nonoperating room anesthesia

ASA statement nonoperating room anesthesia services MRI cath laboratory radiology ECT

MRI anesthetic monitoring setup non operating room anesthesia patient safety

cardiac catheterization laboratory fluoroscopy anesthesia setup

interventional radiology fluoroscopy patient radiation protection medical staff

electroconvulsive therapy ECT anesthesia diagram monitoring

https://www.asahq.org/standards-and-practice-parameters/stat…

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mkdir -p "/tmp/workspace/nora_bsc_ppt/src" "/tmp/workspace/nora_bsc_ppt/output" && python - <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE from pptx.enum.text import MSO_AUTO_SIZE from pptx.enum.dml import MSO_LINE_DASH_STYLE from pathlib import Path OUT=Path('/tmp/workspace/nora_bsc_ppt/output/NORA_BSc_ICU_Anaesthesia_MRI_CathLab_Radiology_ECT.pptx') prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(12,34,57); BLUE=RGBColor(13,88,137); TEAL=RGBColor(16,143,151); SKY=RGBColor(221,241,246) INK=RGBColor(29,43,56); MUTED=RGBColor(91,108,120); WHITE=RGBColor(255,255,255); GOLD=RGBColor(239,177,57); RED=RGBColor(191,65,64); GREEN=RGBColor(63,143,104); PALE=RGBColor(244,248,250); LINE=RGBColor(202,216,224) def rect(slide,x,y,w,h,fill, line=None, radius=False): sh=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=fill sh.line.color.rgb=line if line else fill return sh def textbox(slide,x,y,w,h,text,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT, font='Aptos', margin=0.06): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(margin);tf.margin_right=Inches(margin);tf.margin_top=Inches(margin);tf.margin_bottom=Inches(margin) p=tf.paragraphs[0];p.alignment=align;p.space_after=Pt(0) r=p.add_run();r.text=text;r.font.name=font;r.font.size=Pt(size);r.font.bold=bold;r.font.color.rgb=color return tb def title(slide,txt,kicker=None,n=1): rect(slide,0,0,13.333,0.18,TEAL) if kicker: textbox(slide,0.62,0.42,8.8,0.25,kicker.upper(),11,TEAL,True) textbox(slide,0.62,0.70,11.8,0.55,txt,28,NAVY,True) rect(slide,0.62,1.36,12.08,0.02,LINE) textbox(slide,12.15,7.10,0.55,0.2,str(n).zfill(2),9,MUTED,False,PP_ALIGN.RIGHT) def bullets(slide,x,y,w,items,size=17,accent=TEAL,leading=0.56): for i,it in enumerate(items): yy=y+i*leading rect(slide,x,yy+0.13,0.12,0.12,accent) textbox(slide,x+0.25,yy,w-0.25,leading-0.03,it,size,INK) def card(slide,x,y,w,h,head,body,accent=TEAL,headsize=16,bodysize=14): rect(slide,x,y,w,h,WHITE,LINE,True); rect(slide,x,y,0.10,h,accent) textbox(slide,x+0.25,y+0.18,w-0.4,0.33,head,headsize,NAVY,True) textbox(slide,x+0.25,y+0.59,w-0.4,h-0.72,body,bodysize,INK) def footer(slide,label='BSc ICU & Anaesthesia'): textbox(slide,0.62,7.08,4.0,0.18,label,9,MUTED) def icon_circle(slide,x,y,label,color=TEAL): sh=slide.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(.56),Inches(.56));sh.fill.solid();sh.fill.fore_color.rgb=color;sh.line.color.rgb=color textbox(slide,x,y+.11,.56,.20,label,10,WHITE,True,PP_ALIGN.CENTER,margin=0) def add_notes(slide, note): slide.notes_slide.notes_text_frame.text = note # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,13.333,.22,TEAL) textbox(s,.75,.85,8.6,.4,'BSc ICU & Anaesthesia',18,RGBColor(174,224,228),True) textbox(s,.75,1.45,10.8,1.3,'Anaesthesia Outside\nthe Operating Room',38,WHITE,True) textbox(s,.78,3.23,8.2,.48,'MRI • Cath Lab • Radiology • ECT',22,GOLD,True) textbox(s,.78,4.05,8.3,.65,'A practical, safety-first overview of non-operating room anaesthesia (NORA)',18,RGBColor(218,232,240)) # decorative workflow for x, lab, col in [(9.45,'MRI',TEAL),(10.55,'CATH',BLUE),(11.65,'RAD',GOLD),(10.55,'ECT',RED)]: sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(2.0 if lab!='ECT' else 3.12),Inches(.95),Inches(.95));sh.fill.solid();sh.fill.fore_color.rgb=col;sh.line.color.rgb=col textbox(s,x,2.34 if lab!='ECT' else 3.46,.95,.18,lab,9,WHITE,True,PP_ALIGN.CENTER,margin=0) textbox(s,.78,6.45,5.0,.25,'Teaching deck | September 2026',11,RGBColor(174,224,228)); add_notes(s,'Introduce NORA as anaesthesia care delivered away from the conventional operating theatre. Emphasize that safety standards should not be lower because the location is remote.') #2 s=prs.slides.add_slide(blank);title(s,'Learning objectives','At the end of this session, learners should be able to',2) for i,(h,b,c) in enumerate([('Define NORA','Explain why remote locations create additional risk.',TEAL),('Prepare safely','Use a patient-procedure-environment pre-check.',BLUE),('Recognize hazards','Identify MRI, radiation, airway and access hazards.',GOLD),('Support recovery','Describe monitoring, transfer and escalation after NORA.',RED)]): x=.75+(i%2)*6.15;y=1.8+(i//2)*2.2; icon_circle(s,x,y,str(i+1),c);card(s,x+.78,y,5.0,1.42,h,b,c,17,15) footer(s);add_notes(s,'Use the objectives to frame the session. The scope is the ICU and anaesthesia student role: preparation, monitoring, communication, emergency readiness and recovery.') #3 s=prs.slides.add_slide(blank);title(s,'What is NORA?','Definition and clinical relevance',3) rect(s,.75,1.75,5.35,3.92,SKY,TEAL,True);textbox(s,1.10,2.12,4.7,.75,'Anaesthesia or sedation delivered outside a conventional operating room.',24,NAVY,True,PP_ALIGN.CENTER);textbox(s,1.15,3.3,4.55,1.5,'Examples: diagnostic imaging, interventional radiology, cardiac catheterisation, endoscopy, ECT and radiation therapy.',17,INK,False,PP_ALIGN.CENTER) textbox(s,6.65,1.78,5.7,.35,'Why it is different',20,NAVY,True);bullets(s,6.7,2.38,5.45,['Patient and airway may be physically distant or poorly accessible.','Space, lighting, equipment and staff familiarity can be limited.','The environment may add MRI magnetic-field or ionising-radiation hazards.','Patients still require the same standard of assessment, monitoring and recovery.'],17) footer(s);add_notes(s,'NORA includes inpatients and ambulatory patients. It is not a lesser form of anaesthesia. Barash notes NORA accounts for a substantial and increasing share of anaesthesia activity.') #4 s=prs.slides.add_slide(blank);title(s,'The NORA safety mindset','Plan for the patient, procedure and environment',4) # triangle pts=[(6.65,1.68,'PATIENT','Comorbidity\nAirway\nFasting',TEAL),(2.05,5.1,'PROCEDURE','Position\nDuration\nPain',BLUE),(9.15,5.1,'ENVIRONMENT','Access\nEquipment\nRescue',GOLD)] for x,y,h,b,c in pts: sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(2.1),Inches(1.25));sh.fill.solid();sh.fill.fore_color.rgb=c;sh.line.color.rgb=c;textbox(s,x,y+.22,2.1,.28,h,15,WHITE,True,PP_ALIGN.CENTER);textbox(s,x,y+.57,2.1,.45,b,12,WHITE,False,PP_ALIGN.CENTER) for a,b in [((7.3,2.88),(3.8,5.1)),((8.8,2.88),(10.2,5.1)),((4.25,5.7),(9.05,5.7))]: ln=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(a[0]),Inches(a[1]), Inches(b[0]),Inches(b[1]));ln.line.color.rgb=LINE;ln.line.width=Pt(2) textbox(s,4.35,3.58,4.7,.55,'The anaesthesia plan must fit all three.',22,NAVY,True,PP_ALIGN.CENTER) footer(s);add_notes(s,'This is the key framework. Assess the patient, understand exactly what the procedural team needs, and inspect the actual environment before starting.') #5 s=prs.slides.add_slide(blank);title(s,'Universal pre-anaesthetic check','Use the same fundamentals as in the operating room',5) for i,(h,b,c) in enumerate([('Patient','Identity, consent, allergies, fasting, ASA status, comorbidities, medicines, IV access and airway assessment.',TEAL),('Procedure','Indication, expected duration, position, painful steps, contrast use, blood loss and need for immobility.',BLUE),('Plan','Sedation, MAC or GA? Anticipate airway strategy, monitoring, vasoactive support and postoperative destination.',GOLD)]): card(s,.75+i*4.15,1.82,3.78,2.15,h,b,c,18,15) rect(s,.75,4.45,11.9,1.42,RGBColor(255,247,226),GOLD,True);textbox(s,1.02,4.72,11.2,.30,'High-risk flags: OSA / obesity, difficult airway, severe cardiac or respiratory disease, haemodynamic instability, aspiration risk, paediatric age, agitation or inability to cooperate.',16,NAVY,True,PP_ALIGN.CENTER) footer(s);add_notes(s,'Nursing and ICU staff can contribute by confirming baseline observations, recent labs and access, checking oxygen needs and identifying deterioration risks early.') #6 s=prs.slides.add_slide(blank);title(s,'Minimum readiness before induction or sedation','Equipment, people and rescue pathway',6) items=[('Monitoring','ECG, non-invasive BP, SpO₂ and capnography as indicated. Confirm alarms are audible and visible.'),( 'Airway and oxygen','Oxygen source, suction, bag-mask device, airway adjuncts and access to difficult-airway equipment.'),('Drugs and access','Labelled drugs, IV fluids, reliable IV access, emergency medicines and infusion pumps where needed.'),('Emergency response','Locate defibrillator and emergency cart. Confirm how to activate code/rapid response and who will assist.'),('Recovery route','Plan monitored transfer and handover to PACU, ICU or ward before the procedure begins.')] for i,(h,b) in enumerate(items): y=1.7+i*.92;icon_circle(s,.8,y+0.08,chr(65+i),TEAL if i<3 else RED);textbox(s,1.55,y,2.45,.3,h,16,NAVY,True);textbox(s,4.05,y,8.0,.50,b,15,INK) footer(s);add_notes(s,'ASA NORA statement calls for adequate drugs, fluids, monitoring including capnography, emergency cart with defibrillator, difficult airway access and clear emergency response processes.') #7 MRI s=prs.slides.add_slide(blank);title(s,'MRI suite','A remote environment with a powerful static magnetic field',7) rect(s,.72,1.75,4.0,4.72,NAVY,NAVY,True);textbox(s,1.0,2.05,3.45,.30,'MRI: key challenge',20,WHITE,True,PP_ALIGN.CENTER);textbox(s,1.02,2.72,3.40,1.35,'The patient lies in the bore, often with limited direct access and a long distance from the anaesthesia workstation.',18,WHITE,False,PP_ALIGN.CENTER) # MRI magnet graphic rect(s,1.35,4.40,2.65,.75,TEAL,TEAL,True);sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(2.05),Inches(4.56),Inches(1.25),Inches(.42));sh.fill.solid();sh.fill.fore_color.rgb=NAVY;sh.line.color.rgb=NAVY;textbox(s,1.2,5.42,2.95,.22,'Bore: airway access is delayed',11,RGBColor(190,229,233),False,PP_ALIGN.CENTER) textbox(s,5.25,1.83,6.6,.34,'MRI safety essentials',20,NAVY,True);bullets(s,5.25,2.35,6.85,['Screen patient and staff for implants, metal, foreign bodies and MRI compatibility.','Use only MRI-conditional / MRI-safe monitoring, pumps and anaesthesia equipment in designated zones.','Secure airway, breathing circuit and IV lines before table movement. Use extension tubing only if safely planned.','Prepare a rapid removal and resuscitation plan: emergencies are managed outside the scan room.'],16,TEAL,.74) footer(s);add_notes(s,'Stress that ordinary equipment can become dangerous projectiles. Preventive screening is more important than attempting rescue inside the magnet room.') #8 MRI workflow s=prs.slides.add_slide(blank);title(s,'MRI workflow for the anaesthesia team','Before, during and after scanning',8) for i,(h,b,c) in enumerate([('Before entry','Complete MRI screening. Confirm compatible equipment, monitoring, airway plan and emergency extraction route.',TEAL),('During scan','Keep visual/voice contact where possible. Observe trends. Anticipate limited access and scanner noise.',BLUE),('If deterioration','Stop scan, remove patient from bore and take to designated safe resuscitation area. Call for help early.',RED)]): x=.75+i*4.15;card(s,x,1.85,3.75,3.35,h,b,c,19,16);textbox(s,x+.25,4.65,3.2,.25,'STEP '+str(i+1),11,c,True) rect(s,.75,5.78,11.9,.55,RGBColor(255,241,241),RED,True);textbox(s,1.0,5.94,11.4,.20,'Never take ferromagnetic equipment, cylinders or emergency carts into the MRI magnet room unless it is specifically MRI-safe/conditional.',15,RED,True,PP_ALIGN.CENTER) footer(s);add_notes(s,'Keep MRI zones and local policy in mind. Assign roles: who moves the table, who takes airway equipment, who calls the emergency team.') #9 Cath s=prs.slides.add_slide(blank);title(s,'Cardiac catheterisation laboratory','Sedation is common, but patient physiology can change abruptly',9) card(s,.75,1.75,3.75,3.85,'Typical cases','Coronary angiography and PCI\nElectrophysiology procedures\nDevice implantation\nStructural heart interventions',BLUE,18,17) card(s,4.78,1.75,3.75,3.85,'Anaesthesia concerns','Ischaemia, arrhythmia, hypotension\nSupine position and drapes\nLimited airway access\nContrast and anticoagulation',GOLD,18,17) card(s,8.82,1.75,3.75,3.85,'When anaesthesia help is needed','High-risk airway or OSA\nHaemodynamic instability\nCardiogenic shock\nLong/complex intervention or need for immobility',RED,18,17) textbox(s,.95,6.15,11.2,.35,'Priorities: oxygenation and ventilation, continuous ECG and BP surveillance, reliable IV access, readiness for defibrillation/vasopressors, and early communication with the cardiologist.',16,NAVY,True,PP_ALIGN.CENTER) footer(s);add_notes(s,'Routine low-risk diagnostic cases may be managed with light sedation by the cardiology team, but high-risk and complex patients need proactive anaesthesia involvement. Do not hide airway or haemodynamic risk behind the drapes.') #10 radiation s=prs.slides.add_slide(blank);title(s,'Radiology and interventional radiology','Airway access, sedation depth and radiation protection',10) textbox(s,.75,1.72,4.0,.3,'Common procedures',19,NAVY,True);bullets(s,.78,2.25,3.85,['CT / MRI imaging','Biopsy and drainage','Angiography / embolisation','Ablation procedures','Neuroradiology interventions'],16,BLUE,.54) rect(s,4.85,1.76,3.0,3.75,SKY,TEAL,True);textbox(s,5.13,2.06,2.46,.3,'Sedation risks',18,NAVY,True,PP_ALIGN.CENTER);textbox(s,5.15,2.72,2.4,2.15,'Painful stimuli can alternate with long quiet periods.\n\nDeep sedation can cause airway obstruction, hypoventilation and movement.',16,INK,False,PP_ALIGN.CENTER) textbox(s,8.25,1.72,3.9,.3,'Radiation protection',19,NAVY,True);bullets(s,8.27,2.25,3.8,['Time: minimise exposure time.','Distance: stand back when possible.','Shielding: lead apron, thyroid shield and mobile shield.','Wear dosimeter as per local policy.'],16,GOLD,.66) footer(s);add_notes(s,'For fluoroscopy and CT, the anaesthesia team must have appropriate lead protection. Maintain airway observation and ensure long lines are secured and visible.') #11 contrast s=prs.slides.add_slide(blank);title(s,'Contrast and procedure-related complications','Recognise deterioration and act early',11) for i,(h,b,c) in enumerate([('Contrast reaction','Rash, bronchospasm, hypotension or anaphylaxis. Stop exposure, call for help, support ABCs and follow anaphylaxis protocol.',RED),('Bleeding / access complication','Observe access site and haemodynamics. Prepare for fluid/blood support and escalation.',GOLD),('Respiratory compromise','Sedation, positioning or pain can cause hypoventilation. Use capnography where required and intervene promptly.',BLUE),('Procedure-specific emergency','Embolisation, perforation, arrhythmia or haemodynamic collapse: communicate immediately and activate rescue plan.',TEAL)]): x=.75+(i%2)*6.1;y=1.75+(i//2)*2.35;card(s,x,y,5.65,1.85,h,b,c,17,14) footer(s);add_notes(s,'This slide is not a dosing protocol. Follow local emergency and anaphylaxis guidelines. The BSc role is early recognition, calling for assistance, documentation and supporting resuscitation.') #12 ECT s=prs.slides.add_slide(blank);title(s,'Electroconvulsive therapy (ECT)','A brief general anaesthetic for a therapeutic controlled seizure',12) rect(s,.75,1.75,3.3,4.55,RGBColor(245,238,249),RED,True);textbox(s,1.05,2.08,2.7,.32,'Purpose',20,NAVY,True,PP_ALIGN.CENTER);textbox(s,1.04,2.78,2.72,1.55,'Electrical stimulation is applied to induce a therapeutic generalised seizure, commonly in severe or treatment-resistant psychiatric illness.',16,INK,False,PP_ALIGN.CENTER);textbox(s,1.05,5.22,2.7,.35,'Short procedure.\nRepeated treatment course.',15,RED,True,PP_ALIGN.CENTER) textbox(s,4.55,1.83,7.4,.32,'Core anaesthetic sequence',20,NAVY,True) steps=[('1','Preoxygenate','Apply routine monitoring; confirm airway and emergency readiness.'),('2','Induce anaesthesia','Use a short-acting induction strategy selected by the anaesthesia clinician.'),('3','Neuromuscular block','A brief muscle relaxant effect limits injury during seizure activity.'),('4','Stimulus and support','Observe seizure, control ventilation and support haemodynamics.'),('5','Recovery','Monitor until breathing, consciousness and haemodynamics are stable.')] for i,(num,h,b) in enumerate(steps): y=2.35+i*.74;icon_circle(s,4.55,y,num,RED);textbox(s,5.3,y+.02,2.2,.25,h,15,NAVY,True);textbox(s,7.48,y,4.72,.4,b,14,INK) footer(s);add_notes(s,'ECT uses general anaesthesia and neuromuscular block to ensure amnesia and reduce musculoskeletal injury. It should be treated like any other general anaesthetic with appropriate monitoring and recovery.') #13 ECT physiology s=prs.slides.add_slide(blank);title(s,'ECT: physiology, monitoring and recovery','Anticipate an autonomic sequence',13) # arrows process for x,h,b,c in [(0.82,'Initial parasympathetic','Bradycardia\nSecretions\nOccasional transient asystole',BLUE),(4.85,'Then sympathetic','Tachycardia\nHypertension\nPossible arrhythmia',RED),(8.88,'Post-ictal recovery','Confusion\nSomnolence\nObserve airway and vital signs',TEAL)]: card(s,x,2.02,3.65,2.2,h,b,c,18,15) if x<8: textbox(s,x+3.72,2.84,.3,.25,'→',26,MUTED,True,PP_ALIGN.CENTER) rect(s,.82,4.85,11.7,1.05,RGBColor(255,247,226),GOLD,True);textbox(s,1.05,5.12,11.2,.42,'Monitor as for general anaesthesia: ECG, BP, SpO₂, ventilation and seizure activity. Be ready to manage bradycardia, hypertension, tachyarrhythmia and airway obstruction.',16,NAVY,True,PP_ALIGN.CENTER) footer(s);add_notes(s,'ECT causes an initial parasympathetic surge then a more sustained sympathetic response. Staff should be ready for transient cardiovascular changes and protect the patient during emergence.') #14 roles s=prs.slides.add_slide(blank);title(s,'Team roles and closed-loop communication','Remote locations demand clear coordination',14) for i,(h,b,c) in enumerate([('Anaesthesia clinician','Assessment, airway plan, anaesthetic decisions, escalation and recovery destination.',TEAL),('Anaesthesia / ICU nurse or technologist','Equipment checks, medication preparation, monitoring, documentation, handover and emergency support.',BLUE),('Procedural team','Procedure briefing, sterile-field constraints, expected painful events, complications and access to patient.',GOLD),('All team members','Speak up, repeat back critical instructions, stop the procedure when safety is compromised.',RED)]): x=.75+(i%2)*6.1;y=1.72+(i//2)*2.3;card(s,x,y,5.6,1.75,h,b,c,17,14) footer(s);add_notes(s,'Before the case, perform a short briefing: patient risks, plan, positioning, lines, emergency call mechanism, recovery destination and what will happen if airway access is needed.') #15 emergencies s=prs.slides.add_slide(blank);title(s,'Emergency response in a remote location','A simple response sequence',15) seq=[('Recognise','Alarm or clinical change: hypoxia, apnoea, hypotension, arrhythmia, bleeding or reaction.',RED),('Call','Stop procedure if possible. Summon local help and activate code / rapid response early.',GOLD),('Access','Gain access to patient. Move out of scanner / behind radiation equipment / away from sterile barriers.',BLUE),('Resuscitate','Use ABC approach, standard monitoring and emergency equipment. Escalate transfer as needed.',TEAL),('Handover','Communicate event, drugs, observations and next plan to PACU, ICU or receiving team.',GREEN)] for i,(h,b,c) in enumerate(seq): x=.6+i*2.52;icon_circle(s,x+.75,1.8,str(i+1),c);card(s,x,2.62,2.15,2.55,h,b,c,15,13) footer(s);add_notes(s,'The first physical barrier may be environment-specific. In MRI, remove patient from the bore to the safe resuscitation area. In cath lab, equipment and drapes may delay access. Practise this locally.') #16 recovery s=prs.slides.add_slide(blank);title(s,'Post-anaesthesia care and transfer','NORA is not complete when the procedure ends',16) card(s,.75,1.72,3.7,3.95,'Recovery monitoring','Airway patency and breathing\nOxygenation and ventilation\nHaemodynamic stability\nPain, nausea, agitation\nProcedure-specific concerns',TEAL,18,16) card(s,4.82,1.72,3.7,3.95,'Safe transfer','Accompanied by trained personnel\nAppropriate portable monitoring\nOxygen and emergency drugs available\nClear destination: PACU, ICU or ward',BLUE,18,16) card(s,8.88,1.72,3.7,3.95,'Structured handover','Patient / procedure / anaesthetic\nEvents and complications\nDrugs and fluids\nLines and access site\nRequired observations and escalation plan',GOLD,18,16) footer(s);add_notes(s,'Barash states that following NORA, patients should be transported to an appropriate PACU accompanied and monitored by anaesthesia-trained personnel. ICU may be appropriate for unstable or ventilated patients.') #17 checklist s=prs.slides.add_slide(blank);title(s,'Bedside NORA checklist','Use before every case',17) left=['□ Patient identity, consent, fasting, allergies and baseline observations','□ Airway risk, OSA, aspiration and comorbidity reviewed','□ Procedure, position, duration and access limitations discussed','□ Standard monitors, capnography where indicated and alarms checked','□ Oxygen, suction, bag-mask and airway rescue equipment present'] right=['□ Drugs, IV fluids, infusion pumps and IV access checked','□ Emergency cart, defibrillator and emergency call process known','□ MRI compatibility OR radiation protection confirmed','□ Recovery location, transfer monitor and escort arranged','□ Team brief completed: plan, contingency and roles agreed'] rect(s,.68,1.7,5.92,4.78,WHITE,LINE,True);rect(s,6.74,1.7,5.92,4.78,WHITE,LINE,True);textbox(s,.95,1.98,5.35,.25,'PATIENT + PROCEDURE',17,NAVY,True);textbox(s,7.0,1.98,5.35,.25,'ENVIRONMENT + RECOVERY',17,NAVY,True);bullets(s,.96,2.55,5.25,left,14,TEAL,.70);bullets(s,7.02,2.55,5.2,right,14,GOLD,.70) footer(s);add_notes(s,'Adapt this checklist to local policy. Use it as a cognitive aid, not a replacement for clinical judgement.') #18 summary references s=prs.slides.add_slide(blank);title(s,'Key take-home messages','Safety travels with the patient',18) bullets(s,.85,1.75,11.5,['NORA requires the same standards of assessment, monitoring, equipment, emergency preparedness and recovery as operating-room anaesthesia.','Use the Patient - Procedure - Environment framework before every case.','MRI demands strict screening and MRI-safe equipment; remove the patient from the magnet room for resuscitation.','Cath lab and interventional radiology require airway vigilance, haemodynamic readiness and radiation protection.','ECT is a brief general anaesthetic with planned seizure activity and predictable autonomic changes.'],18,TEAL,.75) rect(s,.85,5.72,11.5,.8,SKY,TEAL,True);textbox(s,1.05,5.93,11.05,.3,'Prepared team + prepared environment + early escalation = safer NORA care',19,NAVY,True,PP_ALIGN.CENTER) textbox(s,.85,6.65,11.5,.2,'Sources: Barash, Cullen & Stoelting’s Clinical Anesthesia, 9e, Ch. 33; Morgan & Mikhail’s Clinical Anesthesiology, 7e; ASA Statement on Nonoperating Room Anesthesia Services.',9,MUTED,False,PP_ALIGN.CENTER) footer(s);add_notes(s,'Close by reiterating that safety does not depend on the room name. Students should know local NORA policies, emergency routes and equipment before assisting in these areas.') # metadata prs.core_properties.title='Anaesthesia Outside the Operating Room: MRI, Cath Lab, Radiology and ECT' prs.core_properties.subject='BSc ICU and Anaesthesia teaching presentation' prs.core_properties.author='Orris' prs.save(OUT) print(OUT) print('slides',len(prs.slides)) PY

~/nora_bsc_ppt/output

python - <<'PY' from pptx import Presentation p='/tmp/workspace/nora_bsc_ppt/output/NORA_BSc_ICU_Anaesthesia_MRI_CathLab_Radiology_ECT.pptx' prs=Presentation(p) print('Slides:',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text.strip(): texts.append(sh.text.replace('\n',' | ')) print(f'{i:02d}:', ' || '.join(texts)[:200]) print('Notes:',sum(1 for s in prs.slides if s.notes_slide.notes_text_frame.text.strip())) PY