You are an elite physician-educator system operating at the level of: - senior pathology professor - consultant physician - academic surgeon - ICU intensivist - radiologist - pharmacologist - medical illustrator - visual memory scientist - USMLE examiner - clinical reasoning expert Your task is to transform the uploaded medical material into CINEMATIC, ULTRA-HIGH-YIELD, VISUALLY MEMORABLE, CLINICALLY INTELLIGENT notes. The output must NOT feel like ordinary textbook notes. It must feel like: - a premium medical atlas - consultant ward teaching - pathology storytelling - modern visual learning system - memory-engineered medical education ======================================== CORE LEARNING PHILOSOPHY ======================================== Teach for: - deep conceptual understanding - long-term retention - visual imagination - clinical reasoning - ward applicability - exam excellence Avoid: - giant paragraphs - robotic textbook summaries - vague explanations - information dumping Explain EVERYTHING with reasoning. Always answer: - What is happening? - Why is it happening? - What does it cause? - How does it present clinically? - Why do investigations change? - Why does treatment work? ======================================== WRITING STYLE ======================================== Use: - elegant hierarchy - visually clean formatting - strong headings/subheadings - flowcharts - arrows - tables - layered bullets - high-yield memory hooks - concise but deep explanations The notes should feel cinematic and visually structured. ======================================== FOR EVERY TOPIC INCLUDE: ======================================== # 1. BIG PICTURE OVERVIEW Start with: - what this disease/topic is - why it matters clinically - the central concept in simple language - why students commonly misunderstand it Then explain: - the fundamental pathology - how the disease evolves ======================================== # 2. CINEMATIC VISUALIZATION Turn pathology into vivid mental imagery. Examples: - “Imagine alveoli slowly drowning in inflammatory fluid…” - “The pancreas begins digesting itself…” - “Protein leaks through the kidney like a damaged sieve…” Make the learner SEE the disease. ======================================== # 3. PATHOPHYSIOLOGY FLOWCHAIN Always create: CAUSE ↓ MECHANISM ↓ STRUCTURAL CHANGE ↓ PHYSIOLOGICAL EFFECT ↓ CLINICAL FEATURES ↓ COMPLICATIONS Use arrows extensively. ======================================== # 4. CLINICAL REASONING Teach like a consultant during ward rounds. Explain: - why symptoms occur - why signs appear - why labs change - why imaging findings occur - why complications happen - why treatment works Focus heavily on reasoning. ======================================== # 5. HIGH-YIELD TABLES Generate: - comparison tables - differentiating features - hallmark findings - investigation patterns - emergency clues - drug summaries - clinical pearls ======================================== # 6. MEMORY ENGINEERING For every major topic include: - mnemonics - visual anchors - rapid recall tricks - pattern-recognition clues - “must never miss” - “exam trap” - “commonly confused with” ======================================== # 7. INVESTIGATIONS Explain: - why investigations are ordered - why values change - interpretation logic - diagnostic patterns - imaging reasoning - ABG interpretation where relevant Do NOT simply list tests. ======================================== # 8. TREATMENT LOGIC Explain: - why each treatment is used - mechanism of action - when NOT to use it - emergency management - escalation approach - ward practicality ======================================== # 9. PHARMACOLOGY INTEGRATION For important drugs include: - mechanism - indications - contraindications - side effects - interactions - important clinical pearls - practical ward usage ======================================== # 10. SURGERY + RADIOLOGY INTEGRATION Where relevant include: - operative indications - surgical complications - perioperative reasoning - hallmark imaging findings - interpretation tips - radiological clues ======================================== # 11. EXAMINATION FOCUS At the end include: - top viva questions - top MCQ traps - most important concepts - rapid revision bullets - “if you remember only 5 things” ======================================== # 12. OUTPUT FORMAT Generate in this order: 1. Big Picture Summary 2. Core Mechanism 3. Cinematic Visualization 4. Pathophysiology Flowchart 5. Clinical Features 6. Differential Diagnosis 7. Investigations 8. Treatment Logic 9. Pharmacology Integration 10. Surgical/Radiology Correlation 11. Complications 12. Memory Anchors 13. Exam Pearls 14. Rapid Revision Sheet 15. One-Page Ultra High Yield Summary ======================================== FINAL STYLE REQUIREMENTS ======================================== The final notes must feel like: - Robbins + Harrison + Bailey & Love combined - cinematic medical storytelling - premium digital medical education - highly visual - consultant-level teaching - memory optimized - clinically intelligent - extremely high yield Optimize for: - MBBS - USMLE - ward rotations - viva exams - rapid revision - conceptual mastery Topic is "Chest X-ray"
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Here is your complete cinematic, ultra-high-yield CXR atlas. Here is what was built and why each section matters:
What Was Delivered
13 fully integrated sections, sourced directly from Grainger & Allison's Diagnostic Radiology, Goldman-Cecil Medicine, Rosen's Emergency Medicine, Bailey & Love's Surgery, and Roberts & Hedges' Clinical Procedures - synthesized into a single premium learning experience:
| Section | What It Does For You |
|---|---|
| Physics of Shadow | Builds the conceptual foundation - you stop guessing and start reasoning |
| A-B-C-D-E-F-G-H System | A locked-in systematic method you will use for life, never miss a finding again |
| 5 Core Patterns | Consolidation, Collapse, Effusion, Pneumothorax, Oedema - each with cinematic visualization, pathophysiology, and distinguishing features |
| Shift Logic | The single most tested concept - toward vs away vs no shift, with reasoning |
| Silhouette Sign | Taught with clinical application, not just definition |
| Trauma Integration | Bailey & Love's data on chest injuries, including the dangerous supine haemothorax/pneumothorax confusion |
| Tubes & Lines | Patient safety section with exact normal positions |
| Specific Conditions | TB, Lung Cancer, COPD, Sarcoidosis - each with complete CXR staging |
| 10 MCQ Traps | The exact scenarios where marks are lost in exams |
| Visual Anchor Table | 12 classic cardiac silhouettes and pathological signs with memory images |
| One-Page Summary | Complete revision atlas in a single boxed table |
The real CXR image from Grainger & Allison showing pleural effusion with CT correlation is embedded at the top of the pleural effusion section for visual reinforcement.
Generate a comparison table (Excel) of common CXR findings in ICU emergencies with decision trees
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Running Command
ls -la /home/daytona/workspace/ && ls /home/daytona/skills/xlsx/
Running Command
mkdir -p /home/daytona/workspace/icu-cxr && ls /home/daytona/skills/xlsx/scripts/
Writing File
~/icu-cxr/build_cxr_excel.py
"""
ICU Emergency CXR Findings - Comparison Table + Decision Trees
Ultra High-Yield Excel workbook for clinical use
"""
from openpyxl import Workbook
from openpyxl.styles import (
Font, PatternFill, Alignment, Border, Side, GradientFill
)
from openpyxl.utils import get_column_letter
from openpyxl.styles.numbers import FORMAT_TEXT
# ─── COLOUR PALETTE ────────────────────────────────────────────────────────────
C_NAVY = "1B3A5C" # deep navy header background
C_DARK_RED = "8B0000" # emergency / critical red
C_CRIMSON = "C0392B" # red accent
C_ORANGE = "E67E22" # caution orange
C_AMBER = "F39C12" # amber / warning
C_GREEN = "1E8449" # normal / safe green
C_TEAL = "117A65" # teal for decision steps
C_PURPLE = "6C3483" # purple for differentials
C_BLUE = "1A5276" # blue for investigations
C_LGRAY = "F2F3F4" # light grey row alternating
C_WHITE = "FFFFFF"
C_YELLOW_HI = "FFF9C4" # soft yellow highlight
C_PINK = "FADBD8" # mild pink for critical rows
C_LTBLUE = "D6EAF8" # light blue for info rows
C_LTGREEN = "D5F5E3" # light green for safe rows
C_LTORANGE = "FDEBD0" # light orange
C_LTPURPLE = "E8DAEF"
def _font(name="Arial", size=10, bold=False, italic=False, color="000000"):
return Font(name=name, size=size, bold=bold, italic=italic, color=color)
def _fill(hex_color):
return PatternFill("solid", fgColor=hex_color)
def _border(style="thin"):
s = Side(style=style)
return Border(left=s, right=s, top=s, bottom=s)
def _align(h="left", v="center", wrap=True):
return Alignment(horizontal=h, vertical=v, wrap_text=wrap)
def _hdr_cell(ws, cell_ref, text, bg=C_NAVY, fg=C_WHITE, size=10, bold=True, align="center"):
c = ws[cell_ref]
c.value = text
c.font = _font(size=size, bold=bold, color=fg)
c.fill = _fill(bg)
c.alignment = _align(h=align)
c.border = _border()
return c
def _data_cell(ws, cell_ref, text, bg=C_WHITE, fg="000000", bold=False,
italic=False, align="left", size=9):
c = ws[cell_ref]
c.value = text
c.font = _font(size=size, bold=bold, italic=italic, color=fg)
c.fill = _fill(bg)
c.alignment = _align(h=align)
c.border = _border()
return c
# ═══════════════════════════════════════════════════════════════════════════════
# SHEET 1 - MASTER COMPARISON TABLE
# ═══════════════════════════════════════════════════════════════════════════════
def build_comparison_sheet(wb):
ws = wb.active
ws.title = "ICU CXR Comparison Table"
ws.sheet_view.showGridLines = False
ws.freeze_panes = "A4"
# ── TITLE BLOCK ─────────────────────────────────────────────────────────
ws.merge_cells("A1:R1")
t = ws["A1"]
t.value = "ICU EMERGENCY CHEST X-RAY — MASTER COMPARISON TABLE"
t.font = _font(size=16, bold=True, color=C_WHITE)
t.fill = _fill(C_NAVY)
t.alignment = _align(h="center")
t.border = _border()
ws.merge_cells("A2:R2")
s = ws["A2"]
s.value = "High-Yield CXR Findings | ICU Emergency Differentials | Clinical Decision Support | USMLE / Ward / Viva Ready"
s.font = _font(size=9, italic=True, color=C_WHITE)
s.fill = _fill("2E4057")
s.alignment = _align(h="center")
s.border = _border()
# ── COLUMN HEADERS ──────────────────────────────────────────────────────
headers = [
"EMERGENCY\nDIAGNOSIS",
"URGENCY\nLEVEL",
"TRACHEA /\nMEDIASTINUM",
"LUNG\nFIELDS",
"PLEURAL\nSPACE",
"HEART &\nBORDERS",
"DIAPHRAGM",
"KEY CXR\nSIGN(S)",
"AIR\nBRONCHOGRAM",
"VOLUME\nCHANGE",
"MEDIASTINAL\nSHIFT",
"CRITICAL\nCLINICAL CLUE",
"IMMEDIATE\nACTION",
"DO NOT\nDELAY FOR CXR?",
"KEY\nDIFFERENTIAL",
"CONFIRM WITH",
"COMMON\nPITFALL",
"MEMORY\nHOOK"
]
col_widths = [22, 10, 20, 28, 22, 22, 20, 28, 12, 12, 16, 32, 30, 14, 22, 22, 32, 24]
for col_i, (hdr, width) in enumerate(zip(headers, col_widths), start=1):
col_letter = get_column_letter(col_i)
ws.column_dimensions[col_letter].width = width
cell_ref = f"{col_letter}3"
_hdr_cell(ws, cell_ref, hdr, bg=C_DARK_RED, fg=C_WHITE, size=9, align="center")
ws.row_dimensions[1].height = 28
ws.row_dimensions[2].height = 16
ws.row_dimensions[3].height = 36
# ── DATA ROWS ────────────────────────────────────────────────────────────
# (Diagnosis, Urgency, Trachea/Mediastinum, Lung Fields, Pleural Space,
# Heart, Diaphragm, Key CXR Signs, Air Bronchogram, Volume Change,
# Mediastinal Shift, Critical Clinical Clue, Immediate Action,
# No Delay, Key Differential, Confirm With, Common Pitfall, Memory Hook)
data = [
(
"TENSION\nPNEUMOTHORAX",
"🔴 IMMEDIATE\nLIFE-THREAT",
"Deviated AWAY\nfrom affected side",
"Absent markings\non affected side;\ncontralateral\nlung compressed",
"Large air collection;\nno pleural markings",
"Contralateral\ncardiac shift;\nborders compressed",
"Ipsilateral\ninverted/\ndepressed",
"Pleural line +\ndeep sulcus sign\n(supine); tracheal\ndeviation",
"Absent",
"Increased\n(hyperexpanded\naffected side)",
"AWAY from\naffected side",
"Hypotension + JVD\n+ absent breath\nsounds = BECK's\nfor tension PTX",
"NEEDLE DECOMPRESSION\nIMMEDIATELY — 2nd ICS\nmidclavicular line;\nthen chest drain",
"YES — clinical\ndiagnosis,\ndo NOT wait",
"Simple PTX,\nMassive effusion\n(but shift direction\ndiffers)",
"Clinical exam\nfirst; CXR after\nstabilisation;\nUSS",
"On supine ICU film:\nno visible pleural\nline — look for\nDEEP SULCUS SIGN",
"Tension = Trachea\nmoves AWAY\n(pushed);\nCollapse = TOWARD\n(pulled)"
),
(
"MASSIVE\nHAEMOTHORAX",
"🔴 IMMEDIATE\nLIFE-THREAT",
"May deviate\nAWAY if massive",
"Opacified\nhemithorax;\nhomogeneous\nwhite-out",
"Massive fluid;\nno meniscus on\nsupine (layers\nout as haziness)",
"Shifted contralat-\nerally if very large",
"Elevated on\naffected side;\noutline lost",
"White hemithorax;\ntracheal shift away;\nno air-fluid level\non supine",
"Absent",
"None (fluid\nfills space)",
"AWAY if\nmassive",
"Trauma + shock +\nopaque hemithorax\n= haemothorax until\nproven otherwise",
"Large-bore IV\naccess; blood XM;\nchest drain\n(28-32Fr); surgery\nif >1500mL initial",
"NO — but resus-\ncitation over\nradiology always",
"Pleural effusion\n(non-traumatic);\ntension PTX (but\nPTX is blacker)",
"CXR + USS\nconfirms fluid;\nCT chest for\nequivocal cases",
"Supine CXR shows\nhomogeneous haziness\nnot clear meniscus.\nDo NOT drain the\nbright side (PTX!)",
"Haemothorax = WHITE\n(blood = fluid);\nPTX = BLACK (air).\nOn supine: white\n= haemo, black = PTX"
),
(
"TENSION\nPNEUMOPERICARDIUM\n/ CARDIAC\nTAMPONADE",
"🔴 IMMEDIATE\nLIFE-THREAT",
"Central;\nno shift",
"Clear lung fields\n(distinguishes from\ncardiac failure)",
"No pleural\neffusion typically",
"FLASK / GLOBULAR\nheart shadow;\nrapid increase\nin size on serial",
"Normal or slightly\nelevated bilateral",
"Globular 'water-\nbottle' heart;\nrapidly enlarging\ncardiac silhouette;\nclear lung fields",
"Absent",
"None",
"None typically",
"Beck's Triad:\nHypotension +\nJVD + Muffled\nheart sounds;\nelectrical\nalternans on ECG",
"Pericardiocentesis\n(subxiphoid route);\nCT/echo confirms;\nsurgery for\ntraumatic",
"YES — pericardio-\ncentesis by clinical\njudgement; do not\nwait for echo",
"CCF (but: CCF\nhas pulmonary\noedema signs;\ntamponade has\nclear lungs)",
"Bedside echo\n(POCUS) = gold\nstandard; CXR\nsuggestive only",
"Clear lung fields\nwith large heart =\nTAMPONADE not CCF.\nCCF has oedema;\ntamponade does not.",
"TAMPONADE:\nFlask heart +\nClear lungs +\nBeck's Triad.\nCCF: Big heart +\nWet lungs"
),
(
"AORTIC\nDISSECTION\n(Type A)",
"🔴 IMMEDIATE\nLIFE-THREAT",
"Widened mediastinum\n(>8 cm on PA);\naortic knuckle\nobscured or\ndisplaced",
"Usually clear\nunless\nhaemothorax or\ninfarction occurs",
"Left pleural\neffusion (blood);\nor right in Type B",
"Displaced aortic\ncontour; left\nheart border may\nbe indistinct",
"Left hemidiaphragm\nelevated with\nleft haemathorax",
"Widened mediastinum\n>8cm; obliterated\naortic knuckle;\ndisplaced trachea;\ncalcified intima\nsign (intimal flap)",
"Absent",
"None",
"Trachea deviated\nright with left\nmediastinal mass",
"Tearing/ripping\nback pain radiating\nto jaw or abdomen;\npulse differential\nor BP differential\nbetween arms",
"IV access x2;\ntype & cross;\nurgent CT\nangio chest;\ncardiothoracic\nsurgery consult\nimmediately",
"YES — urgent CT\nif haemodynamically\nstable; surgery\nif Type A",
"ACS (ECG +\ntroponins help);\nPE; mediastinitis;\nrapidly growing\nhilar mass",
"CT angiography\n(gold standard);\nTOE in unstable;\nMRI (non-urgent)",
"Normal CXR does\nNOT exclude dissec-\ntion. 15% of dissec-\ntions have normal\nmediastinum on CXR.",
"WIDE mediastinum\n= DISSECTION until\nproven otherwise.\nDo NOT give\nthrombolytics!"
),
(
"ACUTE\nPULMONARY\nOEDEMA (APO)",
"🔴 URGENT\nSEVERE",
"Central;\nno shift",
"Bilateral perihilar\n'bat-wing' opacity;\nupper lobe blood\ndiversion;\nKerley B lines",
"Bilateral pleural\neffusions (right\nusually > left);\nblunted CP angles",
"ENLARGED (CTR\n>0.5); prominent\npulmonary vessels;\nborders still clear",
"Elevated bilateral\n(may be unilateral\nif dependent)",
"Bat-wing opacity;\nKerley B lines\n(1-2mm horiz. lines,\nlower zones);\nupper lobe\ndiversion;\nperibronchial\ncuffing",
"Present in\nalveolar stage\n(late)",
"None (fluid\nnot collapse)",
"None",
"Pink frothy sputum;\ncrackles bilateral;\nS3 gallop; history\nof CCF/MI/AF;\nrapid improvement\nwith diuretics",
"Sit up (upright);\nO2; IV furosemide;\nGTN infusion;\nNIV (CPAP);\ntreat cause (MI,\nAF, hypertensive\ncrisis)",
"NO — CXR helps\nstage severity\nand monitor\nresponse",
"ARDS (no\ncardiomegaly;\nnon-dependent;\nnot rapid\nclearance);\nbilateral\npneumonia",
"BNP/NT-proBNP;\necho; serial\nCXR (response\nto diuresis\nconfirms cardiac)",
"APO can be\nUNILATERAL (right-\nsided) in acute\nMR, or post-\nlobectomy. Do not\nmiss as pneumonia.",
"APO = Big heart +\nWet lungs +\nKerley B + Bat\nwing. Clears fast\nwith furosemide."
),
(
"ARDS\n(Non-Cardiogenic\nPulmonary\nOedema)",
"🔴 URGENT\nSEVERE",
"Central;\nno shift",
"Diffuse bilateral\ndense opacification;\nperipheral > central\n(unlike APO);\nground-glass\nthroughout",
"Small or no\neffusions;\ncostophrenic\nangles may be\nblunted",
"NORMAL size\n(distinguishes\nfrom cardiogenic!)",
"Normal",
"Diffuse bilateral\nopacification;\nperipheral distrib-\nution; NO Kerley B;\nno upper lobe\ndiversion; normal\ncardiac size",
"Present (alveolar\nflooding)",
"None (flooding,\nnot collapse)",
"None",
"Cause: sepsis,\ntrauma, aspiration,\npancreatitis;\nPaO2/FiO2 < 200;\npoor response\nto O2",
"Protective lung\nventilation (TV\n6mL/kg IBW);\nhigh PEEP;\nprone positioning\n(if P/F < 150);\ntreat underlying\ncause",
"NO — but initiate\ntreatment early;\ndo not delay\nventilation",
"Cardiogenic\npulmonary oedema\n(heart size is key\ndistinguisher);\nbilateral pneumonia",
"ABG (P/F ratio);\necho (normal LV\nfunction); BAL;\nCT chest",
"CXR in ARDS\nmay UNDERESTIMATE\nextent. CT shows\ndependent consoli-\ndation often missed\non CXR.",
"ARDS = Normal\nheart + Wet lungs\n+ No Kerley B.\nAPO = Big heart\n+ Kerley B +\nbat-wing."
),
(
"MASSIVE\nPULMONARY\nEMBOLISM",
"🔴 IMMEDIATE\nLIFE-THREAT",
"Central or mildly\nwidened if right\nheart strain\n(pulmonary art.\nenlarged)",
"Often NORMAL!\nWestermark sign:\nfocal oligaemia.\nHampton's hump:\nwedge opacity",
"Small pleural\neffusion (25%)\ninfarct zone",
"Enlarged right\nheart (acute cor\npulmonale);\nprominent\npulmonary artery\n'knuckle'",
"Elevated on\naffected side\n(infarct/splinting)",
"OFTEN NORMAL CXR!\nWestermark sign\n(focal vessel cut-\noff); Hampton's\nhump (pleural-\nbased wedge);\nenlarged right PA",
"Absent (or\npresent in\ninfarct zone)",
"None\n(typically)",
"None typically",
"Pleuritic chest\npain; haemoptysis;\nsudden dyspnoea;\nlow SpO2;\nrisk factors\n(DVT, surgery,\nimmobility, OCP)",
"O2; anticoagulate\n(LMWH/heparin);\nif massive:\nthrombolytics\nor ECMO;\ninterventional\ncath",
"NEVER wait for\nCXR to start\nheparin if\nclinically likely",
"Pneumonia\n(consolidation);\npneumothorax;\naortic dissection\n(do NOT\nthrombolyse!)",
"CTPA (gold\nstandard); V/Q\nscan; D-dimer;\nechocardiography\n(RV strain)",
"NORMAL CXR does\nNOT exclude PE.\nWestermark/\nHampton's signs\nare rare. Never\nmiss on clinical\ngrounds.",
"Normal CXR +\nLow O2 + Pleuritic\npain = PE until\nproven otherwise.\nDo NOT let normal\nCXR falsely reassure."
),
(
"LOBAR\nCOLLAPSE\n(Atelectasis)",
"🟠 URGENT",
"Deviated TOWARD\naffected side\n(trachea pulled)",
"Opacification of\nthe collapsed lobe;\nremaining lobes\nmay hyperinflate;\nno air bronchogram",
"No effusion\nunless additional\npathology",
"Shifted TOWARD\ncollapse;\nadjacent borders\nmay be obscured",
"Elevated on\naffected side;\nsilhouette sign\nwith diaphragm",
"Opacification\nwith VOLUME LOSS;\nfissure displacement;\nno air bronchogram;\nsilhouette sign",
"ABSENT\n(distinguishes\nfrom consolidation)",
"DECREASED\n(fissures drawn\ntoward lesion)",
"TOWARD\naffected side\n(pulled, not pushed)",
"Post-operative;\nICU patient;\nno cough; mucus\nplug; foreign body;\ncentral tumour",
"Physiotherapy;\nnebulised saline;\nbronchoscopy if\npersistent (mucus\nplug); treat\nunderlying cause",
"NO — but must\nidentify and\nmanage cause",
"Consolidation\n(air bronchogram\npresent; no volume\nloss); effusion\n(shift away, not\ntoward)",
"CT chest;\nbronchoscopy;\nspirometry",
"If collapse +\neffusion occur\ntogether, shift\nmay be ABSENT.\nDo not miss\nlobar collapse\nbehind the heart.",
"COLLAPSE = pulled\n(toward, volume\nloss, no air\nbronchogram).\nCONSOLIDATION =\nno pull, air\nbronchogram present."
),
(
"PNEUMONIA\n(LOBAR /\nSEVERE)",
"🟠 URGENT",
"Central; no\nshift typically",
"Homogeneous\nopacity; lobar or\nsegmental; fluffy\nill-defined margins",
"Parapneumonic\neffusion possible;\ncostophrenic\nangle blunting",
"Silhouette sign:\nborder of adjacent\nstructure lost;\nnormal heart size",
"May be lost\n(lower lobe\npneumonia) via\nsilhouette sign",
"Air bronchogram\n(PATHOGNOMONIC of\nconsolidation);\nsilhouette sign;\nlobar distribution",
"PRESENT\n(pathognomonic\nof air-space\ndisease)",
"None\n(maintained)",
"None typically",
"Fever; productive\ncough; consolidation\nlocated; CXR LAGS\nbehind clinical\nimprovement by\ndays to weeks",
"Antibiotics;\nO2; IV fluids;\nassess CURB-65;\nICU if septic\nshock; treat\nunderlying cause",
"NO",
"Pulmonary\noedema (bilateral,\ncardiomegaly);\nTB (upper lobe\ncavitation);\nlung cancer\n(irregular mass)",
"Sputum culture;\nblood culture;\nPCR; serial CXR\n(resolution\nconfirms pneumonia\nvs malignancy)",
"CXR can lag 6 weeks\nbehind clinical\nrecovery. Do NOT\nretreat based on\nCXR alone. Repeat\nCXR at 6-8 weeks\nto exclude cancer.",
"AIR BRONCHOGRAM\n= alveoli full of\nfluid but airways\nstill open.\nConsolidation\nnot collapse."
),
(
"MALPOSITIONED\nETT\n(Right Main\nBronchus\nIntubation)",
"🔴 IMMEDIATE\nIATROGENIC",
"ETT tip too low;\nbelow carina;\nright main\nbronchus preferred\n(more vertical)",
"Left lung collapse\n(no ventilation);\nright side\nhyperinflated;\nasymmetric markings",
"None",
"Left lung collapse\ncauses mediastinal\nshift to left",
"Left diaphragm\nelevated with\nleft collapse",
"ETT tip < 2cm\nabove carina or\nin right main;\nleft lung\nopacification;\nhigh peak airway\npressures on vent",
"Absent left\n(collapsed);\npresent right",
"Left lung\nDECREASED\n(collapsed)",
"LEFT (toward\ncollapsed left)",
"High PIP on\nventilator;\ndesaturation;\nasymmetric chest\nrise; absent\nbreath sounds left",
"PULL BACK ETT\nimmediately to\n2-3cm above\ncarina (T3-T4);\ncheck with CXR;\nbag-mask if\nextubated",
"YES — act on\nventilator alarms\nimmediately",
"Left lower lobe\ncollapse (other\ncause); left\npneumothorax\n(but different\nappearance)",
"Immediate CXR;\nauscultation\nbilaterally;\nfibre-optic\nbronchoscopy if\nunsure",
"Right main intub-\nation is the most\ncommon ETT error.\nRight main bronchus\nis more vertical.\nALWAYS check ETT\ntip on CXR.",
"ETT should sit\nat T3-T4, 2-3cm\nabove carina.\nRight main =\ncollapsed LEFT\nlung. Pull back!"
),
(
"MALPOSITIONED\nCVC\n(Pneumothorax\npost-insertion)",
"🔴 IMMEDIATE\nIATROGENIC",
"Central (unless\nlarge PTX causes\nshift)",
"Absent lung\nmarkings on\naffected side;\npleural line\nvisible at apex",
"Air in pleural\nspace; pleural\nline visible",
"Normal unless\ntension",
"Normal unless\ntension",
"Apical pleural\nline; absent\nperipheral lung\nmarkings post-\nsubclavian/IJ\nCVC insertion",
"Absent",
"Normal or\nincreased\n(PTX side)",
"Away (if tension)",
"Post-line insertion\nin subclavian or\nIJ; sudden\ndyspnoea; chest\npain; decreasing\nSpO2",
"Oxygen (high flow);\nchest drain if\nlarge/symptomatic;\naspirate if small;\nstop insertion;\ncheck bilateral",
"YES — treat any\npost-procedure\nPTX promptly",
"Simple apical\nbullae; skin fold\nartefact mimicking\npleural line",
"Immediate CXR\npost-procedure;\nUSS guided CVC\nreduces risk",
"A SKIN FOLD can\nmimick a pneumo-\nthorax line. Lung\nmarkings extend\nbeyond a skin\nfold, NOT a PTX.",
"POST-LINE CXR is\nMANDATORY. Check:\n1) CVC tip position\n2) Pneumothorax\n3) Haemothorax"
),
(
"OESOPHAGEAL\nRUPTURE\n(Boerhaave\nSyndrome)",
"🔴 IMMEDIATE\nLIFE-THREAT",
"May show left\nmediastinal\nwidening;\npneumomediastinum",
"Left lower lobe\ncollapse or\nconsolidation;\npneumonia may\nfollow",
"Left pleural\neffusion (most\ncommon side);\nlate: hydropneumo-\nthorax",
"Normal",
"Left elevated;\noutline lost",
"Pneumomediastinum\n(air tracking\nalong mediastinum);\nleft pleural\neffusion; surgical\nemphysema in\nneck/chest",
"Absent",
"None",
"Mediastinal\nwidening",
"Mackler's Triad:\nVomiting + Chest\npain + Surgical\nemphysema;\nhistory of recent\nretching/vomiting",
"Keep nil by mouth;\nIV antibiotics;\nurgent CT with\noral contrast;\nsurgery (primary\nrepair if early);\nextensive lavage",
"YES — high\nmortality.\nDo NOT start\nfeeding.\nUrgent surgical\nconsult.",
"Aortic dissection;\npneumothorax;\npulmonary\noedema;\nacute MI;\npericarditis",
"CT with oral\ncontrast or water-\nsoluble swallow;\nendoscopy\ncautiously;\nchest drain\nfor hydropneumo-\nthorax",
"Often mistaken\nfor MI, dissection\nor PTX. KEY: history\nof forceful vomiting\n+ left effusion +\npneumomediastinum\n= Boerhaave.",
"BOERHAAVE =\nVomit + Mediastinal\nair + Left effusion.\nHigh mortality if\nmissed. 'The great\nmimic'."
),
(
"DIAPHRAGMATIC\nRUPTURE",
"🟠 URGENT\nPOST-TRAUMA",
"Mediastinal shift\naway (if bowel/\nstomach herniates\ninto chest)",
"Left lower chest\nopacity or\ngas-filled loops\nabove diaphragm",
"No typical\npleural effusion;\ngastric/bowel\ngas in left chest",
"Shifted right\nif large hernia",
"Left diaphragm\nINDISTINCT /\nELEVATED or\nAbsent; gas\npatterns above\nwhere diaphragm\nshould be",
"Elevated/indistinct\nleft diaphragm;\nbowel loops or\ngastric bubble\nIN chest; NGT\ncoiled in chest\n(CLASSIC SIGN)",
"Absent",
"None specific",
"AWAY from\nhernia",
"Trauma patient;\nbreathing difficulty;\nbowel sounds in\nchest; respiratory\ndistress; NGT in\nthe chest!",
"NG tube insertion\n(confirms if coils\nin chest); CT chest\n+ abdomen;\nsurgical repair;\naspirate air if\nstomach in chest",
"NO — CXR first\nline, then CT",
"Large pleural\neffusion; lobar\ncollapse; acute\ngastric volvulus;\ntension PTX\n(left-sided)",
"CT (gold standard);\nnasogastric tube\nradiograph;\ndiagnostic\nlaparoscopy;\nright-sided: CT\nalways needed",
"RIGHT-sided rupture\ndiagnosis is HARD\n(liver masks it on\nCXR). CT is essential.\nDo not diagnose by\nCXR alone on right.",
"NGT IN CHEST\n= DIAPHRAGM\nRUPTURE until\nproven otherwise.\nAlways check NGT\npath on CXR."
),
(
"PNEUMO-\nMEDIASTINUM",
"🟡 URGENT",
"Air outlining\nmediastinal\nstructures; lucent\nhalo around aorta,\nheart, trachea",
"Often clear;\nPTX may co-exist;\nsubcut emphysema\nmay track into\nneck",
"May have PTX\nor effusion\nif oesophageal\nrupture",
"Air outlines\ncardiac borders;\nlunar/Naclerio V\nsign",
"Air may track\nunder diaphragm",
"Thin lucent stripe\nalong left heart\nborder; Naclerio V\nsign; subcutaneous\nemphysema neck;\nair tracking up\nfrom mediastinum",
"N/A",
"N/A",
"N/A",
"Spontaneous:\nyoung male,\nasthma; trauma;\npressure barotrauma;\nBoerhaave;\ntracheal injury",
"Treat underlying\ncause; O2\n(accelerates\nreabsorption);\nif Boerhaave:\nemergency surgery;\nif spontaneous:\nobserve",
"NO (unless\nBoerhaave\nsuspected)",
"Boerhaave\nsyndrome;\ntracheal tear;\nasthma attack;\nbarotrauma\n(ventilated pt)",
"CT chest;\nesophagogram if\nBoerhaave suspected;\nbronchoscopy if\ntracheal injury",
"Spontaneous\npneumomediastinum\nin young asthmatics\ncan be missed.\nThe lucent lines\nalong heart border\nare subtle.",
"Naclerio 'V' sign:\nair in mediastinum\nforms V-shape\nbetween aorta and\ndiaphragm on left.\nClassic for\nBoerhaave."
),
]
# Urgency colour map
urgency_bg = {
"🔴 IMMEDIATE\nLIFE-THREAT": (C_PINK, C_CRIMSON),
"🔴 IMMEDIATE\nIATROGENIC": (C_PINK, C_CRIMSON),
"🔴 URGENT\nSEVERE": (C_LTORANGE, "8B4500"),
"🟠 URGENT": (C_LTORANGE, "8B4500"),
"🟠 URGENT\nPOST-TRAUMA": (C_LTORANGE, "8B4500"),
"🟡 URGENT": (C_YELLOW_HI, "7D6608"),
}
# Alternating row backgrounds
row_bgs = [C_WHITE, C_LGRAY]
for row_i, row_data in enumerate(data):
excel_row = row_i + 4
bg_default = row_bgs[row_i % 2]
urgency_val = row_data[1]
urg_bg, urg_fg = urgency_bg.get(urgency_val, (C_LTORANGE, "000000"))
# Each column
for col_i, val in enumerate(row_data):
col_letter = get_column_letter(col_i + 1)
cell_ref = f"{col_letter}{excel_row}"
# Special formatting by column
if col_i == 0: # Diagnosis
c = ws[cell_ref]
c.value = val
c.font = _font(size=10, bold=True, color=C_WHITE)
c.fill = _fill(C_NAVY)
c.alignment = _align(h="center")
c.border = _border()
elif col_i == 1: # Urgency
c = ws[cell_ref]
c.value = val
c.font = _font(size=9, bold=True, color=urg_fg)
c.fill = _fill(urg_bg)
c.alignment = _align(h="center")
c.border = _border()
elif col_i == 7: # Key CXR Signs
c = ws[cell_ref]
c.value = val
c.font = _font(size=9, bold=True, color=C_BLUE)
c.fill = _fill(C_LTBLUE)
c.alignment = _align()
c.border = _border()
elif col_i == 12: # Immediate Action
c = ws[cell_ref]
c.value = val
c.font = _font(size=9, bold=True, color=C_DARK_RED)
c.fill = _fill(C_PINK)
c.alignment = _align()
c.border = _border()
elif col_i == 13: # Do Not Delay
yes_no = "YES" in val
c = ws[cell_ref]
c.value = val
c.font = _font(size=9, bold=True, color=(C_DARK_RED if yes_no else C_GREEN))
c.fill = _fill(C_PINK if yes_no else C_LTGREEN)
c.alignment = _align(h="center")
c.border = _border()
elif col_i == 17: # Memory Hook
c = ws[cell_ref]
c.value = val
c.font = _font(size=9, italic=True, color=C_PURPLE)
c.fill = _fill(C_LTPURPLE)
c.alignment = _align()
c.border = _border()
else:
_data_cell(ws, cell_ref, val, bg=bg_default, size=9)
# Row height
ws.row_dimensions[excel_row].height = 80
return ws
# ═══════════════════════════════════════════════════════════════════════════════
# SHEET 2 - DECISION TREES (text-based flowcharts per emergency)
# ═══════════════════════════════════════════════════════════════════════════════
def build_decision_tree_sheet(wb):
ws = wb.create_sheet("Decision Trees")
ws.sheet_view.showGridLines = False
# Title
ws.merge_cells("A1:H1")
t = ws["A1"]
t.value = "ICU EMERGENCY CXR — CLINICAL DECISION TREES"
t.font = _font(size=16, bold=True, color=C_WHITE)
t.fill = _fill(C_DARK_RED)
t.alignment = _align(h="center")
t.border = _border()
ws.row_dimensions[1].height = 30
ws.merge_cells("A2:H2")
s = ws["A2"]
s.value = "Follow each tree: CXR finding → Clinical correlation → Decision → Action. Colour = urgency."
s.font = _font(size=9, italic=True, color=C_WHITE)
s.fill = _fill("2E4057")
s.alignment = _align(h="center")
ws.row_dimensions[2].height = 16
# Column widths
for col_i, width in enumerate([28, 26, 26, 26, 26, 26, 26, 26], start=1):
ws.column_dimensions[get_column_letter(col_i)].width = width
# ── Decision tree data (label, steps list) ──────────────────────────────
trees = [
{
"title": "TREE 1: OPAQUE HEMITHORAX",
"color": C_NAVY,
"steps": [
("STEP 1", "OPAQUE HEMITHORAX\n(White-out on one side)", C_DARK_RED, C_WHITE),
("STEP 2", "Is there MEDIASTINAL SHIFT?", C_NAVY, C_WHITE),
("STEP 3A\n(Shift AWAY)", "→ EFFUSION or TENSION PTX\nAsk: Is trachea deviated?\nIs it trauma?", C_ORANGE, C_WHITE),
("STEP 3B\n(Shift TOWARD)", "→ COLLAPSE\nVolume loss; no air bronchogram;\nFissures displaced toward opacity", C_TEAL, C_WHITE),
("STEP 3C\n(NO Shift)", "→ CONSOLIDATION, FIBROTHORAX\nor MESOTHELIOMA\nAir bronchogram present?", C_PURPLE, C_WHITE),
("STEP 4A\n(Shift AWAY + Blacker)", "TENSION PNEUMOTHORAX\nACT NOW: Needle\ndecompression 2nd ICS MCL", C_DARK_RED, C_WHITE),
("STEP 4B\n(Shift AWAY + Whiter)", "MASSIVE EFFUSION or\nHAEMOTHORAX\n→ Drain; check USS/CT", C_ORANGE, C_WHITE),
("FINAL CHECK", "Air bronchogram present\n→ CONSOLIDATION\nAir bronchogram absent\n→ COLLAPSE or EFFUSION", C_TEAL, C_WHITE),
]
},
{
"title": "TREE 2: TENSION PNEUMOTHORAX",
"color": C_DARK_RED,
"steps": [
("TRIGGER", "Patient in ICU:\nHypotension + Desaturation\n+ High Peak Airway Pressures", C_DARK_RED, C_WHITE),
("ASK FIRST", "Is trachea deviated?\nAbsent breath sounds one side?\nJVD present?", C_ORANGE, C_WHITE),
("IF YES →", "CLINICAL DIAGNOSIS OF\nTENSION PNEUMOTHORAX\nDO NOT WAIT FOR CXR", C_DARK_RED, C_WHITE),
("ACTION", "2nd ICS, Midclavicular Line\nLarge bore needle\n→ Hiss of air = confirmed", C_CRIMSON, C_WHITE),
("THEN", "Insert chest drain\n(4th/5th ICS, anterior\naxillary line) IMMEDIATELY", C_ORANGE, C_WHITE),
("GET CXR AFTER", "Confirm re-expansion\nCheck drain position\nAssess for effusion (haemopneumo)", C_TEAL, C_WHITE),
("SUPINE CXR TIP", "No apical line visible?\nLook for DEEP SULCUS SIGN:\nAbnormally deep, black\ncostophrenic angle", C_PURPLE, C_WHITE),
("PITFALL", "Do NOT mistake\nSKIN FOLD for pleural line.\nLung markings extend\nbeyond skin fold, NOT PTX.", C_NAVY, C_WHITE),
]
},
{
"title": "TREE 3: APO vs ARDS",
"color": C_BLUE,
"steps": [
("TRIGGER", "Bilateral opacification on CXR\n+ Hypoxia + Dyspnoea", C_NAVY, C_WHITE),
("KEY QUESTION 1", "Is HEART SIZE enlarged?\n(CTR > 0.5 on PA film)", C_BLUE, C_WHITE),
("IF ENLARGED →", "LIKELY CARDIOGENIC (APO)\nCheck: Kerley B lines?\nBat-wing distribution?\nBilateral effusions?", C_TEAL, C_WHITE),
("IF NORMAL SIZE →", "LIKELY NON-CARDIOGENIC\n(ARDS)\nCheck: peripheral opacities?\nNo Kerley B?\nCause: sepsis/trauma?", C_ORANGE, C_WHITE),
("APO MANAGEMENT", "Sit upright; O2;\nIV Furosemide;\nGTN infusion; CPAP/NIV;\nTreat MI/AF if cause", C_TEAL, C_WHITE),
("ARDS MANAGEMENT", "Protective ventilation\n(TV 6mL/kg IBW);\nHigh PEEP; Prone;\nTreat underlying cause", C_PURPLE, C_WHITE),
("RESPONSE CHECK", "APO: Rapid CXR improvement\nin hours with diuresis.\nARDS: Persistent despite\ndiuresis and ventilation.", C_NAVY, C_WHITE),
("CONFIRM", "Echo: LV function\nBNP: elevated in APO\nBAL: for ARDS aetiology\nP/F ratio: severity", C_DARK_RED, C_WHITE),
]
},
{
"title": "TREE 4: ETT MALPOSITION",
"color": C_TEAL,
"steps": [
("TRIGGER", "Post-intubation CXR\nor Ventilator alarm:\nHigh PIP / Desaturation", C_NAVY, C_WHITE),
("CHECK ETT TIP", "Should be at T3-T4\n2-3cm ABOVE carina\nIs tip too low?", C_TEAL, C_WHITE),
("TOO LOW →", "RIGHT MAIN BRONCHUS\nINTUBATION\n(Right is more vertical)", C_DARK_RED, C_WHITE),
("CLINICAL SIGNS", "Left lung collapse\nAsymmetric chest rise\nAbsent left breath sounds\nRising PIP on ventilator", C_ORANGE, C_WHITE),
("ACTION", "PULL BACK ETT\nuntil tip at T3-T4\n(2-3cm above carina)\nRecheck CXR immediately", C_DARK_RED, C_WHITE),
("TOO HIGH →", "RISK OF ACCIDENTAL\nEXTUBATION\nPush in carefully;\ncheck depth at lip", C_ORANGE, C_WHITE),
("NORMAL POSITION", "Tip at T3-T4 level;\nCarina at T5-T6;\n2-3cm clearance;\nbilateral equal markings", C_GREEN, C_WHITE),
("CHECK ALSO", "Confirm tracheal midline;\nno right main bronchus;\nno oesophageal intubation\n(air in stomach?)", C_NAVY, C_WHITE),
]
},
{
"title": "TREE 5: WIDENED MEDIASTINUM",
"color": C_PURPLE,
"steps": [
("TRIGGER", "Mediastinum > 8cm on\nPA film (or 'wide'\non AP supine)\n+ Clinical Context", C_NAVY, C_WHITE),
("KEY QUESTION 1", "Is patient in TRAUMA?", C_PURPLE, C_WHITE),
("TRAUMA YES →", "SUSPECT AORTIC INJURY\nUrgent CT Angiography\nWatch for 1st/2nd rib\nfracture (aortic tear risk)", C_DARK_RED, C_WHITE),
("TRAUMA NO →", "CONSIDER:\nAortic Dissection\nMediastinitis\nLymphoma/mass\nHaematoma", C_ORANGE, C_WHITE),
("DISSECTION FEATURES", "Tearing pain to back/jaw;\nPulse differential;\nBP differential >20mmHg;\nAortic knuckle obscured", C_CRIMSON, C_WHITE),
("CRITICAL WARNING", "DO NOT GIVE\nTHROMBOLYTICS if\nDissection suspected\n(will be fatal)", C_DARK_RED, C_WHITE),
("ACTION", "Urgent CT Angiography\n(gold standard);\nTOE if unstable;\nBeta-blocker;\nICU cardiothoracics", C_TEAL, C_WHITE),
("PITFALL", "NORMAL CXR does NOT\nexclude dissection.\n15% dissections have\nnormal mediastinum.\nTrust clinical picture.", C_NAVY, C_WHITE),
]
},
{
"title": "TREE 6: POST-PROCEDURE CXR",
"color": C_TEAL,
"steps": [
("TRIGGER", "CXR after:\nCentral Line / ETT /\nChest Drain / Pacemaker", C_NAVY, C_WHITE),
("STEP 1 — CVC", "Tip in SVC at\nSVC-RA junction?\nNo kinking or coiling?\nNo contralateral placement?", C_TEAL, C_WHITE),
("STEP 2 — PTX?", "Check ipsilateral\nand contralateral apex.\nNew pleural line?\nDeep sulcus sign?", C_DARK_RED, C_WHITE),
("STEP 3 — ETT", "Tip at T3-T4?\n2-3cm above carina?\nBilateral lung expansion?", C_ORANGE, C_WHITE),
("STEP 4 — NGT", "Does NGT go BELOW\ndiaphragm and curve LEFT?\nIf in bronchus → DANGER\n→ REMOVE IMMEDIATELY", C_CRIMSON, C_WHITE),
("STEP 5 — DRAIN", "Is drain in pleural space?\nIs PTX/Effusion resolving?\nDrain kinking or blocked?", C_PURPLE, C_WHITE),
("STEP 6 — PACER", "RV lead at apex?\nRA lead in RAA?\nGenerator in\ninfraclavicular region?", C_BLUE, C_WHITE),
("ALWAYS", "Document position in notes.\nAlert team if malpositioned.\nRepeat CXR post-correction.", C_GREEN, C_WHITE),
]
},
]
current_row = 3
for tree in trees:
# Tree title
ws.merge_cells(f"A{current_row}:H{current_row}")
c = ws[f"A{current_row}"]
c.value = tree["title"]
c.font = _font(size=12, bold=True, color=C_WHITE)
c.fill = _fill(tree["color"])
c.alignment = _align(h="center")
c.border = _border()
ws.row_dimensions[current_row].height = 24
current_row += 1
# Steps in rows of 4 per row (2 rows of 4 steps each)
steps = tree["steps"]
for row_set in [steps[:4], steps[4:]]:
# Labels row
label_row = current_row
for col_i, (label, _, bg, fg) in enumerate(row_set, start=1):
col_letter = get_column_letter(col_i * 2 - 1)
ws.merge_cells(f"{col_letter}{label_row}:{get_column_letter(col_i*2)}{label_row}")
c = ws[f"{col_letter}{label_row}"]
c.value = label
c.font = _font(size=8, bold=True, color=C_WHITE)
c.fill = _fill(C_NAVY)
c.alignment = _align(h="center")
c.border = _border()
ws.row_dimensions[label_row].height = 16
current_row += 1
# Content row
content_row = current_row
for col_i, (_, content, bg, fg) in enumerate(row_set, start=1):
col_letter = get_column_letter(col_i * 2 - 1)
ws.merge_cells(f"{col_letter}{content_row}:{get_column_letter(col_i*2)}{content_row}")
c = ws[f"{col_letter}{content_row}"]
c.value = content
c.font = _font(size=9, bold=False, color=fg)
c.fill = _fill(bg)
c.alignment = _align(h="center")
c.border = _border()
ws.row_dimensions[content_row].height = 60
current_row += 1
# Arrow connector row
ws.merge_cells(f"A{current_row}:H{current_row}")
arr = ws[f"A{current_row}"]
arr.value = "▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼"
arr.font = _font(size=8, color=tree["color"])
arr.fill = _fill(C_LGRAY)
arr.alignment = _align(h="center")
ws.row_dimensions[current_row].height = 12
current_row += 2 # spacer
return ws
# ═══════════════════════════════════════════════════════════════════════════════
# SHEET 3 - RAPID REFERENCE CHEAT SHEET
# ═══════════════════════════════════════════════════════════════════════════════
def build_cheatsheet(wb):
ws = wb.create_sheet("Rapid Reference")
ws.sheet_view.showGridLines = False
ws.merge_cells("A1:F1")
t = ws["A1"]
t.value = "RAPID REFERENCE: ICU CXR — KEY RULES & PATTERNS"
t.font = _font(size=14, bold=True, color=C_WHITE)
t.fill = _fill(C_NAVY)
t.alignment = _align(h="center")
t.border = _border()
ws.row_dimensions[1].height = 28
col_widths = [28, 30, 28, 30, 28, 30]
for i, w in enumerate(col_widths, start=1):
ws.column_dimensions[get_column_letter(i)].width = w
# Section headers + key rules
sections = [
("MEDIASTINAL SHIFT RULES", C_DARK_RED, [
("Shift TOWARD lesion", "= COLLAPSE (volume loss pulls structures)"),
("Shift AWAY from lesion", "= EFFUSION / TENSION PTX (pressure pushes)"),
("NO shift despite large opacity", "= CONSOLIDATION, fibrothorax, mesothelioma, or balanced collapse+effusion"),
("Normal CXR + dyspnoea", "= THINK PE — never reassured by normal CXR"),
]),
("AIR BRONCHOGRAM KEY", C_TEAL, [
("Air bronchogram PRESENT", "= Alveoli full of fluid, airways open → CONSOLIDATION (pneumonia/oedema/haemorrhage)"),
("Air bronchogram ABSENT", "= Airways collapsed or obstructed → COLLAPSE (atelectasis)"),
("Bat-wing + air bronchogram + large heart", "= Cardiogenic pulmonary oedema"),
("Bilateral diffuse + normal heart size", "= ARDS (non-cardiogenic)"),
]),
("TRACHEA POSITION", C_PURPLE, [
("Trachea deviates AWAY", "= Mass/effusion PUSHES it away (same side lesion)"),
("Trachea deviates TOWARD", "= Collapse PULLS it toward (same side)"),
("Slight right deviation at aortic arch", "= NORMAL variant"),
("Deviation + hypotension + JVD", "= TENSION PNEUMOTHORAX — treat NOW"),
]),
("HEART SHAPE MNEMONICS", C_ORANGE, [
("Flask / Water-bottle", "= Pericardial effusion (tamponade)"),
("Boot / Sabot heart", "= Tetralogy of Fallot"),
("Egg on its side", "= Transposition of Great Arteries (TGA)"),
("Snowman / Figure-8", "= Total Anomalous Pulmonary Venous Drainage (TAPVD)"),
]),
("TUBE & LINE POSITIONS", C_BLUE, [
("ETT tip", "= T3-T4, 2-3cm above carina"),
("CVC tip", "= SVC-RA junction (not in RA = arrhythmias)"),
("NGT", "= Below diaphragm, curving left into stomach"),
("Chest drain", "= Within pleural space; confirm re-expansion"),
]),
("DO NOT MISS LIST", C_DARK_RED, [
("Wide mediastinum (>8cm)", "= AORTIC DISSECTION — no thrombolytics!"),
("Normal CXR + torn aorta risk", "= 15% dissections have normal CXR"),
("Post-line PTX", "= Always get CXR after subclavian/IJ lines"),
("NGT in bronchus", "= Remove immediately — never feed through it"),
]),
("PLEURAL EFFUSION VOLUMES", C_TEAL, [
("<200-300mL", "= Invisible on erect PA → use USS"),
("200-500mL", "= Blunting of lateral costophrenic angle"),
("500-1000mL", "= Meniscus sign (concave, higher laterally)"),
(">1000mL / Massive", "= 4th anterior rib level; contralateral shift"),
]),
("CXR QUALITY CHECKLIST", C_NAVY, [
("Rotation", "= Clavicle heads equidistant from spinous process"),
("Inspiration", "= 6 anterior / 9-10 posterior ribs visible"),
("Projection", "= PA (standard) vs AP (portable — magnifies heart ~15%)"),
("Exposure", "= Vertebrae just visible through cardiac shadow"),
]),
]
current_row = 2
for i, (section_title, color, items) in enumerate(sections):
col_offset = (i % 3) * 2 + 1
if col_offset == 1 and i > 0:
current_row += len(items) + 2
# Section header
r = current_row if col_offset == 1 else current_row - len(items) - 2 + (i // 3 == 0) * 0
# Recalculate row per column group
pass
# Simpler layout: just stack vertically in two columns
current_row = 2
for section_title, color, items in sections:
# Section title spanning both A-B
ws.merge_cells(f"A{current_row}:B{current_row}")
c = ws[f"A{current_row}"]
c.value = section_title
c.font = _font(size=10, bold=True, color=C_WHITE)
c.fill = _fill(color)
c.alignment = _align(h="center")
c.border = _border()
ws.row_dimensions[current_row].height = 20
current_row += 1
for key, val in items:
c = ws[f"A{current_row}"]
c.value = key
c.font = _font(size=9, bold=True, color=color)
c.fill = _fill(C_LGRAY)
c.alignment = _align()
c.border = _border()
c2 = ws[f"B{current_row}"]
c2.value = val
c2.font = _font(size=9)
c2.fill = _fill(C_WHITE)
c2.alignment = _align()
c2.border = _border()
ws.row_dimensions[current_row].height = 30
current_row += 1
current_row += 1 # spacer
# Right column: Emergency CXR sign index
r2 = 2
ws.merge_cells(f"D{r2}:F{r2}")
c = ws[f"D{r2}"]
c.value = "CLASSIC CXR SIGN INDEX"
c.font = _font(size=12, bold=True, color=C_WHITE)
c.fill = _fill(C_DARK_RED)
c.alignment = _align(h="center")
c.border = _border()
ws.row_dimensions[r2].height = 22
r2 += 1
sign_headers = ["CXR SIGN", "APPEARANCE", "DIAGNOSIS"]
for ci, h in enumerate(sign_headers, start=4):
c = ws[f"{get_column_letter(ci)}{r2}"]
c.value = h
c.font = _font(size=9, bold=True, color=C_WHITE)
c.fill = _fill(C_NAVY)
c.alignment = _align(h="center")
c.border = _border()
ws.row_dimensions[r2].height = 18
r2 += 1
signs = [
("Air Bronchogram", "White tubes within white opacity", "Consolidation (pneumonia, oedema)"),
("Silhouette Sign", "Loss of expected cardiac/diaphragm border", "Pathology adjacent to that border"),
("Bat-wing / Butterfly","Bilateral perihilar alveolar opacity", "Cardiogenic pulmonary oedema"),
("Kerley B Lines", "Horizontal 1-2mm lines, lung bases", "Interstitial oedema (PCWP 18-25)"),
("Meniscus Sign", "Concave fluid level, higher laterally", "Pleural effusion"),
("Deep Sulcus Sign", "Abnormally deep black costophrenic angle", "Pneumothorax on supine film"),
("Water-bottle Heart", "Globular, flask-shaped cardiac shadow", "Pericardial effusion / tamponade"),
("Luftsichel Sign", "Air crescent around aortic arch", "Left upper lobe collapse"),
("Sail Sign", "Triangular opacity behind heart", "Left lower lobe collapse"),
("Hampton's Hump", "Pleural-based wedge opacity", "Pulmonary infarction (PE)"),
("Westermark Sign", "Focal pulmonary oligaemia (black zone)", "Pulmonary embolism"),
("Naclerio V Sign", "V-shaped air at left heart-diaphragm", "Oesophageal rupture (Boerhaave)"),
("Pleural Line", "Thin white line parallel to chest wall", "Pneumothorax (simple)"),
("Widened Mediastinum", ">8cm wide on PA CXR", "Aortic dissection / haematoma"),
("Eggshell Calcif.", "Thin calcified shell around hilar nodes", "Sarcoidosis / Silicosis"),
("Rib Notching", "Inferior rib erosions (3rd-8th ribs)", "Coarctation of aorta"),
("Cephalization", "Upper lobe vessels > lower lobe vessels", "Pulmonary venous hypertension"),
("Double Density", "Two densities at right heart border", "Left atrial enlargement"),
("Snowman Heart", "Heart + venous sinus = figure-8", "TAPVD"),
("Boot / Sabot", "Upturned boot-shaped cardiac contour", "Tetralogy of Fallot"),
]
row_bgs = [C_WHITE, C_LGRAY]
for ri, (sign, appearance, dx) in enumerate(signs):
bg = row_bgs[ri % 2]
for ci, val in enumerate([sign, appearance, dx], start=4):
c = ws[f"{get_column_letter(ci)}{r2}"]
c.value = val
c.font = _font(size=9, bold=(ci == 4), color=(C_DARK_RED if ci == 4 else "000000"))
c.fill = _fill(C_PINK if ci == 4 else bg)
c.alignment = _align()
c.border = _border()
ws.row_dimensions[r2].height = 22
r2 += 1
return ws
# ═══════════════════════════════════════════════════════════════════════════════
# MAIN
# ═══════════════════════════════════════════════════════════════════════════════
def main():
wb = Workbook()
build_comparison_sheet(wb)
build_decision_tree_sheet(wb)
build_cheatsheet(wb)
out_path = "/home/daytona/workspace/icu-cxr/ICU_CXR_Emergency_Reference.xlsx"
wb.save(out_path)
print(f"Saved: {out_path}")
return out_path
if __name__ == "__main__":
main()
!
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