Make a list of emergency situations that is for preparation for NCLEX and NORCET AIIMS exam, what we do 1st and second or procedure or treatment based on medical and nursing terminologies all about

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I now have rich source material. Let me compile the comprehensive emergency situations guide from my medical knowledge supplemented by the textbook content.

🚨 Emergency Situations — NCLEX & NORCET AIIMS Preparation Guide

Priority Management Using Medical & Nursing Terminology

🔑 UNIVERSAL PRIORITY FRAMEWORK

For ALL emergencies, always apply ABC → D → E first:

A — Airway (establish/maintain patency)
B — Breathing (assess rate, depth, SpO₂)
C — Circulation (HR, BP, skin perfusion, IV access)
D — Disability (GCS, pupils, neurological status)
E — Exposure (full body examination, vital signs)

Then apply SBAR for communication: Situation → Background → Assessment → Recommendation

1. 🫀 CARDIAC ARREST (Cardiopulmonary Arrest)

Step	Action	Terminology
1st	Confirm unresponsiveness; call for help / activate code blue	Code Blue activation
2nd	Check carotid pulse (≤10 sec); if absent → start CPR	Cardiac arrest protocol
3rd	Begin chest compressions: 30:2 ratio, 100–120/min, depth 5–6 cm, hard & fast	High-quality CPR
4th	Attach defibrillator; analyze rhythm — shockable (VF/pulseless VT) → shock 200J biphasic	Defibrillation
5th	Resume CPR immediately post-shock (2 min cycle); establish IV/IO access	Post-resuscitation
6th	Epinephrine 1 mg IV/IO every 3–5 min; amiodarone 300 mg IV for VF/VT	Vasopressor/antiarrhythmic
7th	Identify and treat reversible causes (4H 4T)	H's & T's
8th	Post-ROSC: 12-lead ECG, targeted temperature management (TTM) 32–36°C	Return of Spontaneous Circulation

4H's: Hypoxia, Hypovolemia, Hypo/Hyperkalemia, Hypothermia 4T's: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (PE/MI)

Nursing Priority: Do NOT delay first compression for IV/airway. Minimize interruptions (<10 sec).

2. 😮‍💨 RESPIRATORY DISTRESS / ARREST

Step	Action
1st	Position: sit upright (high Fowler's/orthopneic position); O₂ via face mask at 10–15 L/min
2nd	Assess SpO₂, RR, breath sounds (auscultation); apply pulse oximetry
3rd	If apneic → jaw thrust/chin lift; bag-valve-mask (BVM) ventilation
4th	Prepare for endotracheal intubation (ETT); RSI (Rapid Sequence Intubation) if needed
5th	Confirm ETT placement: ETCO₂ capnography, bilateral breath sounds, CXR
6th	Mechanical ventilation: set FiO₂, PEEP, tidal volume (6–8 mL/kg IBW)

Bronchospasm (Asthma Attack):

1st: Salbutamol (albuterol) 2.5–5 mg nebulization + ipratropium
2nd: IV/oral corticosteroids (prednisolone/methylprednisolone)
3rd: IV magnesium sulfate 2g over 20 min (severe case)
Monitor: PEFR, SpO₂, accessory muscle use

3. 🩸 SHOCK — Types & Management

A. Hypovolemic Shock (Hemorrhagic/Fluid Loss)

Step	Action
1st	Control active bleeding (direct pressure, tourniquet)
2nd	Two large-bore IVs (16–18G); rapid IV fluid bolus: Lactated Ringer's / NS 1–2L
3rd	Blood typing & cross-matching; transfuse PRBCs if Hgb <7 g/dL or ongoing hemorrhage
4th	Balanced transfusion: pRBCs : FFP : Platelets = 1:1:1 ratio
5th	Monitor: urine output (target >0.5 mL/kg/hr), BP, HR, lactate, base deficit
6th	Treat underlying cause (surgery, endoscopy)

Grading: Class I (<15% blood loss) → Class IV (>40% blood loss, life-threatening)

Key Lab: Serum lactate >4 mmol/L or base deficit < −4 mEq/L = shock marker

B. Septic Shock (Distributive)

Step	Action
1st	Obtain blood cultures × 2 (before antibiotics); lactate level
2nd	Broad-spectrum IV antibiotics within 1 hour (e.g., piperacillin-tazobactam + vancomycin)
3rd	IV fluid resuscitation: crystalloid 30 mL/kg within 3 hours
4th	Vasopressor if MAP <65 mmHg despite fluids: Norepinephrine (1st line)
5th	Hydrocortisone 200 mg/day IV if vasopressor-refractory
6th	Source control: drain abscess, remove infected catheter

Surviving Sepsis Bundle (1-hour bundle): Measure lactate → blood cultures → antibiotics → IV fluids → vasopressors for MAP <65 mmHg

C. Anaphylactic Shock

Step	Action
1st	Epinephrine (Adrenaline) 0.3–0.5 mg IM (anterolateral thigh) — FIRST LINE
2nd	Position: supine with legs elevated (Trendelenburg)
3rd	O₂ high flow; IV access; fluid resuscitation NS bolus
4th	Repeat epinephrine every 5–15 min if needed
5th	Diphenhydramine (antihistamine H1) IV/IM; ranitidine (H2 blocker)
6th	IV corticosteroids: methylprednisolone 125 mg IV
7th	Nebulized salbutamol for bronchospasm; monitor for biphasic reaction (4–12 hrs)

Nursing Key: Epinephrine MUST be given first — not antihistamine!

D. Cardiogenic Shock

Step	Action
1st	O₂, monitor, IV access; 12-lead ECG for MI
2nd	Dobutamine (inotrope) IV; dopamine if severe hypotension
3rd	Cautious IV fluids (avoid fluid overload)
4th	Urgent PCI (percutaneous coronary intervention) if AMI-related
5th	IABP (Intra-Aortic Balloon Pump) / mechanical circulatory support

4. 🧠 STROKE (CVA — Cerebrovascular Accident)

Time is Brain — "FAST": Face drooping, Arm weakness, Speech difficulty, Time to call

Step	Action
1st	Activate stroke team; note exact time of symptom onset
2nd	ABC stabilization; O₂ if SpO₂ <94%; IV access; NPO
3rd	STAT non-contrast CT brain (rule out hemorrhagic stroke)
4th	Blood glucose check (hypoglycemia mimics stroke)
5th	Ischemic stroke within 4.5 hours: IV tPA (alteplase) 0.9 mg/kg (max 90 mg)
6th	Large vessel occlusion within 24 hours: mechanical thrombectomy
7th	BP management: in ischemic stroke, allow permissive hypertension <220/120 mmHg (pre-tPA); keep <180/105 mmHg post-tPA
8th	Aspirin 325 mg (after hemorrhage excluded); statin therapy

Nursing: Position HOB at 30°; monitor for dysphagia (swallow screen before oral intake); neuro checks q1h

Hemorrhagic Stroke:

Reverse anticoagulation if on warfarin (Vitamin K + FFP or PCC)
Neurosurgical consult
BP target: systolic <140 mmHg with IV labetalol/nicardipine

5. 💉 MYOCARDIAL INFARCTION (STEMI/NSTEMI)

MONA (Classic Nursing Mnemonic — now modified):

Step	Drug/Action	Note
1st	12-lead ECG within 10 min of arrival	ST elevation ≥1mm in ≥2 contiguous leads = STEMI
2nd	Aspirin 325 mg (chewed) + P2Y12 inhibitor (clopidogrel/ticagrelor)	Dual antiplatelet
3rd	Nitroglycerin SL 0.4 mg q5min × 3 (if BP >90 systolic, no RV infarct)	Vasodilator
4th	Morphine 2–4 mg IV (only if pain refractory, no longer 1st-line)	Opioid analgesia
5th	O₂ only if SpO₂ <90%	Avoid hyperoxia
6th	IV heparin (unfractionated) or enoxaparin	Anticoagulation
7th	Primary PCI within 90 min (door-to-balloon) — preferred reperfusion	Catheterization lab
8th	If PCI unavailable: IV fibrinolysis (streptokinase/tPA) within 30 min	Thrombolysis

Nursing Priority: Continuous cardiac monitoring; defibrillator ready; restrict activity; NPO for procedure

6. 🫁 PULMONARY EMBOLISM (PE)

Step	Action
1st	O₂ high flow; IV access; monitor SpO₂, BP, HR
2nd	12-lead ECG (classic: S1Q3T3); D-dimer; ABG
3rd	CT pulmonary angiography (CTPA) — gold standard imaging
4th	Anticoagulation: IV unfractionated heparin bolus 80 U/kg, then 18 U/kg/hr
5th	Massive PE (hemodynamic instability): thrombolysis with tPA 100 mg IV over 2 hrs
6th	Surgical embolectomy if thrombolysis contraindicated

Wells Score used to assess pre-test probability

7. 🔋 DIABETIC EMERGENCIES

A. Diabetic Ketoacidosis (DKA)

Step	Action
1st	IV NS 1L/hr for first 1–2 hours (aggressive fluid resuscitation)
2nd	IV regular insulin: 0.1 U/kg/hr (after K⁺ ≥3.5 mEq/L confirmed)
3rd	Potassium replacement: 20–40 mEq/hr if K⁺ <5.5 mEq/L
4th	Monitor glucose hourly; switch to D5 when glucose <200 mg/dL
5th	Monitor ABG (pH, bicarbonate), urine output, electrolytes q2–4h

DKA criteria: Glucose >250 mg/dL + pH <7.3 + bicarbonate <18 mEq/L + ketonemia/ketonuria

B. Hypoglycemia (BGL <70 mg/dL)

Step	Action
1st	Conscious patient: Rule of 15 — 15g fast-acting carbs, recheck in 15 min
2nd	Unconscious/unable to swallow: Dextrose 25–50g (50% dextrose) IV bolus
3rd	If no IV access: Glucagon 1 mg IM/SC
4th	Identify and treat underlying cause; monitor BGL q15–30 min

8. ⚡ STATUS EPILEPTICUS

Step	Action
1st	Protect from injury; lateral position; time the seizure
2nd	O₂ via face mask; suction if secretions (do NOT insert objects in mouth)
3rd	IV access; blood glucose, electrolytes, drug levels
4th	Benzodiazepine (0–5 min): Lorazepam 0.1 mg/kg IV (or diazepam 0.2 mg/kg IV/rectal)
5th	2nd line (5–20 min): Levetiracetam 60 mg/kg IV OR phenytoin/fosphenytoin 20 mg/kg IV
6th	Refractory (>30 min): Propofol/midazolam/barbiturate infusion; ICU admission + EEG monitoring
7th	Check: Thiamine 100 mg IV before glucose (in alcoholic patients — prevents Wernicke's)

Nursing: Seizure precautions: padded side rails, O₂ at bedside, suction ready, NPO

9. 🧊 INCREASED INTRACRANIAL PRESSURE (ICP)

Step	Action
1st	HOB elevated 30° (neutral head position — avoid jugular compression)
2nd	O₂ to maintain SpO₂ >95%; avoid hypercarbia (PaCO₂ 35–40 mmHg)
3rd	Mannitol 0.25–1 g/kg IV (osmotic diuretic — 1st line)
4th	3% hypertonic saline (alternative to mannitol)
5th	Hyperventilation (PCO₂ 30–35 mmHg) — temporary bridge only
6th	Neurosurgical consultation; ICP monitoring; decompressive craniectomy if refractory

Cushing's Triad (late sign of herniation): Hypertension + Bradycardia + Irregular respirations

10. 🔥 BURNS

Step	Action
1st	Stop the burning process; remove clothing/jewelry
2nd	Airway assessment — inhalation injury: hoarseness, singed nasal hairs, stridor → early intubation
3rd	Calculate TBSA (Rule of Nines); calculate fluid requirements
4th	Parkland Formula: 4 mL × weight (kg) × %TBSA (Lactated Ringer's) — ½ in first 8 hrs, ½ in next 16 hrs
5th	Tetanus prophylaxis; wound care; pain management (IV morphine)
6th	Transfer to burn unit for burns >10% TBSA, face, hands, genitalia, circumferential burns

Rule of Nines: Head 9%, each arm 9%, chest 9%, abdomen 9%, each thigh 9%, each leg 9%, perineum 1%

11. 🤰 OBSTETRIC EMERGENCIES

A. Eclampsia

Step	Action
1st	Protect airway; left lateral decubitus (uterine displacement)
2nd	Magnesium sulfate 4–6 g IV loading dose, then 1–2 g/hr maintenance
3rd	Antihypertensive: hydralazine 5–10 mg IV or labetalol 20 mg IV (target BP <160/110)
4th	Fetal monitoring; plan for delivery
5th	Monitor Mg toxicity: check reflexes (lost first), urine output, respiratory rate (keep calcium gluconate at bedside as antidote)

B. Postpartum Hemorrhage (PPH)

Step	Action
1st	Bimanual uterine massage; assess for cause (4T's: Tone, Tissue, Trauma, Thrombin)
2nd	Oxytocin 20–40 units in 1L NS IV — 1st line uterotonic
3rd	Misoprostol 800–1000 mcg rectal/sublingual
4th	Tranexamic acid 1g IV within 3 hours of delivery
5th	Blood transfusion, surgical intervention (B-Lynch suture, hysterectomy)

12. ☠️ POISONING / OVERDOSE

Poison	1st Action	Antidote
Opioid overdose	Airway support	Naloxone (Narcan) 0.4–2 mg IV/IM/IN
Organophosphate	Atropine IV	Atropine + Pralidoxime (2-PAM)
Acetaminophen (paracetamol)	Activated charcoal (if <1hr)	N-Acetylcysteine (NAC) IV/oral
Benzodiazepine	Supportive	Flumazenil 0.2 mg IV
Warfarin	INR, CBC	Vitamin K IV + FFP/PCC
Cyanide	O₂ 100%	Hydroxocobalamin (Cyanokit)
CO poisoning	Remove from exposure	100% O₂ (hyperbaric if severe)
Iron overdose	Supportive	Deferoxamine
Digoxin toxicity	Cardiac monitoring	Digoxin-specific Fab fragments
Beta-blocker overdose	IV fluids, atropine	Glucagon IV
TCA overdose	ABC	Sodium bicarbonate IV

Universal approach: ABCDE → activated charcoal (if <1hr, alert, no caustic) → specific antidote → supportive care

13. 🌡️ HEAT STROKE / HYPOTHERMIA

Heat Stroke (core temp >40°C + CNS dysfunction)

Step	Action
1st	Remove from heat; ABC
2nd	Rapid cooling — target 39°C within 30 min: ice water immersion OR evaporative cooling + fans
3rd	IV cold NS; do NOT give antipyretics (not effective in heat stroke)
4th	Monitor rhabdomyolysis (CK, urine myoglobin), renal function

Hypothermia (core temp <35°C)

Step	Action
1st	Remove wet clothing; prevent further heat loss
2nd	Gentle warming: passive rewarming (mild) → active external (moderate) → active internal/ECMO (severe <30°C)
3rd	Warm IV fluids (39–42°C); warmed humidified O₂
4th	Monitor for J-waves (Osborn waves) on ECG; VF risk
Mantra	"Not dead until warm and dead" — continue resuscitation until core temp >32°C

14. 🩺 HYPERTENSIVE EMERGENCY

(BP >180/120 mmHg with end-organ damage)

Step	Action
1st	IV access; continuous BP monitoring (arterial line preferred)
2nd	Target: reduce MAP by ≤25% in first hour (NOT to normal — risk of ischemia)
3rd	IV antihypertensives: Nicardipine, Labetalol, Clevidipine, or Nitroprusside
4th	Aortic dissection → Esmolol + nitroprusside; target SBP <120 mmHg urgently
5th	Eclampsia → Magnesium sulfate + labetalol/hydralazine

End-organ damage: Hypertensive encephalopathy, stroke, AMI, acute heart failure, renal failure, aortic dissection, retinopathy

15. 🫀 ACUTE PULMONARY EDEMA (Cardiogenic)

Step	Action
1st	Sit upright (high Fowler's 90°); O₂ via NRB mask or BiPAP/CPAP
2nd	IV furosemide 40–80 mg (diuretic — 1st line)
3rd	IV nitroglycerin infusion (vasodilation — reduces preload)
4th	Morphine 2–4 mg IV (reduce anxiety/preload — use cautiously)
5th	Identify cause: STEMI → PCI; HTN → antihypertensives; arrhythmia → cardioversion

LMNOP Mnemonic: Lasix, Morphine, Nitrates, O₂, Position

16. 🌊 DROWNING / NEAR-DROWNING

Step	Action
1st	Safely remove from water; do NOT delay CPR for water drainage
2nd	Begin CPR (5 rescue breaths first if no breathing, then 30:2)
3rd	Remove wet clothes; prevent hypothermia (warm blankets)
4th	O₂ high flow; prepare for intubation (lung injury)
5th	Monitor for secondary drowning (up to 24 hrs); admit for observation

17. ⚡ SPINAL CORD INJURY

Step	Action
1st	Immobilize spine immediately (cervical collar, log-roll technique)
2nd	Airway: jaw thrust ONLY (no head-tilt in cervical injury)
3rd	Neurogenic shock (vasodilation + bradycardia): IV fluids + vasopressors + atropine
4th	MRI spine; neurosurgical consultation
5th	High-dose methylprednisolone (controversial; used within 8 hrs)
6th	Foley catheter (urinary retention); pressure ulcer prevention

18. 🩹 TRAUMA (Polytrauma — Primary Survey)

Using ATLS Protocol:

Survey	Assessment	Priority Actions
A — Airway	Obstruction, stridor, consciousness	Jaw thrust, suction, intubation
B — Breathing	Tension pneumothorax, open chest wound	Needle decompression (2nd ICS MCL), chest seal
C — Circulation	Hemorrhage, BP, HR	Pressure, IV fluids, blood products
D — Disability	GCS, pupils, spinal	C-spine immobilization
E — Exposure	Wounds, fractures	Log roll, prevent hypothermia

Tension Pneumothorax: Absent breath sounds + tracheal deviation + hypotension → immediate needle decompression (2nd intercostal space, midclavicular line) — do NOT wait for X-ray

🏥 NURSING-SPECIFIC PRIORITY RULES (NCLEX/NORCET)

Rule	Principle
Maslow's Hierarchy	Physiological needs first (airway > breathing > circulation)
ABC Priority	Airway always first unless DO NOT RESUSCITATE order
Safety	Seizure precautions, fall precautions, infection control
Assessments First	Assess before intervening (exception: cardiac arrest — act immediately)
Delegation	RN: Assessment, teaching, unstable patients; LPN/LVN: stable, routine care; UAP: bathing, vitals (stable)
When in doubt, prioritize:	Acute over chronic; unstable over stable; life-threatening over comfort

📊 QUICK REFERENCE: KEY ANTIDOTES

Drug/Toxin	Antidote
Heparin	Protamine sulfate
Warfarin/Coumadin	Vitamin K + FFP/PCC
Opioids	Naloxone (Narcan)
Benzodiazepines	Flumazenil
Acetaminophen	N-Acetylcysteine
Digoxin	Digoxin-specific Fab
Organophosphates	Atropine + Pralidoxime
Beta-blockers	Glucagon
Calcium channel blockers	Calcium gluconate + glucagon
Iron	Deferoxamine
Cyanide	Hydroxocobalamin
CO	100% O₂ / Hyperbaric O₂
TCA overdose	Sodium bicarbonate
Methanol/Ethylene glycol	Fomepizole (4-MP)
Magnesium toxicity	Calcium gluconate

📝 EXAM-FOCUSED MNEMONICS

Mnemonic	Meaning
FAST	Face, Arm, Speech, Time (stroke)
MONA	Morphine, O₂, Nitroglycerin, Aspirin (MI — modified)
4H 4T	Reversible causes of cardiac arrest
LMNOP	Lasix, Morphine, Nitrates, O₂, Position (pulmonary edema)
RICE	Rest, Ice, Compression, Elevation (musculoskeletal)
ABCDE	Airway, Breathing, Circulation, Disability, Exposure
SBAR	Situation, Background, Assessment, Recommendation
Rule of Nines	Burns TBSA estimation
Parkland Formula	4 × kg × %TBSA = fluid for burns
SAMPLE	Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events (history taking)

🔺 TOP HIGH-YIELD NCLEX/NORCET POINTS

Epinephrine is ALWAYS 1st in anaphylaxis — not antihistamine
tPA contraindicated in hemorrhagic stroke; give only after CT rules out bleed
No aspirin in children <18 (Reye's syndrome risk)
Succinylcholine used for RSI but contraindicated in burn patients >24–48 hrs (hyperkalemia risk)
Position in shock: supine with legs elevated (except cardiogenic/pulmonary edema — sit up)
Potassium must be ≥3.5 before starting insulin in DKA
Thiamine BEFORE glucose in alcoholic patients (prevent Wernicke's encephalopathy)
Never do LP before CT if ICP suspected (herniation risk)
CPR ratio: 30:2 adults; 30:2 one-rescuer child; 15:2 two-rescuer child
Magnesium antidote = Calcium gluconate (keep at bedside during mag infusion)
Urine output target in shock: >0.5 mL/kg/hr; in burns: 0.5–1.0 mL/kg/hr
Primary PCI within 90 minutes (door-to-balloon) for STEMI
Oxygen NOT given in suspected COPD if SpO₂ >88–92% (hypercapnic drive)
Trendelenburg is NOT recommended in most shock (evidence-based update)
Jaw thrust (not head-tilt-chin-lift) in suspected cervical spine injury

Sources: ROSEN's Emergency Medicine (9780323757898), Sabiston Textbook of Surgery, Goldman-Cecil Medicine, Miller's Anesthesia — Medical Library; current ACLS/ATLS/Sepsis Surviving guidelines

Create a quick-reference PDF cheat sheet with these 18 emergencies

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace not found"

Running Command

mkdir -p /home/daytona/workspace/emergency-cheatsheet && python3 -c "from report…

Writing File

~/emergency-cheatsheet/build_pdf.py

#!/usr/bin/env python3
"""
Emergency Quick-Reference Cheat Sheet PDF
NCLEX & NORCET AIIMS Exam Preparation
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, PageBreak
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate

OUTPUT = "/home/daytona/workspace/emergency-cheatsheet/Emergency_CheatSheet_NCLEX_NORCET.pdf"

# ─── Colour Palette ────────────────────────────────────────────────────────────
C_RED       = colors.HexColor("#C0392B")
C_DARK_RED  = colors.HexColor("#922B21")
C_ORANGE    = colors.HexColor("#E67E22")
C_BLUE      = colors.HexColor("#1A5276")
C_TEAL      = colors.HexColor("#117A65")
C_PURPLE    = colors.HexColor("#6C3483")
C_DARK_GRAY = colors.HexColor("#2C3E50")
C_MID_GRAY  = colors.HexColor("#5D6D7E")
C_LIGHT_BG  = colors.HexColor("#EBF5FB")
C_HEADER_BG = colors.HexColor("#1A5276")
C_ROW1      = colors.HexColor("#D6EAF8")
C_ROW2      = colors.HexColor("#EBF5FB")
C_GREEN     = colors.HexColor("#1E8449")
C_YELLOW_BG = colors.HexColor("#FEF9E7")
C_RED_BG    = colors.HexColor("#FDEDEC")
C_WHITE     = colors.white
C_BLACK     = colors.black
C_AMBER     = colors.HexColor("#F39C12")

# ─── Styles ────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

COVER_TITLE = S("CoverTitle",
    fontName="Helvetica-Bold", fontSize=26, textColor=C_WHITE,
    alignment=TA_CENTER, spaceAfter=6, leading=32)

COVER_SUB = S("CoverSub",
    fontName="Helvetica", fontSize=13, textColor=colors.HexColor("#AED6F1"),
    alignment=TA_CENTER, spaceAfter=4, leading=18)

COVER_NOTE = S("CoverNote",
    fontName="Helvetica-Oblique", fontSize=10, textColor=colors.HexColor("#D6EAF8"),
    alignment=TA_CENTER, spaceAfter=2)

SEC_HEADING = S("SecHeading",
    fontName="Helvetica-Bold", fontSize=11, textColor=C_WHITE,
    alignment=TA_LEFT, spaceBefore=4, spaceAfter=2, leading=14,
    leftIndent=4)

BODY = S("Body",
    fontName="Helvetica", fontSize=8.5, textColor=C_DARK_GRAY,
    spaceAfter=2, leading=12, alignment=TA_LEFT)

BODY_BOLD = S("BodyBold",
    fontName="Helvetica-Bold", fontSize=8.5, textColor=C_DARK_GRAY,
    spaceAfter=2, leading=12)

SMALL = S("Small",
    fontName="Helvetica", fontSize=7.5, textColor=C_MID_GRAY,
    spaceAfter=1, leading=10)

NOTE_STYLE = S("Note",
    fontName="Helvetica-Oblique", fontSize=8, textColor=C_TEAL,
    spaceAfter=3, leading=11, leftIndent=6)

MNEM_STYLE = S("Mnem",
    fontName="Helvetica-Bold", fontSize=8.5, textColor=C_PURPLE,
    spaceAfter=2, leading=12, leftIndent=6)

FOOTER_STYLE = S("Footer",
    fontName="Helvetica", fontSize=7, textColor=C_MID_GRAY,
    alignment=TA_CENTER)

TABLE_HEADER = S("TblHdr",
    fontName="Helvetica-Bold", fontSize=8, textColor=C_WHITE,
    alignment=TA_CENTER, leading=10)

TABLE_CELL = S("TblCell",
    fontName="Helvetica", fontSize=8, textColor=C_DARK_GRAY,
    leading=10, alignment=TA_LEFT)

TABLE_CELL_BOLD = S("TblCellBold",
    fontName="Helvetica-Bold", fontSize=8, textColor=C_DARK_RED,
    leading=10, alignment=TA_LEFT)

PAGE_W, PAGE_H = A4
MARGIN = 1.4 * cm
USABLE_W = PAGE_W - 2 * MARGIN

# ─── Helpers ──────────────────────────────────────────────────────────────────
def section_header(title, color=C_HEADER_BG, icon=""):
    """Coloured banner heading."""
    t = Table([[Paragraph(f"{icon}  {title}", SEC_HEADING)]],
              colWidths=[USABLE_W])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4, 4, 4, 4]),
    ]))
    return t

def steps_table(rows, col_widths=None):
    """Step → Action two-column table."""
    if col_widths is None:
        col_widths = [2.2*cm, USABLE_W - 2.2*cm]
    data = []
    for i, (step, action, *rest) in enumerate(rows):
        bg = C_ROW1 if i % 2 == 0 else C_ROW2
        note_txt = rest[0] if rest else ""
        cell_action = Paragraph(f"<b>{action}</b>" + (f"<br/><font color='#117A65' size='7.5'><i>{note_txt}</i></font>" if note_txt else ""), TABLE_CELL)
        data.append([Paragraph(f"<b>{step}</b>", TABLE_CELL_BOLD), cell_action])
    t = Table(data, colWidths=col_widths)
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,-1), colors.HexColor("#FDFEFE")),
        ("ROWBACKGROUNDS",(0,0), (-1,-1), [C_ROW1, C_ROW2]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#BFC9CA")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    return t

def antidote_table(rows):
    hdr = [Paragraph("Drug / Toxin", TABLE_HEADER), Paragraph("Antidote", TABLE_HEADER)]
    data = [hdr]
    for toxin, antidote in rows:
        data.append([Paragraph(toxin, TABLE_CELL), Paragraph(f"<b>{antidote}</b>", TABLE_CELL_BOLD)])
    col_w = [USABLE_W/2, USABLE_W/2]
    t = Table(data, colWidths=col_w)
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), C_RED),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_ROW2, C_RED_BG]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#BFC9CA")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    return t

def mnemonic_table(rows, bg_color=C_YELLOW_BG):
    data = []
    for m, meaning in rows:
        data.append([Paragraph(f"<b>{m}</b>", MNEM_STYLE), Paragraph(meaning, BODY)])
    t = Table(data, colWidths=[3.5*cm, USABLE_W - 3.5*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg_color),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#D4E6F1")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    return t

def highlight_box(text, bg=C_RED_BG, text_color=C_DARK_RED):
    p = Paragraph(text, ParagraphStyle("hb", fontName="Helvetica-Bold", fontSize=8.5,
        textColor=text_color, leading=12, alignment=TA_LEFT))
    t = Table([[p]], colWidths=[USABLE_W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("BOX",           (0,0), (-1,-1), 1, text_color),
    ]))
    return t

def sp(h=4):
    return Spacer(1, h)

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#AED6F1"), spaceAfter=4)

# ─── Page callback ────────────────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    # Footer
    canvas.setFont("Helvetica", 7)
    canvas.setFillColor(C_MID_GRAY)
    canvas.drawCentredString(PAGE_W/2, 1.1*cm,
        f"NCLEX & NORCET AIIMS Emergency Quick-Reference  •  Page {doc.page}")
    canvas.drawString(MARGIN, 1.1*cm, "For educational use only")
    canvas.drawRightString(PAGE_W - MARGIN, 1.1*cm, "Orris Medical Assistant 2026")
    # Top rule
    canvas.setStrokeColor(C_HEADER_BG)
    canvas.setLineWidth(2)
    canvas.line(MARGIN, PAGE_H - 1.2*cm, PAGE_W - MARGIN, PAGE_H - 1.2*cm)
    canvas.restoreState()

def on_first_page(canvas, doc):
    # Full-bleed cover gradient simulation via rectangles
    canvas.saveState()
    canvas.setFillColor(C_HEADER_BG)
    canvas.rect(0, 0, PAGE_W, PAGE_H, fill=1, stroke=0)
    canvas.setFillColor(colors.HexColor("#0D2B45"))
    canvas.rect(0, 0, PAGE_W, PAGE_H * 0.35, fill=1, stroke=0)
    canvas.restoreState()

# ─── Content builder ──────────────────────────────────────────────────────────
def build():
    doc = BaseDocTemplate(
        OUTPUT,
        pagesize=A4,
        leftMargin=MARGIN, rightMargin=MARGIN,
        topMargin=2.0*cm, bottomMargin=1.8*cm,
        title="Emergency Quick-Reference — NCLEX & NORCET AIIMS",
        author="Orris Medical Assistant",
        subject="Emergency Nursing & Medical Management"
    )

    frame = Frame(MARGIN, 1.8*cm, USABLE_W, PAGE_H - 3.8*cm, id="main")
    cover_frame = Frame(MARGIN, 1.8*cm, USABLE_W, PAGE_H - 3.8*cm, id="cover")

    doc.addPageTemplates([
        PageTemplate(id="cover", frames=[cover_frame], onPage=on_first_page),
        PageTemplate(id="body",  frames=[frame],       onPage=on_page),
    ])

    story = []

    # ── COVER ──────────────────────────────────────────────────────────────────
    story.append(Spacer(1, 3.5*cm))
    story.append(Paragraph("🚨 EMERGENCY QUICK-REFERENCE", COVER_TITLE))
    story.append(Paragraph("CHEAT SHEET", COVER_TITLE))
    story.append(Spacer(1, 0.5*cm))
    story.append(Paragraph("NCLEX  •  NORCET AIIMS  •  Nursing &amp; Medical Exams", COVER_SUB))
    story.append(Spacer(1, 0.4*cm))
    story.append(Paragraph("18 Critical Emergencies — First &amp; Second Priority Actions", COVER_SUB))
    story.append(Spacer(1, 1.0*cm))

    # Cover summary boxes
    cover_items = [
        ["01 Cardiac Arrest", "02 Respiratory Distress", "03 Shock (All Types)"],
        ["04 Stroke / CVA", "05 Myocardial Infarction", "06 Pulmonary Embolism"],
        ["07 Diabetic Emergencies", "08 Status Epilepticus", "09 Raised ICP"],
        ["10 Burns", "11 Obstetric Emergencies", "12 Poisoning / Overdose"],
        ["13 Heat Stroke / Hypothermia", "14 Hypertensive Emergency", "15 Acute Pulmonary Edema"],
        ["16 Drowning", "17 Spinal Cord Injury", "18 Polytrauma (ATLS)"],
    ]
    cover_cell_style = ParagraphStyle("cs", fontName="Helvetica-Bold", fontSize=8.5,
        textColor=C_DARK_GRAY, alignment=TA_CENTER, leading=11)
    cover_data = []
    for row in cover_items:
        cover_data.append([Paragraph(c, cover_cell_style) for c in row])
    ct = Table(cover_data, colWidths=[USABLE_W/3]*3)
    ct.setStyle(TableStyle([
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [colors.HexColor("#EBF5FB"), colors.HexColor("#D6EAF8")]),
        ("GRID",           (0,0), (-1,-1), 0.5, colors.HexColor("#85C1E9")),
        ("TOPPADDING",     (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",  (0,0), (-1,-1), 6),
        ("LEFTPADDING",    (0,0), (-1,-1), 4),
        ("VALIGN",         (0,0), (-1,-1), "MIDDLE"),
    ]))
    story.append(ct)
    story.append(Spacer(1, 0.8*cm))
    story.append(Paragraph("+ Antidotes Reference  •  Key Mnemonics  •  High-Yield Exam Points", COVER_NOTE))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph("Based on: ROSEN's Emergency Medicine • Goldman-Cecil Medicine • ACLS/ATLS Guidelines", COVER_NOTE))

    story.append(PageBreak())

    # ── Switch to body template ────────────────────────────────────────────────
    from reportlab.platypus import NextPageTemplate
    story.append(NextPageTemplate("body"))

    # ── PAGE 2: Universal Framework + Emergency 1 & 2 ─────────────────────────
    story.append(section_header("UNIVERSAL PRIORITY FRAMEWORK — Always Apply First", C_DARK_GRAY, "🔑"))
    story.append(sp(4))
    abc_data = [
        [Paragraph("<b>A — Airway</b>", TABLE_CELL_BOLD), Paragraph("Establish/maintain patency; jaw thrust or chin-lift; suction; intubate if needed", TABLE_CELL)],
        [Paragraph("<b>B — Breathing</b>", TABLE_CELL_BOLD), Paragraph("Assess RR, depth, SpO₂; O₂ therapy; bag-valve-mask if apneic", TABLE_CELL)],
        [Paragraph("<b>C — Circulation</b>", TABLE_CELL_BOLD), Paragraph("HR, BP, skin perfusion; 2 large-bore IVs; IV fluids; stop bleeding", TABLE_CELL)],
        [Paragraph("<b>D — Disability</b>", TABLE_CELL_BOLD), Paragraph("GCS, pupils (PERRLA), glucose check, neurological status", TABLE_CELL)],
        [Paragraph("<b>E — Exposure</b>", TABLE_CELL_BOLD), Paragraph("Full body exam; vital signs; prevent hypothermia", TABLE_CELL)],
    ]
    abct = Table(abc_data, colWidths=[3.2*cm, USABLE_W - 3.2*cm])
    abct.setStyle(TableStyle([
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [colors.HexColor("#EAFAF1"), colors.HexColor("#F9FBE7")]),
        ("GRID",           (0,0), (-1,-1), 0.3, colors.HexColor("#A9DFBF")),
        ("TOPPADDING",     (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",    (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(abct)
    story.append(sp(6))
    story.append(highlight_box(
        "NURSING PRIORITY RULE: Physiological needs ALWAYS first (Maslow). "
        "Acute > Chronic | Unstable > Stable | Life-threatening > Comfort",
        bg=colors.HexColor("#EAFAF1"), text_color=C_TEAL))
    story.append(sp(8))

    # ── Emergency 1: Cardiac Arrest ───────────────────────────────────────────
    story.append(section_header("1. CARDIAC ARREST (Cardiopulmonary Arrest)", C_RED, "🫀"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "Confirm unresponsiveness; shout for help; ACTIVATE CODE BLUE", ""),
        ("2nd", "Check carotid pulse ≤10 sec → absent → START CPR immediately", ""),
        ("3rd", "Chest compressions: 30:2, rate 100–120/min, depth 5–6 cm, hard & fast — MINIMIZE INTERRUPTIONS (<10 sec)", ""),
        ("4th", "Attach defibrillator; analyze rhythm → VF/pulseless VT (shockable) → SHOCK 200J biphasic", ""),
        ("5th", "Resume CPR 2 min immediately post-shock; establish IV/IO access", ""),
        ("6th", "Epinephrine 1 mg IV/IO every 3–5 min; Amiodarone 300 mg IV (VF/VT)", "Vasopressor + antiarrhythmic"),
        ("7th", "Identify & treat reversible causes: 4H's + 4T's (see below)", ""),
        ("8th", "Post-ROSC: 12-lead ECG; Targeted Temperature Management 32–36°C; ICU", ""),
    ]))
    story.append(sp(4))
    story.append(highlight_box(
        "4H's: Hypoxia | Hypovolemia | Hypo/Hyperkalemia | Hypothermia       "
        "4T's: Tension pneumothorax | Tamponade | Toxins | Thrombosis (PE/MI)",
        bg=colors.HexColor("#FDEDEC"), text_color=C_DARK_RED))
    story.append(sp(4))
    story.append(Paragraph(
        "<b>CPR Ratios:</b> Adults 30:2 | Child (1-rescuer) 30:2 | Child (2-rescuer) 15:2 | Infant 15:2",
        NOTE_STYLE))
    story.append(sp(8))

    # ── Emergency 2: Respiratory Distress ─────────────────────────────────────
    story.append(section_header("2. RESPIRATORY DISTRESS / ARREST", C_BLUE, "😮‍💨"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "POSITION: High Fowler's / orthopneic (sit upright); O₂ via face mask 10–15 L/min", ""),
        ("2nd", "Assess: SpO₂, RR, breath sounds (auscultation), ABG, peak flow", ""),
        ("3rd", "If apneic: jaw-thrust/chin-lift; BVM (bag-valve-mask) ventilation", ""),
        ("4th", "Prepare RSI (Rapid Sequence Intubation) → Endotracheal intubation (ETT)", ""),
        ("5th", "Confirm ETT: ETCO₂ capnography + bilateral breath sounds + CXR", ""),
        ("6th", "Mechanical ventilation: FiO₂, PEEP, tidal volume 6–8 mL/kg IBW", ""),
    ]))
    story.append(sp(4))
    asthma_data = [
        [Paragraph("<b>Asthma Attack Steps</b>", TABLE_HEADER)],
        [Paragraph("1st: Salbutamol (Albuterol) 2.5–5 mg nebulization + Ipratropium bromide", TABLE_CELL)],
        [Paragraph("2nd: IV/oral Corticosteroids (Prednisolone / Methylprednisolone)", TABLE_CELL)],
        [Paragraph("3rd: IV Magnesium sulfate 2g over 20 min (severe/refractory)", TABLE_CELL)],
        [Paragraph("Monitor: PEFR, SpO₂, use of accessory muscles, RR, LOC", TABLE_CELL)],
    ]
    at = Table(asthma_data, colWidths=[USABLE_W])
    at.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), C_BLUE),
        ("BACKGROUND",    (0,1), (-1,-1), colors.HexColor("#EBF5FB")),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#AED6F1")),
        ("TOPPADDING",    (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(at)

    story.append(PageBreak())

    # ── Emergency 3: SHOCK ────────────────────────────────────────────────────
    story.append(section_header("3. SHOCK — All Types & Management", C_ORANGE, "🩸"))
    story.append(sp(3))

    shock_types = [
        ("Hypovolemic\n(Hemorrhagic)", "1st: Control bleeding (direct pressure/tourniquet)\n2nd: 2 large-bore IVs; NS/LR 1–2L rapid bolus\n3rd: Type & cross-match; pRBCs if Hgb <7 g/dL\n4th: Balanced transfusion pRBCs:FFP:Platelets = 1:1:1\n5th: Monitor UO >0.5 mL/kg/hr, lactate, base deficit"),
        ("Septic\n(Distributive)", "1st: Blood cultures ×2 BEFORE antibiotics; lactate level\n2nd: Broad-spectrum IV antibiotics WITHIN 1 HOUR\n3rd: Crystalloid 30 mL/kg IV within 3 hours\n4th: Norepinephrine (1st-line vasopressor) if MAP <65 mmHg\n5th: Hydrocortisone 200 mg/day if vasopressor-refractory"),
        ("Anaphylactic\n(Distributive)", "1st: EPINEPHRINE 0.3–0.5 mg IM (anterolateral thigh) — FIRST LINE!\n2nd: Supine + legs elevated; O₂; IV access; NS bolus\n3rd: Repeat epinephrine q5–15 min if needed\n4th: Diphenhydramine IV + Ranitidine (H2 blocker)\n5th: Methylprednisolone 125 mg IV; monitor biphasic (4–12 hrs)"),
        ("Cardiogenic", "1st: O₂, monitor, IV access; 12-lead ECG for AMI\n2nd: Dobutamine (inotrope); Dopamine if severe hypotension\n3rd: CAUTIOUS fluids (avoid overload); Furosemide if pulm. edema\n4th: Urgent PCI if AMI-related (door-to-balloon ≤90 min)\n5th: IABP / mechanical circulatory support"),
    ]
    shock_data = [[Paragraph("<b>Type</b>", TABLE_HEADER), Paragraph("<b>Priority Steps</b>", TABLE_HEADER)]]
    bgs = [colors.HexColor("#FDEBD0"), colors.HexColor("#FFF9C4"),
           colors.HexColor("#FDEDEC"), colors.HexColor("#EBF5FB")]
    for i, (stype, ssteps) in enumerate(shock_types):
        shock_data.append([
            Paragraph(f"<b>{stype}</b>", ParagraphStyle("st", fontName="Helvetica-Bold", fontSize=8,
                textColor=C_DARK_RED, leading=11, alignment=TA_CENTER)),
            Paragraph(ssteps.replace("\n", "<br/>"), TABLE_CELL)
        ])
    st = Table(shock_data, colWidths=[2.8*cm, USABLE_W - 2.8*cm])
    st.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), C_ORANGE),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.HexColor("#FFF3E0"), colors.HexColor("#FFF9C4"),
                                            colors.HexColor("#FDEDEC"), colors.HexColor("#EBF5FB")]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#F0B27A")),
        ("TOPPADDING",    (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(st)
    story.append(sp(4))
    story.append(highlight_box(
        "KEY LAB: Lactate >4 mmol/L OR Base Deficit < −4 mEq/L = SHOCK  |  "
        "UO <0.5 mL/kg/hr = severe renal hypoperfusion  |  "
        "EPINEPHRINE = 1st in anaphylaxis (NOT antihistamine!)",
        bg=colors.HexColor("#FEF9E7"), text_color=C_AMBER))
    story.append(sp(8))

    # ── Emergency 4: Stroke ───────────────────────────────────────────────────
    story.append(section_header("4. STROKE / CVA (Cerebrovascular Accident)", C_PURPLE, "🧠"))
    story.append(sp(3))
    story.append(highlight_box(
        'FAST: Face drooping | Arm weakness | Speech difficulty | Time to call  —  "Time is Brain!"',
        bg=colors.HexColor("#F5EEF8"), text_color=C_PURPLE))
    story.append(sp(4))
    story.append(steps_table([
        ("1st", "Activate stroke team; NOTE exact time of symptom onset", ""),
        ("2nd", "ABC stabilization; O₂ if SpO₂ <94%; IV access; NPO (nil per os)", ""),
        ("3rd", "STAT non-contrast CT brain — rule out hemorrhagic stroke FIRST", ""),
        ("4th", "Blood glucose check (hypoglycemia mimics stroke — correct BGL first)", ""),
        ("5th", "Ischemic stroke ≤4.5 hrs: IV tPA (Alteplase) 0.9 mg/kg (max 90 mg)", "10% as bolus, rest over 60 min"),
        ("6th", "Large vessel occlusion ≤24 hrs: Mechanical Thrombectomy", ""),
        ("7th", "BP: allow ≤220/120 pre-tPA; keep <180/105 mmHg post-tPA", ""),
        ("8th", "Aspirin 325 mg (after hemorrhage excluded); Statin therapy", ""),
    ]))
    story.append(sp(3))
    story.append(Paragraph(
        "<b>Nursing:</b> HOB 30° | Swallow screen before oral intake | Neuro checks q1h | "
        "Hemorrhagic stroke: reverse anticoagulation; target SBP <140 mmHg",
        NOTE_STYLE))

    story.append(PageBreak())

    # ── Emergency 5: MI ────────────────────────────────────────────────────────
    story.append(section_header("5. MYOCARDIAL INFARCTION — STEMI / NSTEMI", C_RED, "💉"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "12-lead ECG within 10 min of arrival — ST elevation ≥1mm in ≥2 contiguous leads = STEMI", ""),
        ("2nd", "Aspirin 325 mg (chewed) + P2Y12 inhibitor (Clopidogrel / Ticagrelor) — Dual antiplatelet therapy", ""),
        ("3rd", "Nitroglycerin SL 0.4 mg q5 min ×3 (if SBP >90, NO RV infarct)", "Vasodilator — reduces preload"),
        ("4th", "O₂ ONLY if SpO₂ <90% (avoid hyperoxia); Morphine 2–4 mg IV if refractory pain", ""),
        ("5th", "IV Heparin (unfractionated) or Enoxaparin — Anticoagulation", ""),
        ("6th", "PRIMARY PCI within 90 min (door-to-balloon) — PREFERRED reperfusion", ""),
        ("7th", "If PCI unavailable: IV Fibrinolysis (Streptokinase / tPA) within 30 min", "Contraindicated if hemorrhagic stroke, recent surgery"),
    ]))
    story.append(sp(4))
    story.append(highlight_box(
        "MONA Mnemonic: Morphine | O₂ (if SpO₂ <90%) | Nitroglycerin | Aspirin  —  "
        "Continuous cardiac monitoring + defibrillator ready + restrict activity + NPO for procedure",
        bg=colors.HexColor("#FDEDEC"), text_color=C_DARK_RED))
    story.append(sp(8))

    # ── Emergency 6: PE ────────────────────────────────────────────────────────
    story.append(section_header("6. PULMONARY EMBOLISM (PE)", C_BLUE, "🫁"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "O₂ high flow; IV access; continuous monitoring of SpO₂, BP, HR", ""),
        ("2nd", "12-lead ECG (classic: S1Q3T3); D-dimer; ABG; Wells Score pre-test probability", ""),
        ("3rd", "CT Pulmonary Angiography (CTPA) — GOLD STANDARD imaging", ""),
        ("4th", "Anticoagulation: IV Unfractionated Heparin 80 U/kg bolus → 18 U/kg/hr infusion", ""),
        ("5th", "MASSIVE PE (hemodynamic instability): Thrombolysis tPA 100 mg IV over 2 hrs", ""),
        ("6th", "Surgical embolectomy if thrombolysis contraindicated", ""),
    ]))
    story.append(sp(8))

    # ── Emergency 7: Diabetic ─────────────────────────────────────────────────
    story.append(section_header("7. DIABETIC EMERGENCIES", C_TEAL, "🔋"))
    story.append(sp(3))

    dka_hypo_data = [
        [Paragraph("<b>DKA (Diabetic Ketoacidosis)</b>", TABLE_HEADER),
         Paragraph("<b>Hypoglycemia (BGL &lt;70 mg/dL)</b>", TABLE_HEADER)],
        [Paragraph("Criteria: BGL >250 mg/dL + pH <7.3 + HCO₃ <18 + ketonemia", SMALL),
         Paragraph("Rule of 15: 15g fast carbs → recheck in 15 min (conscious)", SMALL)],
        [Paragraph("1st: IV NS 1L/hr for 1–2 hrs (fluid resuscitation)", TABLE_CELL),
         Paragraph("1st: 15g fast-acting carbs PO if conscious", TABLE_CELL)],
        [Paragraph("2nd: IV Regular Insulin 0.1 U/kg/hr (ONLY if K⁺ ≥3.5 mEq/L)", TABLE_CELL),
         Paragraph("2nd: If unconscious/no IV: Glucagon 1 mg IM/SC", TABLE_CELL)],
        [Paragraph("3rd: K⁺ replacement 20–40 mEq/hr if K⁺ <5.5 mEq/L", TABLE_CELL),
         Paragraph("3rd: If IV access: Dextrose 25–50g (50% dextrose) IV bolus", TABLE_CELL)],
        [Paragraph("4th: Switch to D5 when BGL <200 mg/dL", TABLE_CELL),
         Paragraph("4th: Identify cause; monitor BGL q15–30 min", TABLE_CELL)],
        [Paragraph("5th: Monitor ABG, electrolytes, UO q2–4h", TABLE_CELL),
         Paragraph("⚠ Potassium must be ≥3.5 before insulin in DKA!", TABLE_CELL_BOLD)],
    ]
    dka_t = Table(dka_hypo_data, colWidths=[USABLE_W/2, USABLE_W/2])
    dka_t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,0), C_TEAL),
        ("BACKGROUND",    (1,0), (1,0), C_GREEN),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.HexColor("#E8F8F5"), colors.HexColor("#EAFAF1")]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#A2D9CE")),
        ("TOPPADDING",    (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(dka_t)

    story.append(PageBreak())

    # ── Emergency 8: Status Epilepticus ───────────────────────────────────────
    story.append(section_header("8. STATUS EPILEPTICUS (Seizure >5 min or recurrent without recovery)", C_PURPLE, "⚡"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "Protect from injury; lateral position (recovery); TIME the seizure; do NOT restrain or insert objects in mouth", ""),
        ("2nd", "O₂ via face mask; suction secretions; IV access; BGL, electrolytes, drug levels", ""),
        ("3rd", "Thiamine 100 mg IV BEFORE glucose in alcoholic patients (prevents Wernicke's encephalopathy)", ""),
        ("4th (0–5 min)", "Benzodiazepine: Lorazepam 0.1 mg/kg IV  OR  Diazepam 0.2 mg/kg IV/rectal  OR  Midazolam IM", "1st-line anticonvulsant"),
        ("5th (5–20 min)", "2nd-line: Levetiracetam 60 mg/kg IV  OR  Phenytoin/Fosphenytoin 20 mg/kg IV", ""),
        ("6th (>30 min)", "Refractory: Propofol / Midazolam / Phenobarbital infusion → ICU + continuous EEG monitoring", ""),
    ]))
    story.append(sp(3))
    story.append(Paragraph(
        "<b>Nursing seizure precautions:</b> Padded side rails | O₂ at bedside | Suction ready | NPO during seizure | Privacy",
        NOTE_STYLE))
    story.append(sp(8))

    # ── Emergency 9: Raised ICP ───────────────────────────────────────────────
    story.append(section_header("9. INCREASED INTRACRANIAL PRESSURE (Raised ICP)", C_DARK_GRAY, "🧊"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "HOB 30° elevation (neutral head position — avoid jugular compression)", ""),
        ("2nd", "O₂ to maintain SpO₂ >95%; target PaCO₂ 35–40 mmHg (avoid hypercarbia)", ""),
        ("3rd", "Mannitol 0.25–1 g/kg IV (osmotic diuretic — 1st line); monitor serum osmolality <320 mOsm/kg", ""),
        ("4th", "3% Hypertonic Saline (alternative to mannitol; preferred if hypotensive)", ""),
        ("5th", "Controlled hyperventilation (PCO₂ 30–35 mmHg) — TEMPORARY bridge only", ""),
        ("6th", "Neurosurgical consult; ICP monitoring; Decompressive craniectomy if refractory", ""),
    ]))
    story.append(sp(4))
    story.append(highlight_box(
        "CUSHING'S TRIAD (late sign of herniation): Hypertension + Bradycardia + Irregular Respirations  |  "
        "⚠ NEVER do LP before CT if raised ICP suspected (herniation risk!)",
        bg=colors.HexColor("#F4ECF7"), text_color=C_PURPLE))
    story.append(sp(8))

    # ── Emergency 10: Burns ───────────────────────────────────────────────────
    story.append(section_header("10. BURNS", C_ORANGE, "🔥"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "STOP burning process; remove clothing & jewelry (not stuck to skin)", ""),
        ("2nd", "Airway assessment for INHALATION INJURY: hoarseness, singed nasal hairs, stridor, carbonaceous sputum → EARLY intubation", ""),
        ("3rd", "Calculate TBSA (Total Body Surface Area) — Rule of Nines", ""),
        ("4th", "PARKLAND FORMULA: 4 mL × weight(kg) × %TBSA = Lactated Ringer's (½ in first 8 hrs, ½ in next 16 hrs)", ""),
        ("5th", "Target UO: 0.5–1.0 mL/kg/hr adults; 1 mL/kg/hr children", ""),
        ("6th", "Tetanus prophylaxis; pain management (IV Morphine); wound care", ""),
        ("7th", "Transfer to burn unit: >10% TBSA, face/hands/genitalia, circumferential, chemical/electrical burns", ""),
    ]))
    story.append(sp(3))
    story.append(highlight_box(
        "RULE OF NINES: Head 9% | Each Arm 9% | Chest 9% | Abdomen 9% | Each Thigh 9% | Each Lower Leg 9% | Perineum 1%",
        bg=colors.HexColor("#FEF9E7"), text_color=C_ORANGE))

    story.append(PageBreak())

    # ── Emergency 11: Obstetric ───────────────────────────────────────────────
    story.append(section_header("11. OBSTETRIC EMERGENCIES", C_PURPLE, "🤰"))
    story.append(sp(3))

    obs_data = [
        [Paragraph("<b>Eclampsia</b>", TABLE_HEADER),
         Paragraph("<b>Postpartum Hemorrhage (PPH)</b>", TABLE_HEADER)],
        [Paragraph("1st: Protect airway; LEFT LATERAL decubitus (uterine displacement)", TABLE_CELL),
         Paragraph("1st: Bimanual uterine massage; assess 4T's cause", TABLE_CELL)],
        [Paragraph("2nd: Magnesium Sulfate 4–6g IV loading → 1–2g/hr maintenance", TABLE_CELL_BOLD),
         Paragraph("2nd: Oxytocin 20–40 units in 1L NS IV — 1st-line uterotonic", TABLE_CELL_BOLD)],
        [Paragraph("3rd: Antihypertensive: Hydralazine 5–10 mg IV OR Labetalol 20 mg IV (target BP <160/110)", TABLE_CELL),
         Paragraph("3rd: Misoprostol 800–1000 mcg rectal/sublingual", TABLE_CELL)],
        [Paragraph("4th: Fetal monitoring; plan for delivery", TABLE_CELL),
         Paragraph("4th: Tranexamic acid 1g IV within 3 hrs of delivery", TABLE_CELL)],
        [Paragraph("5th: ANTIDOTE FOR Mg TOXICITY = Calcium Gluconate (keep at bedside!)", TABLE_CELL_BOLD),
         Paragraph("5th: Blood transfusion; surgical (B-Lynch suture / hysterectomy)", TABLE_CELL)],
    ]
    obs_t = Table(obs_data, colWidths=[USABLE_W/2, USABLE_W/2])
    obs_t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,0), C_PURPLE),
        ("BACKGROUND",    (1,0), (1,0), colors.HexColor("#922B21")),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.HexColor("#F5EEF8"), colors.HexColor("#FDEDEC")]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#D7BDE2")),
        ("TOPPADDING",    (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(obs_t)
    story.append(sp(4))
    story.append(highlight_box(
        "PPH — 4T's Causes: Tone (atony, most common) | Tissue (retained placenta) | Trauma (laceration) | Thrombin (coagulopathy)",
        bg=colors.HexColor("#FDEDEC"), text_color=C_DARK_RED))
    story.append(sp(8))

    # ── Emergency 12: Poisoning ───────────────────────────────────────────────
    story.append(section_header("12. POISONING / OVERDOSE", C_DARK_GRAY, "☠️"))
    story.append(sp(3))
    story.append(Paragraph("<b>Universal Approach:</b> ABCDE → Activated charcoal (if <1 hr, alert, non-caustic) → Specific antidote → Supportive care", BODY_BOLD))
    story.append(sp(4))
    story.append(antidote_table([
        ("Opioids (Morphine, Heroin, Fentanyl)", "Naloxone (Narcan) 0.4–2 mg IV/IM/IN"),
        ("Organophosphates (Nerve agents, Pesticides)", "Atropine IV (repeat until dry) + Pralidoxime (2-PAM)"),
        ("Acetaminophen / Paracetamol", "N-Acetylcysteine (NAC) IV/oral — start within 8–10 hrs"),
        ("Benzodiazepines", "Flumazenil 0.2 mg IV (use cautiously — seizure risk)"),
        ("Warfarin / Coumadin", "Vitamin K IV + FFP or Prothrombin Complex Concentrate (PCC)"),
        ("Heparin", "Protamine Sulfate"),
        ("Digoxin toxicity", "Digoxin-specific Fab fragments (Digibind)"),
        ("Beta-blocker overdose", "Glucagon IV + high-dose insulin therapy"),
        ("Calcium channel blocker", "Calcium Gluconate IV + Glucagon"),
        ("Tricyclic Antidepressant (TCA)", "Sodium Bicarbonate IV (QRS narrowing)"),
        ("Carbon Monoxide (CO)", "100% O₂ (NRB mask); Hyperbaric O₂ if severe"),
        ("Cyanide poisoning", "Hydroxocobalamin (Cyanokit) IV"),
        ("Iron overdose", "Deferoxamine IV/IM"),
        ("Methanol / Ethylene glycol", "Fomepizole (4-MP) IV; dialysis if severe"),
        ("Magnesium toxicity", "Calcium Gluconate 1g IV (ANTIDOTE)"),
    ]))

    story.append(PageBreak())

    # ── Emergency 13: Heat Stroke / Hypothermia ───────────────────────────────
    story.append(section_header("13. HEAT STROKE & HYPOTHERMIA", C_RED, "🌡️"))
    story.append(sp(3))
    temp_data = [
        [Paragraph("<b>Heat Stroke (Core temp >40°C + CNS dysfunction)</b>", TABLE_HEADER),
         Paragraph("<b>Hypothermia (Core temp &lt;35°C)</b>", TABLE_HEADER)],
        [Paragraph("1st: Remove from heat; ABC stabilization", TABLE_CELL),
         Paragraph("1st: Remove wet clothing; prevent further heat loss", TABLE_CELL)],
        [Paragraph("2nd: RAPID COOLING — target 39°C within 30 min: ice water immersion OR evaporative cooling + fans", TABLE_CELL_BOLD),
         Paragraph("2nd: Passive (mild) → Active external (moderate) → Active internal/ECMO (severe <30°C)", TABLE_CELL)],
        [Paragraph("3rd: IV cold NS; DO NOT give antipyretics (not effective)", TABLE_CELL),
         Paragraph("3rd: Warm IV fluids 39–42°C; warmed humidified O₂", TABLE_CELL)],
        [Paragraph("4th: Monitor: rhabdomyolysis (CK, urine myoglobin), renal function, electrolytes", TABLE_CELL),
         Paragraph("4th: ECG monitoring — Osborn (J) waves; VF risk; DO NOT pronounce dead until warm >32°C", TABLE_CELL_BOLD)],
    ]
    temp_t = Table(temp_data, colWidths=[USABLE_W/2, USABLE_W/2])
    temp_t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,0), C_RED),
        ("BACKGROUND",    (1,0), (1,0), C_BLUE),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.HexColor("#FFF3E0"), colors.HexColor("#EBF5FB")]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#BFC9CA")),
        ("TOPPADDING",    (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(temp_t)
    story.append(sp(4))
    story.append(highlight_box(
        '"Not dead until WARM and dead" — continue CPR/resuscitation until core temp >32°C in hypothermia',
        bg=colors.HexColor("#EBF5FB"), text_color=C_BLUE))
    story.append(sp(8))

    # ── Emergency 14: Hypertensive Emergency ─────────────────────────────────
    story.append(section_header("14. HYPERTENSIVE EMERGENCY (BP >180/120 + End-Organ Damage)", C_RED, "🩺"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "IV access; continuous BP monitoring (arterial line preferred); ECG; labs (Cr, UA, troponin, CXR)", ""),
        ("2nd", "Target: Reduce MAP by ≤25% in FIRST HOUR — NOT to normal (risk of ischemic injury)", ""),
        ("3rd", "IV antihypertensives: Nicardipine / Labetalol / Clevidipine / Nitroprusside infusion", ""),
        ("4th (Aortic Dissection)", "Esmolol + Nitroprusside; target SBP <120 mmHg URGENTLY", ""),
        ("5th (Eclampsia)", "Magnesium Sulfate + Labetalol / Hydralazine", ""),
        ("6th (Hypertensive Encephalopathy)", "Reduce BP 30–40%; IV Labetalol or Nicardipine", "Fully reversible with prompt treatment"),
    ]))
    story.append(sp(4))
    story.append(highlight_box(
        "End-organ damage targets: Heart (ACS/HF) | Brain (Stroke/Encephalopathy) | Kidney (AKI) | Aorta (Dissection) | Eyes (Retinopathy) | Eclampsia",
        bg=colors.HexColor("#FDEDEC"), text_color=C_DARK_RED))
    story.append(sp(8))

    # ── Emergency 15: Acute Pulmonary Edema ───────────────────────────────────
    story.append(section_header("15. ACUTE PULMONARY EDEMA (Cardiogenic)", C_BLUE, "🫀"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "POSITION: High Fowler's (90°) / sit upright; legs dangling; O₂ via NRB mask OR BiPAP/CPAP", ""),
        ("2nd", "IV Furosemide 40–80 mg — DIURETIC (1st line); monitor UO", ""),
        ("3rd", "IV Nitroglycerin infusion — vasodilator (reduces preload); monitor BP closely", ""),
        ("4th", "Morphine 2–4 mg IV (reduces anxiety/preload — use cautiously; monitor RR)", ""),
        ("5th", "Identify & treat cause: STEMI → PCI | HTN → antihypertensives | Arrhythmia → cardioversion", ""),
    ]))
    story.append(sp(4))
    story.append(highlight_box(
        "LMNOP Mnemonic: Lasix (Furosemide) | Morphine | Nitrates | O₂ | Position (upright)",
        bg=colors.HexColor("#EBF5FB"), text_color=C_BLUE))

    story.append(PageBreak())

    # ── Emergency 16: Drowning ────────────────────────────────────────────────
    story.append(section_header("16. DROWNING / NEAR-DROWNING", C_BLUE, "🌊"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "Safely remove from water; ensure rescuer safety", ""),
        ("2nd", "Do NOT delay CPR for water drainage — begin immediately if unresponsive/apneic", ""),
        ("3rd", "5 RESCUE BREATHS first (if apneic), then standard CPR 30:2", "Different from standard adult CPR"),
        ("4th", "Remove wet clothes; warm blankets; prevent hypothermia", ""),
        ("5th", "O₂ high flow; prepare for ETT intubation (pulmonary injury/edema likely)", ""),
        ("6th", "Monitor for secondary drowning up to 24 hrs — admit for observation even if asymptomatic", ""),
    ]))
    story.append(sp(8))

    # ── Emergency 17: Spinal Cord Injury ─────────────────────────────────────
    story.append(section_header("17. SPINAL CORD INJURY", C_DARK_GRAY, "⚡"))
    story.append(sp(3))
    story.append(steps_table([
        ("1st", "IMMOBILIZE SPINE immediately — cervical collar + log-roll technique (maintain neutral alignment)", ""),
        ("2nd", "Airway: JAW THRUST ONLY (no head-tilt-chin-lift in cervical spine injury)", ""),
        ("3rd", "Neurogenic shock (vasodilation + bradycardia): IV fluids + Norepinephrine + Atropine", ""),
        ("4th", "MRI spine STAT; Neurosurgical consultation for decompression", ""),
        ("5th", "Foley catheter (urinary retention); Bowel management; Pressure ulcer prevention", ""),
        ("6th", "DVT prophylaxis (LMWH); respiratory support; skin care; psychological support", ""),
    ]))
    story.append(sp(4))
    story.append(highlight_box(
        "Neurogenic shock ≠ Spinal shock: Neurogenic = hemodynamic (hypotension + bradycardia). "
        "Spinal shock = flaccid paralysis below injury level (temporary).",
        bg=colors.HexColor("#F2F3F4"), text_color=C_DARK_GRAY))
    story.append(sp(8))

    # ── Emergency 18: Polytrauma ──────────────────────────────────────────────
    story.append(section_header("18. POLYTRAUMA — ATLS Primary Survey", C_DARK_RED, "🩹"))
    story.append(sp(3))
    atls_data = [
        [Paragraph("<b>Survey</b>", TABLE_HEADER),
         Paragraph("<b>Assessment</b>", TABLE_HEADER),
         Paragraph("<b>Priority Actions</b>", TABLE_HEADER)],
        [Paragraph("A — Airway\n+ C-spine", TABLE_CELL_BOLD),
         Paragraph("Obstruction, stridor, LOC", TABLE_CELL),
         Paragraph("Jaw thrust; suction; oropharyngeal airway; intubate", TABLE_CELL)],
        [Paragraph("B — Breathing", TABLE_CELL_BOLD),
         Paragraph("Tension pneumothorax, open chest, flail chest", TABLE_CELL),
         Paragraph("Needle decompression (2nd ICS MCL); chest seal; O₂", TABLE_CELL)],
        [Paragraph("C — Circulation", TABLE_CELL_BOLD),
         Paragraph("Active hemorrhage, BP, HR, skin perfusion", TABLE_CELL),
         Paragraph("Direct pressure; tourniquet; 2 large-bore IVs; blood products 1:1:1", TABLE_CELL)],
        [Paragraph("D — Disability", TABLE_CELL_BOLD),
         Paragraph("GCS, pupils, motor/sensory", TABLE_CELL),
         Paragraph("GCS calculation; C-spine precautions; glucose check", TABLE_CELL)],
        [Paragraph("E — Exposure", TABLE_CELL_BOLD),
         Paragraph("Hidden wounds, fractures, temperature", TABLE_CELL),
         Paragraph("Log roll; full-body exam; warm blankets (hypothermia prevention)", TABLE_CELL)],
    ]
    atls_t = Table(atls_data, colWidths=[2.5*cm, 4.5*cm, USABLE_W - 7.0*cm])
    atls_t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), C_DARK_RED),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_ROW1, C_ROW2]),
        ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#BFC9CA")),
        ("TOPPADDING",    (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(atls_t)
    story.append(sp(4))
    story.append(highlight_box(
        "TENSION PNEUMOTHORAX: Absent breath sounds + tracheal deviation + hypotension + JVD → "
        "IMMEDIATE needle decompression (2nd intercostal space, midclavicular line) — DO NOT wait for X-ray!",
        bg=colors.HexColor("#FDEDEC"), text_color=C_DARK_RED))

    story.append(PageBreak())

    # ── KEY MNEMONICS PAGE ─────────────────────────────────────────────────────
    story.append(section_header("KEY MNEMONICS FOR NCLEX & NORCET AIIMS", C_TEAL, "📝"))
    story.append(sp(5))
    story.append(mnemonic_table([
        ("ABCDE",      "Airway | Breathing | Circulation | Disability | Exposure — Universal primary survey"),
        ("FAST",       "Face drooping | Arm weakness | Speech difficulty | Time → Stroke recognition"),
        ("MONA",       "Morphine | O₂ (if SpO₂ <90%) | Nitroglycerin | Aspirin — Myocardial Infarction"),
        ("LMNOP",      "Lasix | Morphine | Nitrates | O₂ | Position (upright) — Acute pulmonary edema"),
        ("4H 4T",      "Reversible causes of cardiac arrest (see Emergency #1)"),
        ("SBAR",       "Situation | Background | Assessment | Recommendation — Handoff communication"),
        ("SAMPLE",     "Signs/Symptoms | Allergies | Medications | Past history | Last oral intake | Events"),
        ("PPH 4T's",   "Tone (atony) | Tissue (retained placenta) | Trauma (laceration) | Thrombin (coagulopathy)"),
        ("RICE",       "Rest | Ice | Compression | Elevation — Musculoskeletal injury"),
        ("Parkland",   "4 × weight(kg) × %TBSA = mL Lactated Ringer's (½ in first 8 hrs; ½ in next 16 hrs)"),
        ("Rule of 9s", "Head 9% | Each arm 9% | Chest 9% | Abd 9% | Each thigh 9% | Each lower leg 9% | Perineum 1%"),
        ("Rule of 15", "Hypoglycemia: 15g carbs PO → recheck BGL in 15 min → repeat if still <70 mg/dL"),
    ]))
    story.append(sp(10))

    # ── HIGH-YIELD EXAM POINTS ────────────────────────────────────────────────
    story.append(section_header("TOP 15 HIGH-YIELD EXAM POINTS", C_RED, "🔺"))
    story.append(sp(5))
    hiyield = [
        ("1", "EPINEPHRINE is ALWAYS 1st in anaphylaxis — NOT antihistamine (diphenhydramine)"),
        ("2", "tPA is CONTRAINDICATED in hemorrhagic stroke — always confirm with CT first"),
        ("3", "No ASPIRIN in children <18 years (Reye's syndrome risk)"),
        ("4", "Potassium must be ≥3.5 mEq/L BEFORE starting insulin in DKA"),
        ("5", "Thiamine 100 mg IV BEFORE glucose in alcoholics (prevents Wernicke's encephalopathy)"),
        ("6", "NEVER perform LP before CT scan if raised ICP is suspected (herniation risk)"),
        ("7", "CPR ratio: 30:2 adults | 30:2 child (1 rescuer) | 15:2 child (2 rescuers)"),
        ("8", "JAW THRUST (not head-tilt) is used in suspected cervical spine injury"),
        ("9", "Magnesium antidote = Calcium Gluconate — MUST keep at bedside during Mg infusion"),
        ("10", "Urine output target in shock: >0.5 mL/kg/hr | In burns: 0.5–1.0 mL/kg/hr"),
        ("11", "Primary PCI within 90 minutes (door-to-balloon time) for STEMI"),
        ("12", "Oxygen NOT given in COPD if SpO₂ >88–92% (hypercapnic respiratory drive)"),
        ("13", "Trendelenburg is NOT recommended in most shock types (current evidence-based update)"),
        ("14", "Stroke ischemic window: tPA ≤4.5 hrs | Thrombectomy ≤24 hrs (large vessel)"),
        ("15", '"Not dead until WARM and dead" — continue CPR in hypothermia until core temp >32°C'),
    ]
    hy_data = []
    for num, point in hiyield:
        hy_data.append([
            Paragraph(f"<b>{num}</b>", ParagraphStyle("num", fontName="Helvetica-Bold",
                fontSize=9, textColor=C_WHITE, alignment=TA_CENTER, leading=11)),
            Paragraph(point, TABLE_CELL)
        ])
    hy_t = Table(hy_data, colWidths=[0.9*cm, USABLE_W - 0.9*cm])
    hy_t.setStyle(TableStyle([
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [colors.HexColor("#FDEDEC"), colors.HexColor("#FFF3E0")]),
        ("BACKGROUND",     (0,0), (0,-1), C_RED),
        ("GRID",           (0,0), (-1,-1), 0.3, colors.HexColor("#F1948A")),
        ("TOPPADDING",     (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",    (0,0), (-1,-1), 6), ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ]))
    story.append(hy_t)
    story.append(sp(8))

    # ── Nursing Priority Rules ─────────────────────────────────────────────────
    story.append(section_header("NURSING DELEGATION & PRIORITY RULES", C_TEAL, "🏥"))
    story.append(sp(4))
    story.append(mnemonic_table([
        ("Maslow First", "Physiological needs (airway > breathing > circulation) always before safety or psychological needs"),
        ("ABC Rule",     "Airway is ALWAYS first — unless DNR (Do Not Resuscitate) order exists"),
        ("Assess First", "ASSESS before intervening — except cardiac arrest (act immediately)"),
        ("Delegation",   "RN: Assessment, teaching, unstable pts | LPN/LVN: Stable, routine care | UAP: Bathing, stable vitals"),
        ("Priority",     "Acute > Chronic | Unstable > Stable | Life-threatening > Comfort needs"),
        ("Safety",       "Seizure precautions | Fall precautions | Infection control (hand hygiene)"),
    ], bg_color=colors.HexColor("#E8F8F5")))
    story.append(sp(6))
    story.append(Paragraph(
        "<i>Sources: ROSEN's Emergency Medicine • Goldman-Cecil Medicine • Miller's Anesthesia • "
        "ACLS/ATLS/Sepsis Surviving Sepsis Campaign Guidelines • Sabiston Textbook of Surgery</i>",
        SMALL))

    doc.build(story)
    print(f"PDF created: {OUTPUT}")

if __name__ == "__main__":
    build()