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I need a quick summarized algorithm of difficult airway from DAS ( intubation and extubation), AIDAA (intubation and extubation) , DAS for obstetrics airway DAS for pediatric airway,

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DAS difficult airway society intubation extubation guidelines algorithm 2015 2022 summary

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AIDAA difficult airway guidelines algorithm intubation extubation India 2022 2023

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https://openairway.org/wp-content/uploads/2016/06/FCA2-Refre…

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12643155/

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12643154/

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AIDAA 2016 obstetric pediatric difficult airway guidelines algorithm summary

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I now have comprehensive information to compile a thorough summarized algorithm reference. Let me put it all together.

Difficult Airway Algorithms — Quick Reference Summary

1. DAS 2015 — Unanticipated Difficult Intubation in Adults

Core Concept: Plan A → B → C → D (stop-and-think between each)

Pre-induction: Assess airway, pre-oxygenate, state a backup plan before every induction.

PLAN A — Facemask ventilation + Tracheal intubation

  • Optimize head/neck position (ramping in obese); use NODESAT/THRIVE nasal O₂
  • ≤3 laryngoscopy attempts (include 1 by experienced colleague)
  • Use video laryngoscopy, bougie, external laryngeal manipulation
  • Confirm intubation with capnography (6 consecutive waveforms)
  • ✅ Succeed → proceed | ❌ Fail → call for help → Plan B

PLAN B — Supraglottic Airway (SAD) for oxygenation

  • Insert 2nd-generation SAD (e.g., ProSeal, i-gel, Supreme)
  • Max 2 attempts
  • SAD can be used to: (a) oxygenate + wake up, (b) intubate through SAD, (c) proceed without intubating
  • ✅ Oxygenation restored → STOP AND THINK (4 options below) | ❌ Fail → Plan C
STOP AND THINK — 4 options:
  1. Wake the patient up
  2. Intubate through the SAD (fibreoptic-guided)
  3. Proceed without intubation (if surgery permits)
  4. Tracheostomy/cricothyroidotomy (elective)

PLAN C — Final attempt at facemask ventilation

  • 2-person technique + airway adjuncts (OPA/NPA)
  • ✅ Success → wake up the patient | ❌ Fail → CICO → Plan D

PLAN D — Emergency Front-of-Neck Access (eFONA) — CICO situation

  • Scalpel-bougie-tube cricothyroidotomy (preferred over cannula)
  • Landmark: transverse stab incision → caudal traction → bougie → 6.0 cuffed tube
Post-event: Monitor for complications, complete airway alert form, explain to patient in writing, notify GP and local database.

2. DAS 2013 — Extubation Guidelines

Step 1: Classify Risk

Low-Risk"At-Risk"
No airway difficulty at intubation, no ongoing risk factorsKnown/suspected difficult airway, access issues, obesity, OSA, surgical factors, haemodynamic instability

LOW-RISK Extubation

  1. Optimize patient (position, reversal of NMB, warm, oxygenated)
  2. Suction (direct vision)
  3. Awake extubation (preferred routine) OR asleep extubation (select cases only)
  4. Post-extubation: O₂ supplementation, recovery position, monitoring

AT-RISK Extubation (structured approach)

Step 1 — Formulate Plan:
  • Can patient tolerate re-intubation? Is airway expected to deteriorate?
  • Technique choice: awake (standard), awake-advanced, or asleep
Step 2 — Awake extubation (standard):
  • Ensure full reversal of NMB (quantitative TOF preferred)
  • Suction under direct vision; ensure cooperative, oxygenated patient
  • Have re-intubation plan and equipment ready
Step 3 — Advanced techniques (if standard too risky):
  • Airway Exchange Catheter (AEC): Leave in situ as a rail for re-intubation (max 72h); always confirm with capnography if re-intubated via AEC
  • Remifentanil infusion: Provides smooth extubation while maintaining respiratory drive and airway reflexes
  • SAD exchange: Replace ETT with LMA, allow recovery, then remove SAD
Step 4 — Post-extubation care:
  • O₂ throughout transfer; document difficulties; handover to recovery team

3. DAS/OAA 2015 — Obstetric Difficult Airway

Key Principles

  • RSI is standard (full stomach/aspiration risk); left lateral tilt
  • Lower SpO₂ threshold for action (faster desaturation than non-pregnant)
  • Fetal welfare and maternal safety both considered
  • Team communication is critical: call obstetrician early

Master Algorithm (GA Caesarean Section)

Pre-induction:
  • Pre-oxygenate (3-5 min or 8 vital capacity breaths with tight-fitting mask, +HFNO)
  • Ramped/head-up position; antacid prophylaxis (ranitidine/sodium citrate)
  • RSI: cricoid pressure + propofol/thiopentone + suxamethonium
PLAN A — Tracheal intubation:
  • Optimized direct or video laryngoscopy; bougie
  • Max 2 attempts (1 retry with optimized conditions/different device)
  • ✅ Intubated → confirm capnography, maintain cricoid pressure until cuff inflated
FAILED INTUBATION → STOP AND THINK:
Immediate decision based on: urgency of surgery, ability to ventilate
ScenarioAction
Can ventilate + non-urgentWake up → regional/awake fibreoptic
Can ventilate + life-threatening (maternal/fetal)Proceed with SAD (2nd-generation, e.g., i-gel)
CICOEmergency FONA (scalpel cricothyroidotomy)
PLAN B — Oxygenation with SAD:
  • 2nd-generation SAD; max 2 attempts
  • If successful and proceeding with surgery: maintain cricoid pressure, use lowest leak pressure, continuous capnography
PLAN C — Face mask ventilation (2-person if needed)
PLAN D — Emergency FONA / cricothyroidotomy
Post-event:
  • Maintain cricoid through extubation (if risk of aspiration)
  • Complete airway alert form; debrief patient and team

4. DAS/APA — Pediatric Difficult Airway

Key Differences from Adults

  • Anatomy: Large head, short neck, anterior/cephalad larynx, short trachea, large tongue
  • Maintain spontaneous ventilation where possible (less reserve, faster desaturation)
  • Sedation preferred over paralysis in anticipated difficulty
  • Smaller SAD sizes; straight blade often preferred <2 years
  • FONA = needle cricothyroidotomy in small children (<8 yr); surgical in older

Algorithm 1: Difficult Mask Ventilation

  1. Reposition (neutral in infant, sniffing in older child)
  2. OPA/NPA; 2-person technique
  3. If persistent failure → SAD insertion
  4. CICO → emergency needle cricothyroidotomy (< 8yr) or scalpel cricothyroidotomy (≥ 8yr)

Algorithm 2: Unanticipated Difficult Tracheal Intubation (1–8 yr, paralysed)

PLAN A: Direct laryngoscopy with optimization (OELM, pillow under shoulders)
  • Max 2 attempts; call for senior help after 1st failure
PLAN B: Alternative laryngoscopy/device
  • Videolaryngoscope (e.g., C-MAC, Storz), or smaller tube with stylet
  • 1–2 attempts
PLAN C: SAD insertion (i-gel, LMA Classic)
  • Oxygenate; STOP AND THINK → wake up or proceed through SAD
PLAN D: CICO → Emergency airway access
  • Age < 8yr: wide-bore cannula cricothyroidotomy (jet ventilation via Manujet or 50ml syringe)
  • Age ≥ 8yr: scalpel-bougie-tube (as per adult technique with smaller tube)

5. AIDAA 2025 — Unanticipated Difficult Airway in Adults (Updated)

Core Concept: Maintain SpO₂ ≥95% at every step; "Code D" as emergency alert

Primary Airway Plan (intubation, SGA, facemask, or TIVA + oxygen):
  • Use video laryngoscopy as first-line where available
  • Confirm intubation with 6 consecutive sustained capnography waveforms
If Primary Plan Fails:
  1. Declare "Code D" — hospital emergency code for difficult airway; call for experienced help immediately
  2. Maintain depth of anaesthesia throughout rescue attempts
  3. Deliver nasal O₂ throughout (THRIVE/HFNO preferred)
  4. Track SpO₂ and time elapsed continuously
Airway Rescue — No hierarchy between devices:
  • Switch promptly between tracheal tube (TT), SGA, and facemask
  • Max 3 attempts each with TT, SGA, and mask ventilation
  • Proceed to next attempt only if SpO₂ ≥95%
  • If SpO₂ not maintained or bradycardia → bypass steps → emergency cricothyroidotomy immediately
Complete Ventilation Failure (CVF) — all three fail:
  • → Emergency cricothyroidotomy without delay
Post-event: Document, airway alert form, patient communication, follow-up

6. AIDAA 2025 — Extubation of the "At-Risk" Airway

Framework: SAFE

LetterAction
S — Stratify RiskClassify: routine vs. "at-risk" (known difficult airway, airway edema, obesity, OSA, prolonged intubation, neck surgery, etc.)
A — Assemble & AnticipateAssemble equipment, experienced personnel, re-intubation plan; anticipate complications
F — Facilitate ExtubationExecute extubation using the appropriate technique (see below)
E — Evaluate & EscalateMonitor post-extubation; escalate early if deterioration

AT-RISK Extubation — 3 Limbs (3 Ds + 3 Ss)

Limb 1 — Routine at-risk extubation (conditions manageable with standard care)
Limb 2 — 3 Ds (difficult conditions):
  • Difficult re-intubation expected
  • Deteriorating airway (edema, bleeding, hematoma)
  • Dependency on tube (e.g., tracheomalacia, cervical instability)
Limb 3 — 3 Ss (special techniques):
  • Staged Sequential Extubation (SSE): Remove ETT over an Airway Exchange Catheter (AEC), allowing re-intubation if needed; or step down to SAD then remove
  • Supervised extubation in controlled environment (HDU/ICU) with senior presence
  • Stay intubated: Delayed extubation when airway is not safe yet
Post-extubation for all at-risk: Continue O₂ (PerEOx — peri-extubation oxygenation), handover with re-intubation plan, stay alert for laryngospasm, bronchospasm, stridor, NPPE, aspiration.

Quick Comparison Table

FeatureDAS 2015 (Adult Intubation)DAS ExtubationDAS ObstetricsDAS PediatricAIDAA 2025 IntubationAIDAA 2025 Extubation
StructurePlan A→B→C→DRisk classify → techniqueRSI → Plan A→B→C→DPlan A→B→C→D (age-adjusted)Primary plan → Code D → rescueSAFE framework
Max intubation attempts3 total (Plan A)—2 (more conservative)2–33 TT + 3 SGA + 3 mask—
CICO rescueScalpel-bougie (surgical)—Scalpel-bougie (surgical)Needle (<8yr) / scalpel (≥8yr)Emergency cricothyroidotomy—
Key triggerFailed intubationRisk stratificationFailed intubation during RSIFailed intubationSpO₂ <95% / bradycardiaAny at-risk feature
Key innovationSimplified overview + detailed versionAEC / remifentanil techniques2 attempts max; wake up vs. proceed decisionSpontaneous ventilation preference"Code D" + no-hierarchy device switchingSAFE + SSE + 3Ds/3Ss
Confirm intubationCapnography—Capnography + cricoid until cuff inflatedCapnography6 consecutive capnography waveforms—
Key references:

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The full summary is ready above! Here's a quick orientation to help you navigate it:
What's included:
  1. DAS 2015 Adult Intubation — Plan A→B→C→D with attempt limits and FONA (scalpel-bougie)
  2. DAS 2013 Extubation — Risk stratify (low-risk vs. at-risk) → AEC / remifentanil / SAD exchange techniques
  3. DAS/OAA 2015 Obstetrics — RSI-based, max 2 intubation attempts, wake-up vs. proceed decision tree, CICO management
  4. DAS/APA Pediatrics — Age-adjusted plans, spontaneous ventilation preference, needle vs. scalpel FONA by age
  5. AIDAA 2025 Adult Intubation — "Code D" activation, no-hierarchy device switching (TT/SGA/mask), SpO₂ ≥95% gate before each attempt
  6. AIDAA 2025 Extubation — SAFE framework + 3 Ds / 3 Ss limb system + Staged Sequential Extubation (SSE)
A few high-yield distinctions to remember:
  • DAS obstetrics allows only 2 laryngoscopy attempts (vs. 3 in adult general)
  • AIDAA's "Code D" is a unique institutional emergency activation concept
  • AIDAA explicitly states no hierarchy between TT, SGA, and mask during rescue — switch freely
  • DAS pediatric FONA differs by age: needle (<8 yr) vs. scalpel (≥8 yr)
  • AIDAA 2025 extubation introduced SSE (Staged Sequential Extubation) as a formal strategy
Let me know if you'd like any section expanded, a printable table, or a specific scenario walked through.

Need all and need summarise to write in exam

Here is a tight, exam-ready write-up for all six algorithms — structured so you can reproduce it in an exam in logical order.

DIFFICULT AIRWAY ALGORITHMS — EXAM WRITE-UP

1. DAS 2015 — Unanticipated Difficult Intubation in Adults

Pre-induction essentials:
  • Airway assessment + pre-oxygenation (3–5 min or 8 vital capacity breaths)
  • State a backup plan before every induction
  • Nasal O₂ (THRIVE/HFNO) throughout

Plan A — Facemask ventilation + Tracheal intubation

  • Optimise position (ramp obese patients), use video laryngoscopy + bougie
  • Maximum 3 attempts (one may be by a senior colleague)
  • Confirm with capnography
  • Fail → call for help → Plan B

Plan B — SAD insertion (oxygenation priority)

  • Insert 2nd-generation SAD (i-gel, ProSeal, Supreme)
  • Maximum 2 attempts
  • If SAD ventilates → STOP AND THINK → 4 options:
    1. Wake patient up
    2. Intubate through SAD (fibreoptic)
    3. Proceed without intubation (if appropriate)
    4. Elective surgical airway
  • Fail → Plan C

Plan C — Final facemask ventilation attempt

  • 2-person technique + OPA/NPA
  • Success → wake up | Fail → CICO → Plan D

Plan D — Emergency Front-of-Neck Access (eFONA)

  • Scalpel-bougie-tube cricothyroidotomy
  • Stab incision → caudal traction → bougie → size 6.0 cuffed tube
Post-event: Airway alert form, written explanation to patient, notify GP

2. DAS 2012/2013 — Extubation Guidelines

Step 1: Stratify Risk

Low RiskAt Risk
Easy intubation, no complications, no ongoing risk factorsDifficult intubation, obesity, OSA, airway oedema, restricted access, haemodynamic instability

Low-Risk Extubation

  1. Fully reverse NMB; optimise position + oxygenation
  2. Suction under direct vision
  3. Awake extubation (preferred) OR asleep (selected cases)
  4. Post-extubation O₂ + monitoring

At-Risk Extubation — 3 Techniques

  1. Awake extubation (standard) — full reversal, co-operative, oxygenated patient; re-intubation plan ready
  2. Airway Exchange Catheter (AEC) — leave in situ after extubation; re-intubate over AEC if needed; confirm with capnography
  3. SAD exchange / Remifentanil technique — replace ETT with LMA; remifentanil infusion maintains spontaneous ventilation + reflexes during extubation
Post-extubation: O₂ throughout transfer, detailed handover, document all difficulties

3. DAS/OAA 2015 — Obstetric Difficult Airway

Key differences from general adult:
  • RSI is standard (full stomach risk); left lateral tilt
  • Faster desaturation → lower threshold for action
  • Only 2 laryngoscopy attempts (more conservative than general DAS)
  • Dual concern: maternal and fetal safety
  • Always include obstetrician in decision-making

Algorithm (GA Caesarean Section)

Pre-induction:
  • Pre-oxygenate + HFNO; antacid prophylaxis
  • RSI: cricoid pressure + propofol/thiopentone + suxamethonium
Plan A — Tracheal intubation (max 2 attempts):
  • Optimised DL or VL + bougie; maintain cricoid pressure
  • Confirm with capnography; maintain cricoid until cuff inflated
Failed intubation → STOP AND THINK:
SituationAction
Can ventilate + non-urgent surgeryWake up → regional/awake FOI
Can ventilate + life-threatening (maternal or fetal)Proceed with 2nd-gen SAD (i-gel preferred)
CICOEmergency eFONA (scalpel cricothyroidotomy)
Plan B: 2nd-generation SAD — max 2 attempts Plan C: 2-person facemask ventilation Plan D: Scalpel cricothyroidotomy
Post-event: Cricoid maintained till full airway protection; airway alert form; debrief team + patient

4. DAS/APA — Paediatric Difficult Airway

Key anatomical/physiological differences:
  • Large head, short neck, anterior/cephalad larynx, large tongue, short trachea
  • Faster desaturation; less respiratory reserve
  • Prefer to maintain spontaneous ventilation in anticipated difficulty
  • Straight blade preferred < 2 years

Algorithm 1: Difficult Mask Ventilation

  1. Reposition (neutral infant; sniffing in older child)
  2. OPA/NPA + 2-person technique
  3. Fail → SAD insertion
  4. CICO → emergency airway access (age-dependent — see below)

Algorithm 2: Unanticipated Difficult Tracheal Intubation (1–8 yr, paralysed)

Plan A: DL with optimisation (OELM, shoulder roll) — max 2 attempts; call for help after 1st failure
Plan B: Alternative device — VL (C-MAC/Storz), stylet — 1–2 attempts
Plan C: SAD insertion (i-gel/LMA Classic) — oxygenate → STOP AND THINK → wake up or intubate through SAD
Plan D — CICO — Emergency airway (age-based):
AgeTechnique
< 8 yearsWide-bore cannula cricothyroidotomy → jet ventilation (Manujet/50 mL syringe)
≥ 8 yearsScalpel-bougie-tube (adult technique, smaller tube)

5. AIDAA 2025 — Unanticipated Difficult Airway in Adults

Key innovations vs. DAS:
  • No fixed hierarchy between rescue devices
  • "Code D" as a formal hospital emergency code
  • SpO₂ ≥95% gate before every attempt
  • 6 consecutive capnography waveforms to confirm intubation

Algorithm

Primary Airway Plan (intubation / SGA / facemask / TIVA + O₂):
  • Video laryngoscopy as first-line where available
  • If successful → continue; if any difficulty → declare Code D immediately
Rescue Phase (no hierarchy — switch freely):
  • Attempt Tracheal tube (TT) → SGA → Facemask in any order
  • Max 3 attempts each
  • Proceed to next attempt only if SpO₂ ≥ 95%
  • Deliver nasal O₂ (HFNO preferred) throughout
  • Track SpO₂ + elapsed time continuously
  • Maintain depth of anaesthesia throughout
If SpO₂ drops / bradycardia develops at any point: → Bypass remaining steps → Emergency cricothyroidotomy immediately
Complete Ventilation Failure (all 3 devices fail): → Emergency cricothyroidotomy without further delay
Post-event: Airway alert form, patient communication, follow-up

6. AIDAA 2025 — Extubation of the "At-Risk" Airway

Framework: SAFE

StepContent
SStratify RiskIdentify at-risk features: known difficult airway, airway oedema, obesity, OSA, prolonged intubation, neck surgery, cervical instability
AAssemble & AnticipateGather equipment + experienced personnel; formulate written re-intubation plan; anticipate complications
FFacilitate ExtubationExecute using appropriate limb/technique (see below)
EEvaluate & EscalateMonitor continuously post-extubation; escalate early; maintain O₂ (PerEOx)

At-Risk Extubation — 3 Limbs

Limb 1 — Standard at-risk extubation:
  • Full NMB reversal (quantitative TOF), co-operative patient, O₂ supplementation
Limb 2 — 3 Ds (for high-risk conditions):
  • Difficult re-intubation expected
  • Deteriorating airway (oedema, haematoma, bleeding)
  • Dependency on tube (tracheomalacia, unstable cervical spine)
  • → Use AEC or staged techniques
Limb 3 — 3 Ss (special strategies):
  • Staged Sequential Extubation (SSE): remove ETT over AEC → step down to SAD → then remove SAD
  • Supervised extubation in controlled environment (HDU/ICU)
  • Stay intubated (delayed extubation) when airway is unsafe
Post-extubation for all at-risk:
  • PerEOx (peri-extubation oxygenation) — continue O₂ throughout transfer
  • Handover with explicit re-intubation plan
  • Watch for: laryngospasm, bronchospasm, stridor, NPPE, aspiration, apnoea

EXAM MEMORY ANCHORS

AlgorithmMemory Hook
DAS adult intubationA-B-C-D (3 tries A, 2 tries B, 1 last C, scalpel D)
DAS extubationLow vs. At-risk → AEC / Remi / SAD exchange
DAS obstetricsRSI + max 2 attempts + Wake OR Proceed + eFONA
DAS paediatricSpontaneous ventilation + needle (<8yr) vs. scalpel (≥8yr)
AIDAA intubationCode D + no hierarchy + SpO₂ ≥95% gate + 3 each
AIDAA extubationSAFE + 3 Ds + 3 Ss + SSE
One-line rule that applies to ALL algorithms:
"Oxygenation takes priority over intubation at every step — if you cannot oxygenate, surgical airway without delay."

Waiting

The full exam-ready write-up is complete above. Here's how to use it efficiently:
For a short answer (5–10 marks): Write the algorithm name → state the core concept → list Plans A→B→C→D with attempt limits → end with eFONA + post-event care. One paragraph per plan.
For a long answer (15–20 marks): Add the comparison table, key differences (obstetric = max 2 attempts; pediatric = age-based FONA; AIDAA = Code D + no hierarchy), and the SAFE/3Ds/3Ss framework for extubation.
Highest-yield points examiners test:
  • Max attempts: DAS adult = 3, DAS obstetric = 2, AIDAA = 3 each device
  • CICO rescue: adults = scalpel-bougie, pediatric <8yr = cannula/needle
  • AIDAA's unique terms: Code D, SpO₂ ≥95% gate, 6 capnography waveforms, no hierarchy
  • AIDAA extubation mnemonic: SAFE + 3 Ds + 3 Ss + SSE
  • Universal rule: oxygenation > intubation; surgical airway if CICO
Let me know if you want this converted into a downloadable PDF or Word document for printing.

But i need everything in pdf

Reading File
Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace

Running Command

mkdir -p /home/daytona/workspace/difficult-airway-pdf

Writing File

~/difficult-airway-pdf/generate_pdf.py

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

OUTPUT = "/home/daytona/workspace/difficult-airway-pdf/Difficult_Airway_Algorithms.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
NAVY   = colors.HexColor("#1a2e4a")
TEAL   = colors.HexColor("#1a7f7a")
AMBER  = colors.HexColor("#e07b00")
PINK   = colors.HexColor("#b5294e")
GREEN  = colors.HexColor("#2e7d32")
LGRAY  = colors.HexColor("#f4f6f8")
MGRAY  = colors.HexColor("#dde2e8")
WHITE  = colors.white

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

title_style = ParagraphStyle("MainTitle",
    fontSize=20, leading=26, textColor=WHITE, fontName="Helvetica-Bold",
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subtitle_style = ParagraphStyle("SubTitle",
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h1 = ParagraphStyle("H1",
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h2 = ParagraphStyle("H2",
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    spaceBefore=8, spaceAfter=3)

h3 = ParagraphStyle("H3",
    fontSize=10, leading=13, textColor=TEAL, fontName="Helvetica-Bold",
    spaceBefore=5, spaceAfter=2)

body = ParagraphStyle("Body",
    fontSize=9, leading=13, textColor=colors.HexColor("#222222"),
    fontName="Helvetica", spaceAfter=3, leftIndent=6, justified=TA_JUSTIFY)

bullet = ParagraphStyle("Bullet",
    fontSize=9, leading=13, textColor=colors.HexColor("#222222"),
    fontName="Helvetica", spaceAfter=2, leftIndent=14, bulletIndent=4)

bold_body = ParagraphStyle("BoldBody",
    fontSize=9, leading=13, textColor=NAVY,
    fontName="Helvetica-Bold", spaceAfter=3, leftIndent=6)

note_style = ParagraphStyle("Note",
    fontSize=8.5, leading=12, textColor=colors.HexColor("#555555"),
    fontName="Helvetica-Oblique", spaceAfter=3, leftIndent=6)

warn_style = ParagraphStyle("Warn",
    fontSize=9, leading=13, textColor=PINK, fontName="Helvetica-Bold",
    spaceAfter=3, leftIndent=6)

def section_header(title, color=NAVY):
    """Returns a coloured banner paragraph."""
    data = [[Paragraph(title, h1)]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING", (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("ROUNDEDCORNERS", [4,4,4,4]),
    ]))
    return t

def plan_box(plan_label, content_lines, color=TEAL):
    """Compact plan box with label and bullet lines."""
    label_para = Paragraph(plan_label, ParagraphStyle("PlanLabel",
        fontSize=10, leading=13, textColor=WHITE, fontName="Helvetica-Bold"))
    content = "\n".join(f"• {l}" for l in content_lines)
    content_para = Paragraph(content.replace("\n","<br/>"),
        ParagraphStyle("PlanContent", fontSize=8.5, leading=12,
                       textColor=colors.HexColor("#222222"), fontName="Helvetica"))
    data = [[label_para], [content_para]]
    col = 17*cm
    t = Table(data, colWidths=[col])
    t.setStyle(TableStyle([
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        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("BOX", (0,0), (-1,-1), 0.5, MGRAY),
    ]))
    return t

def two_col_table(headers, rows, col_widths=None):
    if col_widths is None:
        col_widths = [6*cm, 11*cm]
    header_style = ParagraphStyle("TH", fontSize=9, fontName="Helvetica-Bold",
                                  textColor=WHITE, leading=12)
    cell_style   = ParagraphStyle("TD", fontSize=8.5, fontName="Helvetica",
                                  textColor=colors.HexColor("#222222"), leading=12)
    data = [[Paragraph(h, header_style) for h in headers]]
    for row in rows:
        data.append([Paragraph(str(c), cell_style) for c in row])
    t = Table(data, colWidths=col_widths)
    style = TableStyle([
        ("BACKGROUND", (0,0), (-1,0), NAVY),
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        ("GRID", (0,0), (-1,-1), 0.3, MGRAY),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ])
    t.setStyle(style)
    return t

def multi_col_table(headers, rows, col_widths):
    header_style = ParagraphStyle("TH2", fontSize=8, fontName="Helvetica-Bold",
                                  textColor=WHITE, leading=10)
    cell_style   = ParagraphStyle("TD2", fontSize=7.5, fontName="Helvetica",
                                  textColor=colors.HexColor("#222222"), leading=10)
    data = [[Paragraph(h, header_style) for h in headers]]
    for row in rows:
        data.append([Paragraph(str(c), cell_style) for c in row])
    t = Table(data, colWidths=col_widths)
    style = TableStyle([
        ("BACKGROUND", (0,0), (-1,0), NAVY),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LGRAY]),
        ("GRID", (0,0), (-1,-1), 0.3, MGRAY),
        ("LEFTPADDING", (0,0), (-1,-1), 4),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
        ("TOPPADDING", (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ])
    t.setStyle(style)
    return t

def highlight_box(text, color=AMBER):
    p = Paragraph(text, ParagraphStyle("HL", fontSize=9, leading=13,
                  textColor=WHITE, fontName="Helvetica-Bold",
                  alignment=TA_CENTER))
    t = Table([[p]], colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
        ("TOPPADDING", (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ]))
    return t

def bp(text):
    return Paragraph(f"• {text}", bullet)

def b(text):
    return Paragraph(text, bold_body)

def p(text):
    return Paragraph(text, body)

def h(text):
    return Paragraph(text, h2)

def h3p(text):
    return Paragraph(text, h3)

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

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=MGRAY, spaceAfter=4, spaceBefore=4)

# ═══════════════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ═══════════════════════════════════════════════════════════════════════════
story = []

# ── COVER PAGE ──────────────────────────────────────────────────────────────
cover_data = [[
    Paragraph("DIFFICULT AIRWAY ALGORITHMS", title_style),
    Paragraph("Exam-Ready Reference Guide", subtitle_style),
    Spacer(1, 6),
    Paragraph("DAS 2015 Intubation  •  DAS Extubation  •  DAS/OAA Obstetrics", subtitle_style),
    Paragraph("DAS/APA Paediatrics  •  AIDAA 2025 Intubation  •  AIDAA 2025 Extubation", subtitle_style),
    Spacer(1, 10),
    Paragraph("May 2026", ParagraphStyle("Dt", fontSize=9, textColor=MGRAY,
              fontName="Helvetica", alignment=TA_CENTER)),
]]
cover_table = Table([cover_data[0]], colWidths=[17*cm])
cover_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), NAVY),
    ("LEFTPADDING", (0,0), (-1,-1), 20),
    ("RIGHTPADDING", (0,0), (-1,-1), 20),
    ("TOPPADDING", (0,0), (-1,-1), 30),
    ("BOTTOMPADDING", (0,0), (-1,-1), 30),
]))
story.append(cover_table)
story.append(sp(14))
story.append(highlight_box(
    "UNIVERSAL RULE: Oxygenation > Intubation — If CICO, surgical airway WITHOUT DELAY",
    color=PINK))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 1. DAS 2015 — ADULT INTUBATION
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("1.  DAS 2015 — Unanticipated Difficult Intubation in Adults", NAVY))
story.append(sp(6))

story.append(h("Pre-Induction Essentials"))
for t in [
    "Airway assessment + state a backup plan before every induction",
    "Pre-oxygenation: 3–5 min tidal breathing OR 8 vital capacity breaths (tight-fitting mask)",
    "Nasal O₂ (THRIVE/HFNO) throughout — maintain apnoeic oxygenation",
    "Optimise position: ramping for obese patients (ear-to-sternal-notch line)",
]:
    story.append(bp(t))
story.append(sp(4))

story.append(plan_box("PLAN A — Facemask Ventilation + Tracheal Intubation", [
    "Optimise position; video laryngoscopy + bougie as primary tools",
    "MAXIMUM 3 laryngoscopy attempts (one may be by senior colleague)",
    "Confirm intubation with CAPNOGRAPHY",
    "FAIL → call for help → Plan B",
], TEAL))
story.append(sp(4))

story.append(plan_box("PLAN B — SAD Insertion (Oxygenation Priority)", [
    "Insert 2nd-generation SAD (i-gel / ProSeal / Supreme)",
    "MAXIMUM 2 attempts",
    "If oxygenation restored → STOP AND THINK (4 options):",
    "  1. Wake the patient up",
    "  2. Intubate through SAD (fibreoptic-guided)",
    "  3. Proceed without intubation (if surgery permits)",
    "  4. Elective surgical airway (tracheostomy/cricothyroidotomy)",
    "FAIL → Plan C",
], GREEN))
story.append(sp(4))

story.append(plan_box("PLAN C — Final Facemask Ventilation Attempt", [
    "2-person technique + OPA/NPA adjuncts",
    "SUCCESS → wake patient up",
    "FAIL → CICO → Plan D",
], AMBER))
story.append(sp(4))

story.append(plan_box("PLAN D — Emergency Front-of-Neck Access (eFONA) — CICO", [
    "Technique: SCALPEL-BOUGIE-TUBE cricothyroidotomy",
    "Transverse stab incision → caudal traction on trachea → bougie → size 6.0 cuffed ETT",
    "Confirm with capnography",
], PINK))
story.append(sp(6))

story.append(h("Post-Event Care"))
for t in [
    "Monitor for complications in recovery",
    "Complete Airway Alert Form",
    "Explain to patient in person AND in writing",
    "Written report to GP + local difficult airway database",
]:
    story.append(bp(t))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 2. DAS EXTUBATION
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("2.  DAS 2012/2013 — Extubation Guidelines", TEAL))
story.append(sp(6))

story.append(h("Step 1: Stratify Risk"))
story.append(two_col_table(
    ["LOW RISK", "AT RISK"],
    [["Easy intubation, no airway complications, no ongoing risk factors",
      "Known/suspected difficult airway, obesity, OSA, airway oedema, restricted access, haemodynamic instability, surgical risk factors"]],
    col_widths=[8.5*cm, 8.5*cm]
))
story.append(sp(8))

story.append(h("LOW-RISK Extubation"))
for t in [
    "Fully reverse NMB; optimise position and oxygenation",
    "Suction under direct vision",
    "Awake extubation (preferred) OR asleep extubation (selected cases only)",
    "Post-extubation: O₂ supplementation + monitoring in recovery",
]:
    story.append(bp(t))
story.append(sp(8))

story.append(h("AT-RISK Extubation — 3 Advanced Techniques"))
story.append(sp(3))

story.append(h3p("Technique 1 — Awake Extubation (Standard)"))
for t in [
    "Full NMB reversal (quantitative TOF preferred)",
    "Co-operative, oxygenated, haemodynamically stable patient",
    "Re-intubation plan + equipment ready at bedside",
    "Suction under direct vision before extubation",
]:
    story.append(bp(t))
story.append(sp(4))

story.append(h3p("Technique 2 — Airway Exchange Catheter (AEC)"))
for t in [
    "Leave AEC in situ after removing ETT (acts as a rail for re-intubation)",
    "AEC can remain up to 72 hours",
    "If re-intubation needed: railroad ETT over AEC under direct vision",
    "ALWAYS confirm re-intubation with capnography",
    "Warn patient of discomfort; supplemental O₂ throughout",
]:
    story.append(bp(t))
story.append(sp(4))

story.append(h3p("Technique 3 — SAD Exchange / Remifentanil Technique"))
for t in [
    "SAD exchange: Replace ETT with LMA → allow recovery → remove SAD when awake",
    "Remifentanil infusion: maintains spontaneous ventilation + airway reflexes during extubation",
    "Titratable, short-acting — smooth emergence without coughing/straining",
]:
    story.append(bp(t))
story.append(sp(6))

story.append(h("Post-Extubation Care (ALL Patients)"))
for t in [
    "O₂ supplementation throughout transfer to recovery",
    "Detailed handover to recovery nurse including re-intubation plan",
    "Document all difficulties on airway alert form",
]:
    story.append(bp(t))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 3. DAS/OAA OBSTETRICS
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("3.  DAS/OAA 2015 — Obstetric Difficult Airway", colors.HexColor("#6a1b9a")))
story.append(sp(6))

story.append(h("Key Differences from General Adult DAS"))
story.append(two_col_table(
    ["Feature", "Obstetric Consideration"],
    [
        ["Intubation attempts", "MAX 2 (more conservative — faster desaturation)"],
        ["Induction technique", "RSI is STANDARD (full stomach / aspiration risk)"],
        ["Patient position", "Left lateral tilt (aortocaval compression)"],
        ["Cricoid pressure", "Applied at induction; maintained until cuff inflated"],
        ["Airway oedema", "Pregnancy-related → smaller ETT (6.0–7.0 mm)"],
        ["Decision-making", "Dual concern: maternal AND fetal safety"],
        ["Team", "Obstetrician involved in wake-up vs. proceed decision"],
    ],
    col_widths=[5*cm, 12*cm]
))
story.append(sp(8))

story.append(h("Pre-Induction"))
for t in [
    "Pre-oxygenate 3–5 min + HFNO nasal O₂; antacid prophylaxis (sodium citrate + H2 blocker)",
    "RSI: propofol or thiopentone + suxamethonium; cricoid pressure applied",
    "Ramped/head-up position; smaller ETT (6.0–7.0 mm)",
]:
    story.append(bp(t))
story.append(sp(4))

story.append(plan_box("PLAN A — Tracheal Intubation (MAX 2 attempts)", [
    "Optimised DL or VL + bougie; maintain cricoid pressure throughout",
    "Confirm with capnography; maintain cricoid until ETT cuff inflated",
    "FAIL after 2 attempts → STOP AND THINK",
], TEAL))
story.append(sp(6))

story.append(h("FAILED INTUBATION — Decision Table"))
story.append(two_col_table(
    ["Clinical Situation", "Action"],
    [
        ["Can ventilate + NON-URGENT surgery", "WAKE PATIENT UP → regional anaesthesia or awake fibreoptic intubation"],
        ["Can ventilate + LIFE-THREATENING (maternal or fetal)", "PROCEED with 2nd-gen SAD (i-gel preferred); maintain cricoid; lowest seal pressure"],
        ["CANNOT ventilate (CICO)", "EMERGENCY eFONA — scalpel cricothyroidotomy immediately"],
    ],
    col_widths=[6*cm, 11*cm]
))
story.append(sp(6))

story.append(plan_box("PLAN B — 2nd-Generation SAD", [
    "i-gel preferred in obstetrics; max 2 attempts",
    "If successful and proceeding: continuous capnography; lowest leak pressure",
    "FAIL → Plan C",
], GREEN))
story.append(sp(4))

story.append(plan_box("PLAN C — 2-Person Facemask Ventilation", [
    "Use OPA/NPA; 2-person technique",
    "FAIL → CICO → Plan D",
], AMBER))
story.append(sp(4))

story.append(plan_box("PLAN D — Emergency eFONA", [
    "Scalpel-bougie-tube cricothyroidotomy (as adult technique)",
    "Confirm with capnography",
], PINK))
story.append(sp(6))

story.append(h("Post-Event"))
for t in [
    "Maintain cricoid pressure until full airway protection restored (if aspiration risk remains)",
    "Complete airway alert form; debrief full team + patient",
    "Neonatologist present if emergency — document fetal outcome",
]:
    story.append(bp(t))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 4. DAS/APA PAEDIATRICS
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("4.  DAS/APA — Paediatric Difficult Airway", colors.HexColor("#1565c0")))
story.append(sp(6))

story.append(h("Key Anatomical & Physiological Differences"))
story.append(two_col_table(
    ["Feature", "Implication"],
    [
        ["Large occiput, short neck", "Neutral position in infants; sniffing in older children"],
        ["Anterior, cephalad larynx; large tongue", "Straight blade preferred < 2 years"],
        ["Short trachea", "Risk of right mainstem intubation — confirm depth carefully"],
        ["High O₂ consumption, low FRC", "Rapid desaturation — pre-oxygenation critical"],
        ["Less respiratory reserve", "Prefer SPONTANEOUS VENTILATION in anticipated difficulty"],
        ["Smaller structures", "Smaller SAD sizes; needle cricothyroidotomy for CICO < 8 yr"],
    ],
    col_widths=[5*cm, 12*cm]
))
story.append(sp(8))

story.append(h("Algorithm 1: Difficult Mask Ventilation"))
story.append(sp(3))
for t in [
    "Reposition: neutral in infant; sniffing position in older child",
    "Insert OPA/NPA; 2-person technique (one holds mask, one squeezes bag)",
    "Fail → SAD insertion (appropriately sized LMA/i-gel)",
    "Fail → CICO → Emergency airway access (see age table below)",
]:
    story.append(bp(t))
story.append(sp(8))

story.append(h("Algorithm 2: Unanticipated Difficult Tracheal Intubation (Age 1–8 yr, paralysed)"))
story.append(sp(3))

story.append(plan_box("PLAN A — Direct Laryngoscopy with Optimisation", [
    "Shoulder roll + OELM (optimal external laryngeal manipulation)",
    "MAX 2 attempts; call for SENIOR HELP after 1st failure",
    "FAIL → Plan B",
], TEAL))
story.append(sp(4))

story.append(plan_box("PLAN B — Alternative Laryngoscopy / Device", [
    "Videolaryngoscope (C-MAC, Storz) or smaller tube with stylet",
    "1–2 attempts maximum",
    "FAIL → Plan C",
], GREEN))
story.append(sp(4))

story.append(plan_box("PLAN C — SAD Insertion", [
    "i-gel or LMA Classic (appropriately sized)",
    "Oxygenate the child → STOP AND THINK:",
    "  → Wake up the child (preferred if possible)",
    "  → Intubate through SAD (fibreoptic-guided)",
    "FAIL → CICO → Plan D",
], AMBER))
story.append(sp(4))

story.append(plan_box("PLAN D — CICO Emergency Airway Access (AGE-DEPENDENT)", [
    "< 8 years: Wide-bore CANNULA cricothyroidotomy → jet ventilation (Manujet / 50 mL syringe)",
    "≥ 8 years: SCALPEL-BOUGIE-TUBE (adult technique, smaller tube size 4.0–5.0 cuffed)",
], PINK))
story.append(sp(6))

story.append(h("FONA Age Summary"))
story.append(two_col_table(
    ["Age Group", "Emergency Airway Technique"],
    [
        ["< 8 years", "Needle/cannula cricothyroidotomy → jet ventilation (Manujet or 50 mL syringe)"],
        ["≥ 8 years", "Scalpel-bougie-tube cricothyroidotomy (as adult; tube 4.0–5.0 cuffed)"],
    ],
    col_widths=[4*cm, 13*cm]
))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 5. AIDAA 2025 — ADULT INTUBATION
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("5.  AIDAA 2025 — Unanticipated Difficult Airway in Adults", colors.HexColor("#b71c1c")))
story.append(sp(6))

story.append(h("Key Innovations vs. DAS"))
story.append(two_col_table(
    ["AIDAA Feature", "Detail"],
    [
        ["Code D", "Formal hospital emergency code — declare immediately when difficulty encountered"],
        ["No device hierarchy", "Switch freely between TT, SGA, facemask — whichever works fastest"],
        ["SpO₂ ≥ 95% gate", "Only proceed to next attempt if SpO₂ ≥ 95%"],
        ["Intubation confirmation", "6 consecutive SUSTAINED capnography waveforms (without CO₂ fall)"],
        ["Nasal O₂", "HFNO throughout all rescue attempts (apnoeic oxygenation)"],
        ["CVF trigger", "Complete Ventilation Failure = all 3 devices failed = immediate cricothyroidotomy"],
    ],
    col_widths=[5*cm, 12*cm]
))
story.append(sp(8))

story.append(h("Algorithm Steps"))
story.append(sp(3))

story.append(plan_box("PRIMARY AIRWAY PLAN (Intubation / SGA / Facemask / TIVA + O₂)", [
    "Video laryngoscopy as FIRST-LINE where available",
    "Confirm intubation with 6 consecutive sustained capnography waveforms",
    "SUCCESS → continue as planned",
    "ANY DIFFICULTY → DECLARE CODE D immediately → call for experienced help",
], TEAL))
story.append(sp(4))

story.append(plan_box("RESCUE PHASE — No Hierarchy — Switch Freely", [
    "Attempt: Tracheal Tube (TT) AND/OR SGA AND/OR Facemask — in any order",
    "MAX 3 attempts with each device",
    "ONLY proceed to next attempt if SpO₂ ≥ 95%",
    "Deliver NASAL O₂ (HFNO preferred) THROUGHOUT",
    "Track SpO₂ + time elapsed continuously",
    "Maintain DEPTH OF ANAESTHESIA throughout rescue",
], GREEN))
story.append(sp(4))

story.append(highlight_box(
    "IF SpO₂ DROPS / BRADYCARDIA DEVELOPS AT ANY POINT → BYPASS REMAINING STEPS → EMERGENCY CRICOTHYROIDOTOMY IMMEDIATELY",
    color=PINK))
story.append(sp(4))

story.append(plan_box("COMPLETE VENTILATION FAILURE (CVF) — All 3 Devices Failed", [
    "EMERGENCY CRICOTHYROIDOTOMY without further delay",
    "No further airway device attempts",
], PINK))
story.append(sp(6))

story.append(h("Post-Event"))
for t in [
    "Complete airway alert form (standard AIDAA format)",
    "Patient communication — verbal + written",
    "Follow-up appointment to explain events",
    "Report to institutional database",
]:
    story.append(bp(t))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 6. AIDAA 2025 — EXTUBATION
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("6.  AIDAA 2025 — Extubation of the 'At-Risk' Airway", colors.HexColor("#e65100")))
story.append(sp(6))

story.append(h("Framework: SAFE"))
story.append(two_col_table(
    ["Letter", "Action & Content"],
    [
        ["S — Stratify Risk",
         "Identify at-risk features: known difficult airway, airway oedema, obesity, OSA, prolonged intubation (> 24 h), neck surgery, cervical instability, post-op haematoma, restricted mouth opening, NMB residue"],
        ["A — Assemble & Anticipate",
         "Gather re-intubation equipment; ensure experienced personnel present; formulate WRITTEN re-intubation plan; anticipate: laryngospasm, bronchospasm, stridor, NPPE, aspiration, apnoea"],
        ["F — Facilitate Extubation",
         "Execute using appropriate limb/technique (see 3 Limbs below). Full NMB reversal (quantitative TOF). Continue PerEOx (peri-extubation oxygenation) throughout."],
        ["E — Evaluate & Escalate",
         "Monitor continuously post-extubation. Escalate EARLY. Maintain O₂ during transfer (PerEOx). Handover with explicit re-intubation plan. Watch for complications listed above."],
    ],
    col_widths=[4*cm, 13*cm]
))
story.append(sp(8))

story.append(h("At-Risk Extubation — 3 Limbs"))
story.append(sp(3))

story.append(plan_box("LIMB 1 — Standard At-Risk Extubation", [
    "Routine extubation with additional safeguards",
    "Full NMB reversal confirmed (quantitative TOF ratio ≥ 0.9)",
    "Co-operative, awake, oxygenated patient",
    "Re-intubation plan and equipment at bedside",
    "Senior anaesthetist present",
], TEAL))
story.append(sp(4))

story.append(plan_box("LIMB 2 — 3 Ds (High-Risk Conditions)", [
    "D1 — Difficult re-intubation expected (known difficult airway — use AEC technique)",
    "D2 — Deteriorating airway (oedema, haematoma, bleeding — defer extubation / delayed extubation)",
    "D3 — Dependency on tube (tracheomalacia, cervical instability — SSE or stay intubated)",
], AMBER))
story.append(sp(4))

story.append(plan_box("LIMB 3 — 3 Ss (Special Strategies)", [
    "S1 — Staged Sequential Extubation (SSE): Remove ETT over AEC → step down to SAD → remove SAD when fully awake",
    "S2 — Supervised extubation: Controlled environment (HDU/ICU), senior presence, full monitoring",
    "S3 — Stay intubated: Delayed extubation when airway deemed unsafe — reassess at planned interval",
], GREEN))
story.append(sp(6))

story.append(h("Post-Extubation (All At-Risk Patients)"))
for t in [
    "PerEOx — continue supplemental O₂ throughout transfer to PACU/HDU/ICU",
    "Handover with explicit re-intubation plan and team briefing",
    "Watch for and act on: laryngospasm, bronchospasm, stridor, NPPE, aspiration, vomiting, apnoea",
    "Document difficulties during extubation, adverse events, and strategies used on airway alert form",
]:
    story.append(bp(t))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 7. MASTER COMPARISON TABLE
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("7.  Master Comparison Table", NAVY))
story.append(sp(8))

cw = [3.2*cm, 2.5*cm, 2.5*cm, 2.7*cm, 2.8*cm, 2.8*cm]
headers = ["Feature", "DAS Adult\nIntubation", "DAS\nExtubation", "DAS\nObstetrics", "AIDAA 2025\nIntubation", "AIDAA 2025\nExtubation"]
rows = [
    ["Structure", "Plan A→B→C→D", "Risk classify → technique", "RSI + Plan A→B→C→D", "Primary plan → Code D → rescue", "SAFE + 3Ds/3Ss"],
    ["Max intubation attempts", "3 (Plan A)", "—", "2 (Plan A)", "3 per device (TT/SGA/mask)", "—"],
    ["Device hierarchy", "A→B→C sequential", "—", "A→B→C sequential", "NO hierarchy — switch freely", "—"],
    ["CICO rescue", "Scalpel-bougie\n(adult)", "—", "Scalpel-bougie\n(adult)", "Emergency\ncricothyroidotomy", "—"],
    ["Paediatric CICO", "—", "—", "—", "Needle <8yr,\nScalpel ≥8yr", "—"],
    ["Key trigger", "Failed intubation", "Risk\nstratification", "Failed intubation\nduring RSI", "SpO₂ <95% or\nbradycardia", "Any at-risk\nfeature"],
    ["Confirm intubation", "Capnography", "—", "Capnography + cricoid\ntill cuff inflated", "6 consecutive\ncapno waveforms", "—"],
    ["Key innovation", "Simplified overview\n+ detailed version;\nbougie emphasis", "AEC / Remi /\nSAD exchange", "Max 2 attempts;\nwake vs. proceed\ndecision table", "Code D; no\nhierarchy;\nSpO₂ gate", "SAFE framework\n+ SSE +\n3Ds/3Ss"],
    ["Emergency code", "—", "—", "—", "CODE D", "—"],
    ["Extubation special technique", "—", "AEC stays in situ;\nrailroad if needed", "—", "—", "SSE (Staged\nSequential\nExtubation)"],
]
story.append(multi_col_table(headers, rows, cw))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# 8. EXAM MEMORY ANCHORS
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("8.  Exam Memory Anchors & High-Yield Points", TEAL))
story.append(sp(8))

story.append(h("Mnemonics"))
story.append(two_col_table(
    ["Algorithm", "Memory Hook"],
    [
        ["DAS Adult Intubation", "A-B-C-D | 3 tries A, 2 tries B, 1 last C, SCALPEL D"],
        ["DAS Extubation", "Low vs. At-risk → AEC / Remifentanil / SAD exchange"],
        ["DAS Obstetrics", "RSI + MAX 2 + WAKE or PROCEED + eFONA"],
        ["DAS Paediatric", "Spontaneous ventilation preferred + NEEDLE (<8yr) vs. SCALPEL (≥8yr)"],
        ["AIDAA 2025 Intubation", "Code D + NO HIERARCHY + SpO₂ ≥95% gate + 3 each"],
        ["AIDAA 2025 Extubation", "SAFE + 3 Ds + 3 Ss + SSE"],
    ],
    col_widths=[5*cm, 12*cm]
))
story.append(sp(8))

story.append(h("Top Examiner-Tested Points"))
story.append(sp(3))
exam_pts = [
    ("Attempt limits", "DAS adult = 3 | DAS obstetric = 2 | AIDAA = 3 each device (TT + SGA + mask)"),
    ("CICO technique", "Adults: scalpel-bougie-tube | Paediatric <8yr: cannula + jet ventilation"),
    ("AIDAA's Code D", "Hospital emergency code declared at FIRST sign of difficulty — not after failure"),
    ("AIDAA SpO₂ gate", "Proceed to NEXT attempt ONLY if SpO₂ ≥ 95%"),
    ("AIDAA confirmation", "6 consecutive SUSTAINED capnography waveforms without CO₂ fall"),
    ("AIDAA no hierarchy", "TT / SGA / Facemask — switch freely — whichever achieves oxygenation fastest"),
    ("AIDAA CVF", "Complete Ventilation Failure = immediate cricothyroidotomy, no further device attempts"),
    ("AIDAA SSE", "Staged Sequential Extubation = ETT → AEC → SAD → remove (step-by-step airway handover)"),
    ("AIDAA SAFE", "S-Stratify, A-Assemble/Anticipate, F-Facilitate, E-Evaluate/Escalate"),
    ("AIDAA 3 Ds", "Difficult re-intubation / Deteriorating airway / Dependency on tube"),
    ("AIDAA 3 Ss", "SSE / Supervised extubation / Stay intubated"),
    ("DAS obstetric SAD", "i-gel preferred; maintain cricoid; lowest leak pressure; continuous capnography"),
    ("DAS paediatric", "Maintain spontaneous ventilation in anticipated difficulty; straight blade <2yr"),
    ("DAS AEC", "Can remain up to 72 h; ALWAYS confirm re-intubation with capnography"),
    ("Universal rule", "OXYGENATION > INTUBATION — surgical airway if CICO without further delay"),
]
for label, detail in exam_pts:
    row_data = [[
        Paragraph(label, ParagraphStyle("EL", fontSize=8.5, fontName="Helvetica-Bold",
                  textColor=NAVY, leading=12)),
        Paragraph(detail, ParagraphStyle("ED", fontSize=8.5, fontName="Helvetica",
                  textColor=colors.HexColor("#222222"), leading=12)),
    ]]
    et = Table(row_data, colWidths=[5*cm, 12*cm])
    et.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (0,0), LGRAY),
        ("GRID", (0,0), (-1,-1), 0.3, MGRAY),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))
    story.append(et)
    story.append(sp(2))

story.append(sp(10))
story.append(highlight_box(
    "UNIVERSAL RULE FOR ALL ALGORITHMS: OXYGENATION > INTUBATION — If CICO, SURGICAL AIRWAY WITHOUT DELAY",
    color=PINK))

# ── FOOTER NOTE ─────────────────────────────────────────────────────────────
story.append(sp(14))
story.append(Paragraph(
    "References: DAS 2015 (Frerk et al., BJA 2015) | DAS Extubation 2012 (Mitchell et al., Anaesthesia) | "
    "DAS/OAA Obstetrics 2015 (Mushambi et al., Anaesthesia) | DAS/APA Paediatrics 2015 | "
    "AIDAA 2025 Intubation (PMC12643155) | AIDAA 2025 Extubation (PMC12643154)",
    ParagraphStyle("Ref", fontSize=7.5, textColor=colors.HexColor("#888888"),
                   fontName="Helvetica-Oblique", leading=11, alignment=TA_CENTER)
))

# ═══════════════════════════════════════════════════════════════════════════
# BUILD PDF
# ═══════════════════════════════════════════════════════════════════════════
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=1.8*cm, bottomMargin=1.8*cm,
    title="Difficult Airway Algorithms — Exam Reference",
    author="Orris Medical"
)
doc.build(story)
print(f"PDF created: {OUTPUT}")
Running Command

cd /home/daytona/workspace/difficult-airway-pdf && python generate_pdf.py 2>&1

Running Command

ls -lh /home/daytona/workspace/difficult-airway-pdf/Difficult_Airway_Algorithms.pdf

Your PDF is ready. Download it here:

Difficult Airway Algorithms

PDF Document · PDF

What's inside (8 sections, colour-coded):
  1. DAS 2015 Adult Intubation — Plans A→B→C→D with attempt limits, STOP AND THINK options, eFONA technique
  2. DAS Extubation — Low-risk vs. at-risk stratification, AEC/Remifentanil/SAD exchange techniques
  3. DAS/OAA Obstetrics — RSI, max 2 attempts, wake vs. proceed decision table, CICO
  4. DAS/APA Paediatrics — Age-based algorithms, FONA by age (<8yr needle vs. ≥8yr scalpel)
  5. AIDAA 2025 Intubation — Code D, no-hierarchy rescue, SpO₂ ≥95% gate, CVF trigger
  6. AIDAA 2025 Extubation — SAFE framework, 3 Ds, 3 Ss, Staged Sequential Extubation
  7. Master Comparison Table — All 6 algorithms side by side
  8. Exam Memory Anchors — 15 high-yield examiner-tested points + mnemonics
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