
  midGreen:    "1B6B47",
  accent:      "F4C842",  // golden yellow accent
  red:         "D94040",  // danger/alert
  lightYellow: "FFF8DC",  // light panels
  white:       "FFFFFF",
  lightGreen:  "A8D8A0",
  teal:        "2E8B6A",
  orange:      "F08030",
  darkText:    "1A2E1A",
  cardBg:      "0D4A30",
  cardBorder:  "F4C842",
  subtitleText:"C8E6C9",
  paleGreen:   "E8F5E9",
  paleYellow:  "FFFDE7",
  alertRed:    "B71C1C",
  warningOrange:"E65100",
};

// ─────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE SLIDE
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();

  // Full dark-green background
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkGreen } });

  // Decorative diagonal accent stripe
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 3.8, w: 10, h: 0.18, fill: { color: C.accent }, line: { type: "none" } });

  // Snake scale hex pattern row (decorative circles)
  for (let i = 0; i < 12; i++) {
    slide.addShape(pres.ShapeType.ellipse, {
      x: i * 0.88 - 0.2, y: 4.1, w: 0.55, h: 0.55,
      fill: { color: i % 2 === 0 ? C.midGreen : C.teal },
      line: { color: C.accent, width: 1 }
    });
  }

  // Top badge
  slide.addShape(pres.ShapeType.roundRect, { x: 3.5, y: 0.22, w: 3, h: 0.55, fill: { color: C.accent }, line: { type: "none" }, rectRadius: 0.15 });
  slide.addText("EMERGENCY MEDICINE", { x: 3.5, y: 0.22, w: 3, h: 0.55, fontSize: 10, bold: true, color: C.darkGreen, align: "center", valign: "middle", margin: 0 });

  // Main title
  slide.addText("🐍 Snake Bite", { x: 0.5, y: 0.9, w: 9, h: 1.2, fontSize: 56, bold: true, color: C.accent, align: "center", fontFace: "Arial Black", glow: { size: 8, opacity: 0.4, color: C.accent } });
  slide.addText("Management & Antivenom", { x: 0.5, y: 1.95, w: 9, h: 0.9, fontSize: 32, bold: true, color: C.white, align: "center", fontFace: "Arial" });

  // Divider line
  slide.addShape(pres.ShapeType.line, { x: 1.5, y: 2.95, w: 7, h: 0, line: { color: C.accent, width: 2 } });

  // Subtitle
  slide.addText("A Comprehensive Clinical Guide to Recognition, Treatment\nand Antivenom Therapy", { x: 1, y: 3.1, w: 8, h: 0.7, fontSize: 14, color: C.subtitleText, align: "center", italic: true });

  // Bottom stats bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 4.85, w: 10, h: 0.78, fill: { color: C.cardBg }, line: { type: "none" } });
  const stats = [
    { val: "5.5M", label: "Annual Bites" },
    { val: "~63K", label: "Deaths/Year" },
    { val: "420+", label: "Species Venomous" },
    { val: "WHO", label: "Neglected Tropical Disease" },
  ];
  stats.forEach((s, i) => {
    const x = 0.5 + i * 2.4;
    slide.addText(s.val, { x, y: 4.88, w: 2.2, h: 0.38, fontSize: 18, bold: true, color: C.accent, align: "center", margin: 0 });
    slide.addText(s.label, { x, y: 5.22, w: 2.2, h: 0.28, fontSize: 9, color: C.lightGreen, align: "center", margin: 0 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 2 — EPIDEMIOLOGY & GLOBAL BURDEN
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.paleGreen } });

  // Left panel
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 3.8, h: 5.625, fill: { color: C.darkGreen }, line: { type: "none" } });

  // Section tag
  slide.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.25, w: 2.8, h: 0.42, fill: { color: C.accent }, line: { type: "none" }, rectRadius: 0.1 });
  slide.addText("EPIDEMIOLOGY", { x: 0.2, y: 0.25, w: 2.8, h: 0.42, fontSize: 11, bold: true, color: C.darkGreen, align: "center", valign: "middle", margin: 0 });

  slide.addText("Global\nBurden", { x: 0.2, y: 0.82, w: 3.2, h: 1.2, fontSize: 34, bold: true, color: C.white, align: "center" });

  // Big stat circles
  const leftStats = [
    { n: "1.2–5.5M", l: "Snakebites/year" },
    { n: "63,415", l: "Deaths globally (2019)" },
    { n: "400K+", l: "Envenomations/year" },
  ];
  leftStats.forEach((s, i) => {
    const y = 2.2 + i * 1.05;
    slide.addShape(pres.ShapeType.ellipse, { x: 0.3, y, w: 0.85, h: 0.85, fill: { color: C.accent }, line: { type: "none" } });
    slide.addText(s.n, { x: 1.28, y: y + 0.02, w: 2.4, h: 0.44, fontSize: 15, bold: true, color: C.accent, margin: 0 });
    slide.addText(s.l, { x: 1.28, y: y + 0.44, w: 2.4, h: 0.38, fontSize: 11, color: C.subtitleText, margin: 0 });
  });

  // Right content
  slide.addText("Who Gets Bitten?", { x: 4.1, y: 0.25, w: 5.7, h: 0.55, fontSize: 22, bold: true, color: C.darkGreen });
  slide.addShape(pres.ShapeType.line, { x: 4.1, y: 0.82, w: 5.5, h: 0, line: { color: C.teal, width: 2 } });

  const facts = [
    { icon: "🌍", text: "Developing countries in tropical/temperate zones — agriculture, fishing communities" },
    { icon: "🏥", text: "Many victims lack access to healthcare or antivenom in endemic regions" },
    { icon: "📈", text: "WHO projects 68,799 deaths by 2030 without intervention" },
    { icon: "🎯", text: "WHO goal: halve snakebite deaths by 2030 through improved access to antivenom" },
    { icon: "⚠️", text: "Wide estimates reflect poor data collection in most-affected areas" },
  ];
  facts.forEach((f, i) => {
    const y = 1.0 + i * 0.87;
    slide.addShape(pres.ShapeType.roundRect, { x: 4.1, y, w: 5.6, h: 0.76, fill: { color: C.white }, line: { color: C.lightGreen, width: 1 }, rectRadius: 0.1 });
    slide.addText(f.icon, { x: 4.2, y: y + 0.08, w: 0.55, h: 0.55, fontSize: 20, align: "center", margin: 0 });
    slide.addText(f.text, { x: 4.85, y: y + 0.08, w: 4.75, h: 0.58, fontSize: 11.5, color: C.darkText, valign: "middle", margin: 0 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 3 — SNAKE CLASSIFICATION
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkText } });

  // Header bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: C.midGreen }, line: { type: "none" } });
  slide.addText("🐍  Venomous Snake Classification", { x: 0.4, y: 0.1, w: 9, h: 0.8, fontSize: 26, bold: true, color: C.white, valign: "middle" });

  // 4 family cards
  const families = [
    {
      name: "Viperidae", color: C.red, sub: "Pit Vipers & True Vipers",
      examples: ["Rattlesnakes (Crotalus)", "Copperheads (Agkistrodon)", "Cottonmouth", "Russell's Viper"],
      venom: "Hemotoxic / Cytotoxic",
      feature: "Triangular head, elliptical pupils, retractable fangs"
    },
    {
      name: "Elapidae", color: C.orange, sub: "Cobras, Kraits, Mambas",
      examples: ["Cobras", "Coral snakes", "Sea snakes", "Kraits", "All Australian venomous snakes"],
      venom: "Neurotoxic",
      feature: "Fixed, grooved fangs — wick venom into victim"
    },
    {
      name: "Lamprophiidae", color: C.teal, sub: "Burrowing Asps",
      examples: ["Atractaspis spp.", "Found in Africa/Middle East"],
      venom: "Cytotoxic",
      feature: "Rear-fanged; can envenomate even if held behind head"
    },
    {
      name: "Colubridae", color: C.midGreen, sub: "Mostly Non-venomous",
      examples: ["Most species harmless", "Boomslang (Africa)", "Twig snakes"],
      venom: "Variable (few toxic)",
      feature: "Largest snake family; only a few clinically significant"
    },
  ];

  families.forEach((f, i) => {
    const x = 0.18 + i * 2.46;
    slide.addShape(pres.ShapeType.roundRect, { x, y: 1.15, w: 2.3, h: 4.25, fill: { color: f.color }, line: { type: "none" }, rectRadius: 0.18 });
    // top label
    slide.addText(f.name, { x, y: 1.22, w: 2.3, h: 0.52, fontSize: 16, bold: true, color: C.white, align: "center", margin: 0 });
    slide.addText(f.sub, { x, y: 1.7, w: 2.3, h: 0.38, fontSize: 9, color: C.white, align: "center", italic: true, margin: 0 });
    // divider
    slide.addShape(pres.ShapeType.line, { x: x + 0.15, y: 2.12, w: 2.0, h: 0, line: { color: C.white, width: 1 } });
    // venom badge
    slide.addShape(pres.ShapeType.roundRect, { x: x + 0.15, y: 2.2, w: 2.0, h: 0.38, fill: { color: C.darkGreen }, line: { type: "none" }, rectRadius: 0.1 });
    slide.addText(f.venom, { x: x + 0.15, y: 2.2, w: 2.0, h: 0.38, fontSize: 10, bold: true, color: C.accent, align: "center", valign: "middle", margin: 0 });
    // examples
    f.examples.forEach((e, j) => {
      slide.addText("• " + e, { x: x + 0.1, y: 2.68 + j * 0.34, w: 2.15, h: 0.34, fontSize: 9.5, color: C.white, margin: 0 });
    });
    // feature box at bottom
    slide.addShape(pres.ShapeType.roundRect, { x: x + 0.08, y: 5.0, w: 2.18, h: 0.32, fill: { color: "00000040" }, line: { type: "none" }, rectRadius: 0.08 });
    slide.addText(f.feature, { x: x + 0.08, y: 5.0, w: 2.18, h: 0.32, fontSize: 7.5, color: C.lightYellow, italic: true, align: "center", valign: "middle", margin: 2 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 4 — VENOM COMPOSITION & EFFECTS
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.paleYellow } });

  // Top header
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.95, fill: { color: C.orange }, line: { type: "none" } });
  slide.addText("🧪  Venom Composition & Pathophysiology", { x: 0.4, y: 0.08, w: 9, h: 0.8, fontSize: 24, bold: true, color: C.white, valign: "middle" });

  // Left: composition wheel concept (circular badges)
  const components = [
    { name: "Phospholipase A2", effect: "Membrane disruption, hemolysis, neurotoxicity", color: C.red },
    { name: "Hyaluronidase", effect: "Spreads venom through tissues", color: C.orange },
    { name: "Serine Proteases", effect: "Fibrinogenolysis, coagulopathy", color: C.midGreen },
    { name: "L-amino acid oxidase", effect: "Oxidative damage, apoptosis", color: C.teal },
    { name: "Metalloproteinases", effect: "Hemorrhage, tissue necrosis", color: C.alertRed },
  ];

  slide.addText("Pit Viper Venom\n>90% Protein / 50+ Enzymes", { x: 0.2, y: 1.05, w: 4.2, h: 0.7, fontSize: 14, bold: true, color: C.darkGreen, align: "center" });

  components.forEach((c, i) => {
    const y = 1.85 + i * 0.73;
    slide.addShape(pres.ShapeType.roundRect, { x: 0.2, y, w: 4.2, h: 0.65, fill: { color: c.color }, line: { type: "none" }, rectRadius: 0.12 });
    slide.addText(c.name, { x: 0.32, y: y + 0.04, w: 4.0, h: 0.28, fontSize: 12, bold: true, color: C.white, margin: 0 });
    slide.addText(c.effect, { x: 0.32, y: y + 0.3, w: 4.0, h: 0.28, fontSize: 9.5, color: C.lightYellow, italic: true, margin: 0 });
  });

  // Right: systemic effects
  slide.addShape(pres.ShapeType.roundRect, { x: 4.8, y: 1.05, w: 4.95, h: 4.35, fill: { color: C.white }, line: { color: C.orange, width: 2 }, rectRadius: 0.2 });
  slide.addText("Systemic Effects by Venom Type", { x: 4.9, y: 1.15, w: 4.75, h: 0.5, fontSize: 15, bold: true, color: C.darkGreen, align: "center" });
  slide.addShape(pres.ShapeType.line, { x: 5.0, y: 1.68, w: 4.5, h: 0, line: { color: C.orange, width: 1.5 } });

  const effects = [
    { type: "HEMOTOXIC", icon: "🩸", items: ["DIC & coagulopathy", "Thrombocytopenia", "Fibrinogenolysis", "Hemolysis"] },
    { type: "NEUROTOXIC", icon: "🧠", items: ["Neuromuscular blockade", "Ptosis, diplopia", "Respiratory failure", "Seizures"] },
    { type: "CYTOTOXIC", icon: "🔥", items: ["Local tissue necrosis", "Progressive swelling", "Compartment syndrome", "Ecchymosis"] },
  ];

  effects.forEach((e, i) => {
    const y = 1.82 + i * 1.16;
    slide.addShape(pres.ShapeType.roundRect, { x: 4.9, y, w: 1.25, h: 0.35, fill: { color: i === 0 ? C.red : i === 1 ? C.teal : C.orange }, line: { type: "none" }, rectRadius: 0.08 });
    slide.addText(e.icon + " " + e.type, { x: 4.9, y, w: 1.25, h: 0.35, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    e.items.forEach((item, j) => {
      slide.addText("▸ " + item, { x: 6.28, y: y + j * 0.28, w: 3.3, h: 0.28, fontSize: 10.5, color: C.darkText, margin: 0 });
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 5 — CLINICAL PRESENTATION
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkGreen } });

  // Title area
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: C.midGreen }, line: { type: "none" } });
  slide.addText("🩺  Clinical Presentation & Severity Grading", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 24, bold: true, color: C.white, valign: "middle" });

  // Severity grading — 4 horizontal bands
  const grades = [
    {
      grade: "DRY BITE",
      color: C.lightGreen,
      textColor: C.darkText,
      badge: "NONE",
      badgeColor: "4CAF50",
      desc: "Fang marks only — no envenomation",
      features: ["No pain beyond puncture site", "No swelling or erythema", "Normal labs", "No systemic symptoms"],
    },
    {
      grade: "MILD",
      color: C.accent,
      textColor: C.darkText,
      badge: "GRADE I",
      badgeColor: C.accent,
      desc: "Local effects only, non-progressive",
      features: ["Local pain & erythema", "Non-progressive swelling", "Normal coagulation", "No systemic signs"],
    },
    {
      grade: "MODERATE",
      color: C.orange,
      textColor: C.white,
      badge: "GRADE II",
      badgeColor: C.warningOrange,
      desc: "Progressing local + systemic involvement",
      features: ["Clearly progressing swelling", "Nausea, vomiting", "Lab abnormalities (PT/INR)", "Diaphoresis, tachycardia"],
    },
    {
      grade: "SEVERE",
      color: C.alertRed,
      textColor: C.white,
      badge: "GRADE III",
      badgeColor: C.alertRed,
      desc: "Life-threatening systemic envenomation",
      features: ["Neurologic dysfunction", "Respiratory distress", "Cardiovascular instability/shock", "DIC, compartment syndrome"],
    },
  ];

  grades.forEach((g, i) => {
    const x = 0.18 + i * 2.44;
    slide.addShape(pres.ShapeType.roundRect, { x, y: 1.1, w: 2.3, h: 4.3, fill: { color: g.color }, line: { type: "none" }, rectRadius: 0.16 });
    slide.addText(g.grade, { x, y: 1.18, w: 2.3, h: 0.48, fontSize: 14, bold: true, color: g.textColor, align: "center", margin: 0 });
    slide.addShape(pres.ShapeType.roundRect, { x: x + 0.35, y: 1.72, w: 1.6, h: 0.3, fill: { color: g.badgeColor }, line: { type: "none" }, rectRadius: 0.08 });
    slide.addText(g.badge, { x: x + 0.35, y: 1.72, w: 1.6, h: 0.3, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    slide.addText(g.desc, { x: x + 0.08, y: 2.1, w: 2.18, h: 0.55, fontSize: 9.5, color: g.textColor, align: "center", italic: true, margin: 2 });
    slide.addShape(pres.ShapeType.line, { x: x + 0.15, y: 2.68, w: 2.0, h: 0, line: { color: g.textColor, width: 0.5 } });
    g.features.forEach((f, j) => {
      slide.addText("✓ " + f, { x: x + 0.1, y: 2.76 + j * 0.35, w: 2.18, h: 0.34, fontSize: 9, color: g.textColor, margin: 0 });
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 6 — FIRST AID & PREHOSPITAL MANAGEMENT
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: "FFF3E0" } });

  // Header
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: C.warningOrange }, line: { type: "none" } });
  slide.addText("⛑️  First Aid & Prehospital Management", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 24, bold: true, color: C.white, valign: "middle" });

  // DO column
  slide.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.12, w: 4.55, h: 4.3, fill: { color: C.white }, line: { color: "4CAF50", width: 2.5 }, rectRadius: 0.18 });
  slide.addShape(pres.ShapeType.roundRect, { x: 0.5, y: 1.04, w: 1.2, h: 0.38, fill: { color: "4CAF50" }, line: { type: "none" }, rectRadius: 0.1 });
  slide.addText("✓  DO", { x: 0.5, y: 1.04, w: 1.2, h: 0.38, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });

  const dos = [
    "🚨 Call emergency services immediately",
    "🛌 Keep patient still and calm — immobilize bitten limb below heart level",
    "💍 Remove rings, watches, tight clothing near bite",
    "📏 Mark bite site; measure & record limb circumference every 15 min",
    "🚗 Transport to hospital as quickly as possible",
    "📷 Photograph snake if safely possible (don't approach or handle)",
    "🩺 Note time of bite, snake description, symptoms",
  ];
  dos.forEach((d, i) => {
    slide.addText(d, { x: 0.38, y: 1.52 + i * 0.54, w: 4.25, h: 0.5, fontSize: 11, color: C.darkText, valign: "middle", margin: 2 });
  });

  // DON'T column
  slide.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 1.12, w: 4.55, h: 4.3, fill: { color: C.white }, line: { color: C.alertRed, width: 2.5 }, rectRadius: 0.18 });
  slide.addShape(pres.ShapeType.roundRect, { x: 5.5, y: 1.04, w: 1.6, h: 0.38, fill: { color: C.alertRed }, line: { type: "none" }, rectRadius: 0.1 });
  slide.addText("✗  DON'T", { x: 5.5, y: 1.04, w: 1.6, h: 0.38, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });

  const donts = [
    "🚫 Do NOT incise or suck venom from wound",
    "🚫 Do NOT apply tourniquet or pressure bandage (crotalid)",
    "🚫 Do NOT apply ice or cold water to bite site",
    "🚫 Do NOT give alcohol or pain medications with sedation",
    "🚫 Do NOT use electric shock therapy",
    "🚫 Do NOT try to catch or kill the snake",
    "🚫 Do NOT elevate bitten limb above heart level",
  ];
  donts.forEach((d, i) => {
    slide.addText(d, { x: 5.38, y: 1.52 + i * 0.54, w: 4.25, h: 0.5, fontSize: 11, color: C.darkText, valign: "middle", margin: 2 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 7 — HOSPITAL ASSESSMENT
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.darkGreen } });

  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: C.teal }, line: { type: "none" } });
  slide.addText("🏥  Hospital Assessment — Immediate Priorities", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 23, bold: true, color: C.white, valign: "middle" });

  // 3-column layout
  const cols = [
    {
      title: "Airway, Breathing\n& Circulation",
      icon: "💨",
      color: C.red,
      items: [
        "Stabilize airway, breathing, circulation",
        "Continuous cardiac monitoring",
        "Pulse oximetry & oxygen saturation",
        "Establish TWO large-bore IV lines",
        "IV crystalloid bolus 20–40 mL/kg if hypotensive",
        "Contact poison control center",
      ]
    },
    {
      title: "History &\nExamination",
      icon: "📋",
      color: C.orange,
      items: [
        "Time and location of bite",
        "Snake description / photo",
        "Symptoms onset & progression",
        "Identify offending species if possible",
        "Measure & mark limb circumference q15 min",
        "Complete physical examination",
      ]
    },
    {
      title: "Laboratory\nInvestigations",
      icon: "🔬",
      color: C.accent,
      items: [
        "CBC with platelets",
        "Blood type and cross-match",
        "Metabolic panel (BMP/CMP)",
        "PT / INR / PTT",
        "Fibrinogen level",
        "FDP, CK, Urinalysis",
      ]
    },
  ];

  cols.forEach((col, i) => {
    const x = 0.2 + i * 3.28;
    slide.addShape(pres.ShapeType.roundRect, { x, y: 1.12, w: 3.1, h: 4.3, fill: { color: C.cardBg }, line: { color: col.color, width: 2 }, rectRadius: 0.18 });
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    slide.addText(col.title, { x, y: 1.7, w: 3.1, h: 0.72, fontSize: 14, bold: true, color: col.color, align: "center", margin: 0 });
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    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 8 — ANTIVENOM: MECHANISM & TYPES
// ─────────────────────────────────────────────────────────────────
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  slide.addText("💉  Antivenom — What It Is & How It Works", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 23, bold: true, color: C.accent, valign: "middle" });

  // Left explainer
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  const mechanism = [
    { step: "1", text: "Animals (sheep/horses) immunized with snake venom" },
    { step: "2", text: "Antibodies harvested from animal serum" },
    { step: "3", text: "IgG purified, Fc portion removed (papain digestion)" },
    { step: "4", text: "Fab or F(ab')₂ fragments isolated — safer, less allergenic" },
    { step: "5", text: "Administered IV → binds & neutralizes circulating venom" },
  ];
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  // Right — 3 product comparison
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  const products = [
    {
      name: "CroFab®", sub: "Crotalidae Polyvalent Immune Fab (Ovine)",
      color: C.teal, textCol: C.white,
      points: ["Small Fab fragments", "From sheep (ovine)", "Shorter half-life", "4–6 vials moderate / 6 vials severe", "~$3,200/vial (2023)"],
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    {
      name: "ANAVIP®", sub: "Crotalidae Immune F(ab')₂ (Equine)",
      color: C.midGreen, textCol: C.white,
      points: ["Larger F(ab')₂ fragments", "From horses — caution: horse allergy", "LONGER half-life", "10 vials moderate or severe", "Lower late coagulopathy risk"],
    },
  ];

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}

// ─────────────────────────────────────────────────────────────────
// SLIDE 9 — ANTIVENOM ADMINISTRATION PROTOCOL
// ─────────────────────────────────────────────────────────────────
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  slide.addText("📋  Antivenom Administration Protocol", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 24, bold: true, color: C.white, valign: "middle" });

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  const steps = [
    { n: "1", title: "Determine Indication", color: C.teal, text: "Moderate–Severe envenomation OR progressing ecchymosis >10 cm/hr. None/Mild = observe only." },
    { n: "2", title: "Dose Selection", color: C.midGreen, text: "CroFab: 4–6 vials (moderate), 6 vials (severe). ANAVIP: 10 vials (moderate or severe). Dose is NOT weight-based." },
    { n: "3", title: "Preparation", color: C.orange, text: "Reconstitute vials. Dilute in 250 mL normal saline. Administer IV only." },
    { n: "4", title: "Infusion", color: C.red, text: "Start at 25–50 mL/hr for first 10 min. If no reaction → increase to 250 mL/hr. Provider at bedside throughout." },
    { n: "5", title: "Response Assessment", color: C.teal, text: "At 1 hour: if stabilized/improved — maintenance doses q6h × 3 (CroFab). If failed → repeat initial dose." },
  ];

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  const reactions = [
    { trigger: "Acute allergic reaction", action: "STOP infusion immediately" },
    { trigger: "", action: "Epinephrine IM or IV (severe hypotension)" },
    { trigger: "", action: "Antihistamines IV + glucocorticoids IV" },
    { trigger: "", action: "Restart antivenom at 5–10 mL/hr once controlled" },
  ];
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}

// ─────────────────────────────────────────────────────────────────
// SLIDE 10 — SPECIFIC MANAGEMENT: ELAPID / CORAL SNAKE
// ─────────────────────────────────────────────────────────────────
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  slide.addText("🔴  Elapid (Coral Snake / Cobra) Management", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 24, bold: true, color: C.white, valign: "middle" });

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  slide.addText("⚠️  No antivenom currently available in the United States for coral snake envenomation — Management is SUPPORTIVE", { x: 0.45, y: 1.18, w: 9.1, h: 0.55, fontSize: 12.5, bold: true, color: C.alertRed, align: "center", valign: "middle", margin: 0 });

  const elapidCards = [
    {
      title: "Why Elapids Are Dangerous",
      icon: "🧠",
      color: C.orange,
      points: [
        "Fixed, grooved fangs — venom wicked in on bite",
        "Purely neurotoxic venom — NMJ blockade",
        "Onset of symptoms may be DELAYED (6–12 hrs)",
        "Minimal local reaction despite severe systemic toxicity",
        "Ptosis, diplopia, and bulbar palsy = early warning signs",
      ]
    },
    {
      title: "Clinical Features",
      icon: "🩺",
      color: C.red,
      points: [
        "Ptosis, diplopia, blurred vision",
        "Dysarthria, dysphagia (bulbar palsy)",
        "Descending flaccid paralysis",
        "Respiratory muscle failure (ICU, ventilation)",
        "Seizures (supportive: IV calcium may help)",
      ]
    },
    {
      title: "Treatment Strategy",
      icon: "💊",
      color: C.teal,
      points: [
        "Aggressive airway management — early intubation",
        "ICU monitoring for respiratory failure",
        "Cholinergic agonists at first sign of paralysis",
        "IV calcium infusion may reduce seizure onset",
        "No wound excision or local treatment needed",
      ]
    },
  ];

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    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 11 — COMPLICATIONS & SPECIAL SITUATIONS
// ─────────────────────────────────────────────────────────────────
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  slide.addText("⚡  Complications & Special Situations", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 24, bold: true, color: C.white, valign: "middle" });

  const complications = [
    {
      title: "Compartment Syndrome",
      color: C.orange,
      content: [
        "Most effective treatment: ANTIVENOM (not fasciotomy)",
        "Antivenom neutralizes venom → reduces compartment pressure",
        "Fasciotomy reserved for proven compartment syndrome AFTER adequate antivenom",
        "Mannitol + antivenom may lower compartment pressure",
      ]
    },
    {
      title: "Coagulopathy / DIC",
      color: C.alertRed,
      content: [
        "Monitor: PT/INR, fibrinogen, FDP every 4–6 hrs",
        "Antivenom is primary treatment",
        "FFP/cryoprecipitate for life-threatening bleeding",
        "ANAVIP has lower late coagulopathy recurrence rate",
      ]
    },
    {
      title: "Wound Infection",
      color: C.teal,
      content: [
        "Surprisingly uncommon — tissue changes are usually STERILE",
        "Prophylactic antibiotics NOT recommended (evidence lacking)",
        "Culture-proven infection: treat with organism-directed therapy",
        "Mouth flora: Pseudomonas, Enterobacteriaceae, Staph, Clostridia",
      ]
    },
    {
      title: "Pediatric / Pregnancy Considerations",
      color: C.accent,
      content: [
        "Antivenom is NOT weight-based — dose is the same as adults",
        "Children may have more severe envenomation (smaller body mass)",
        "Fetal monitoring in pregnancy; antivenom not contraindicated",
        "Consider ICU admission for all severe pediatric cases",
      ]
    },
  ];

  complications.forEach((c, i) => {
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  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 12 — MONITORING & FOLLOW-UP
// ─────────────────────────────────────────────────────────────────
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  slide.addText("📊  Post-Antivenom Monitoring & Follow-Up", { x: 0.4, y: 0.12, w: 9.2, h: 0.78, fontSize: 23, bold: true, color: C.white, valign: "middle" });

  // Timeline
  const timeline = [
    { time: "0–1 hr", color: C.teal, items: ["Vital signs q15 min", "Limb circumference q15 min", "Cardiac rhythm & O₂ sat", "Watch for reaction to antivenom"] },
    { time: "1–4 hrs", color: C.midGreen, items: ["Repeat CBC + coags q4h", "Assess for improvement", "Repeat antivenom dose if progressing", "Consider ICU if severe"] },
    { time: "4–24 hrs", color: C.orange, items: ["Continue maintenance antivenom (CroFab q6h × 3)", "Serial limb measurement q1h once stable", "Wound care & pain management", "Discharge criteria assessment"] },
    { time: "5–14 days", color: C.red, items: ["Serum sickness watch", "Rash, fever, arthralgias", "Treat with steroids + antihistamines", "Follow-up with toxicology/surgery"] },
  ];

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  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 13 — KEY TAKEAWAYS / SUMMARY
// ─────────────────────────────────────────────────────────────────
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  const takeaways = [
    { icon: "🌍", msg: "Snakebite is the world's deadliest neglected tropical disease — 1.2–5.5 million bites/year, ~63,000 deaths" },
    { icon: "🐍", msg: "Pit vipers (Viperidae) cause hemotoxic/cytotoxic injury; Elapids cause neurotoxic paralysis" },
    { icon: "⛑️", msg: "Prehospital: immobilize limb, remove jewelry, transport fast — NO tourniquet, no incision, no ice" },
    { icon: "🔬", msg: "Grade envenomation: None/Mild/Moderate/Severe — drives antivenom decision" },
    { icon: "💉", msg: "CroFab® (Fab, ovine) and ANAVIP® (F(ab')₂, equine) are first-line antivenoms for Crotalid bites" },
    { icon: "⚠️", msg: "Dose is NOT weight-based. Always have epinephrine ready for anaphylaxis during infusion" },
    { icon: "🏥", msg: "Antivenom is best treatment for compartment syndrome from snakebite — fasciotomy usually not needed" },
    { icon: "📋", msg: "Monitor for serum sickness 5–14 days after antivenom (treat with steroids + antihistamines)" },
  ];

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  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 14 — REFERENCES / END SLIDE
// ─────────────────────────────────────────────────────────────────
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  const refs = [
    "Harrison's Principles of Internal Medicine, 22nd Ed. (2025) — Chapter: Disorders Caused by Venomous Snakebites",
    "Sabiston Textbook of Surgery — Chapter 44: Bites and Stings (Antivenom Administration for Crotalid Envenomation)",
    "Tintinalli's Emergency Medicine — Chapter 212: Snakebites (Management of Compartment Syndrome)",
    "WHO Global Snakebite Initiative — Neglected Tropical Disease Action Plan 2019–2030",
    "Gold BS et al. N Engl J Med 2002; Lavonas EJ et al. BMC Emerg Med 2011 (Unified Treatment Algorithm)",
  ];

  refs.forEach((r, i) => {
    slide.addText((i + 1) + ".  " + r, { x: 0.5, y: 1.08 + i * 0.68, w: 9, h: 0.62, fontSize: 11, color: C.white, valign: "middle", margin: 2 });
    if (i < refs.length - 1) {
      slide.addShape(pres.ShapeType.line, { x: 0.5, y: 1.68 + i * 0.68, w: 9, h: 0, line: { color: C.midGreen, width: 0.5 } });
    }
  });

  slide.addText("🐍  Snake Bite Management & Antivenom  |  Medical Education Series  |  2026", { x: 0, y: 4.75, w: 10, h: 0.62, fontSize: 11, color: C.subtitleText, align: "center", valign: "middle" });
}

// ─────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/snakebite-pptx/SnakeBite_Antivenom_Management.pptx" })
  .then(() => console.log("✅  Presentation saved successfully!"))
  .catch(err => { console.error("❌ Error:", err); process.exit(1); });

cd /home/daytona/workspace/snakebite-pptx && node create_presentation.js 2>&1

~/snakebite-pptx/create_presentation.js

Error: String not found in file: '    fill: { color: "00000040" }, line: { type: "none" }, rectRadius: 0.08 });'

ls -lh /home/daytona/workspace/snakebite-pptx/

snake bite wound clinical photos antivenom vial rattlesnake cobra site:wikimedia.org OR site:cdc.gov OR site:nlm.nih.gov free images

rattlesnake bite swelling necrosis clinical photograph snakebite antivenom vial CroFab treatment

cobra king cobra viper Russell's viper rattlesnake photos venomous snakes clinical wikimedia commons

node /home/daytona/skills/shared/scripts/fetch_images.js \ "https://upload.wik…