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

# ── Colour palette ────────────────────────────────────────────────────────────
NAVY      = HexColor('#1B3A6B')
TEAL      = HexColor('#0E7B82')
ORANGE    = HexColor('#D95F02')
RED_DARK  = HexColor('#B00020')
YELLOW_BG = HexColor('#FFF8E1')
TEAL_BG   = HexColor('#E0F4F5')
NAVY_BG   = HexColor('#EEF2FA')
GREY_ROW  = HexColor('#F5F5F5')
WHITE     = colors.white
BLACK     = colors.black

PAGE_W, PAGE_H = A4
MARGIN = 1.8 * cm

# ── Document setup ─────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    '/tmp/workspace/fibrinolytic-guide/Fibrinolytic_Dosing_Guide.pdf',
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=2.2 * cm, bottomMargin=2.0 * cm,
    title='Quick Reference: Fibrinolytic Agents Dosing Guide',
    author='Orris Medical Reference'
)

styles = getSampleStyleSheet()
W = PAGE_W - 2 * MARGIN  # usable width

# ── Custom paragraph styles ───────────────────────────────────────────────────
def pstyle(name, parent='Normal', **kw):
    s = ParagraphStyle(name, parent=styles[parent], **kw)
    return s

title_style   = pstyle('Title2',   fontSize=18, textColor=WHITE,
                        alignment=TA_CENTER, fontName='Helvetica-Bold',
                        spaceAfter=2, leading=22)
subtitle_style= pstyle('Subtitle', fontSize=10, textColor=HexColor('#CCE4F7'),
                        alignment=TA_CENTER, fontName='Helvetica',
                        spaceAfter=4, leading=13)
sec_head      = pstyle('SecHead',  fontSize=11, textColor=WHITE,
                        fontName='Helvetica-Bold', alignment=TA_LEFT,
                        spaceBefore=6, spaceAfter=2, leading=14)
body          = pstyle('Body',     fontSize=8.5, leading=12,
                        fontName='Helvetica', spaceAfter=1)
bold_body     = pstyle('BoldBody', fontSize=8.5, leading=12,
                        fontName='Helvetica-Bold')
small         = pstyle('Small',    fontSize=7.5, leading=10,
                        fontName='Helvetica', textColor=HexColor('#555555'))
footnote      = pstyle('Footnote', fontSize=7, leading=9,
                        fontName='Helvetica-Oblique', textColor=HexColor('#666666'))
warn_style    = pstyle('Warn',     fontSize=8.5, leading=12,
                        fontName='Helvetica-Bold', textColor=RED_DARK)
label_style   = pstyle('Label',    fontSize=7.5, leading=10,
                        fontName='Helvetica-Bold', textColor=NAVY, alignment=TA_CENTER)

# ── Helper: section header bar ─────────────────────────────────────────────────
def section_bar(text, bg=NAVY, text_col=WHITE, width=None):
    w = width or W
    tbl = Table([[Paragraph(text, pstyle('_sh', fontSize=10,
                                          fontName='Helvetica-Bold',
                                          textColor=text_col,
                                          leading=13))]],
                colWidths=[w])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('TOPPADDING',    (0,0), (-1,-1), 5),
        ('BOTTOMPADDING', (0,0), (-1,-1), 5),
        ('LEFTPADDING',   (0,0), (-1,-1), 8),
    ]))
    return tbl

# ── Helper: coloured badge cell ────────────────────────────────────────────────
def badge(text, bg, fg=WHITE):
    return Paragraph(
        f'<font color="{fg.hexval() if hasattr(fg,"hexval") else fg}">'
        f'<b>{text}</b></font>', 
        pstyle('_badge', fontSize=7.5, fontName='Helvetica-Bold',
               alignment=TA_CENTER, leading=10,
               backColor=bg, borderPadding=(2,4,2,4))
    )

# ═══════════════════════════════════════════════════════════════════════════════
# PAGE BACKGROUND callback
# ═══════════════════════════════════════════════════════════════════════════════
def draw_bg(canv, doc):
    """Draw header banner + footer on every page."""
    canv.saveState()
    # Header banner
    canv.setFillColor(NAVY)
    canv.rect(0, PAGE_H - 1.6*cm, PAGE_W, 1.6*cm, fill=1, stroke=0)
    canv.setFillColor(TEAL)
    canv.rect(0, PAGE_H - 1.75*cm, PAGE_W, 0.15*cm, fill=1, stroke=0)
    # Header text
    canv.setFillColor(WHITE)
    canv.setFont('Helvetica-Bold', 13)
    canv.drawString(MARGIN, PAGE_H - 1.15*cm,
                    'Quick Reference: Fibrinolytic Agents Dosing Guide')
    canv.setFont('Helvetica', 8)
    canv.setFillColor(HexColor('#AACCE8'))
    canv.drawRightString(PAGE_W - MARGIN, PAGE_H - 1.15*cm,
                         'For Clinical Use — Verify locally')
    # Footer
    canv.setFillColor(NAVY)
    canv.rect(0, 0, PAGE_W, 1.1*cm, fill=1, stroke=0)
    canv.setFillColor(TEAL)
    canv.rect(0, 1.1*cm, PAGE_W, 0.1*cm, fill=1, stroke=0)
    canv.setFillColor(HexColor('#AACCE8'))
    canv.setFont('Helvetica', 7)
    canv.drawString(MARGIN, 0.45*cm,
        'Sources: Harrison\'s 22E · Braunwald\'s Heart Disease · Tintinalli\'s EM · Goldman-Cecil · Goodman & Gilman\'s')
    canv.drawRightString(PAGE_W - MARGIN, 0.45*cm,
        f'Page {doc.page}')
    canv.restoreState()

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

# ── Intro paragraph ─────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    'Fibrinolytic (thrombolytic) agents activate plasminogen to plasmin, which degrades fibrin clots. '
    'Doses vary significantly by indication. Always confirm the correct indication before ordering — '
    'do not use abbreviations (rtPA, TNK) to avoid medication errors.',
    body))
story.append(Spacer(1, 0.35*cm))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 1 — DRUG COMPARISON TABLE
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_bar('1.  FIBRINOLYTIC AGENTS — OVERVIEW & STEMI DOSING', NAVY))
story.append(Spacer(1, 0.25*cm))

col_w = [3.0*cm, 2.6*cm, 2.6*cm, 2.6*cm, 2.6*cm]

hdr = [
    Paragraph('<b>Property</b>', label_style),
    Paragraph('<b>Streptokinase</b>', label_style),
    Paragraph('<b>Alteplase\n(t-PA)</b>', label_style),
    Paragraph('<b>Reteplase\n(r-PA)</b>', label_style),
    Paragraph('<b>Tenecteplase\n(TNK)</b>', label_style),
]

overview_data = [
    hdr,
    ['Generation',
     Paragraph('1st', body), Paragraph('2nd', body),
     Paragraph('3rd', body), Paragraph('3rd', body)],
    ['Source',
     Paragraph('β-hemolytic streptococci', small),
     Paragraph('Recombinant t-PA', small),
     Paragraph('Deletion mutant of alteplase', small),
     Paragraph('Modified alteplase', small)],
    ['Fibrin selectivity',
     Paragraph('Non-specific', body), Paragraph('Moderate', body),
     Paragraph('Moderate', body), Paragraph('High', body)],
    ['Systemic fibrinogen\ndepletion',
     Paragraph('Severe', warn_style), Paragraph('Mild–moderate', body),
     Paragraph('Moderate', body), Paragraph('Minimal', body)],
    [Paragraph('Half-life', body),
     Paragraph('~23 min\n(effect ≤24 h)', small),
     Paragraph('<5 min\n(effect ~4–6 h)', small),
     Paragraph('13–16 min', small),
     Paragraph('~20 min', small)],
    [Paragraph('Antigenic /\nAllergic reactions', body),
     Paragraph('YES (~5–6%)', warn_style),
     Paragraph('No (<2%)', body),
     Paragraph('No', body),
     Paragraph('No', body)],
    [Paragraph('ICH rate\n(STEMI)', body),
     Paragraph('~0.4%', body), Paragraph('~0.7%', body),
     Paragraph('~0.8%', body), Paragraph('~0.7%', body)],
    [Paragraph('TIMI 2/3 patency\n@ 90 min (STEMI)', body),
     Paragraph('~51%', body), Paragraph('73–84%', body),
     Paragraph('~83%', body), Paragraph('77–88%', body)],
    [Paragraph('<b>STEMI dose</b>', bold_body),
     Paragraph('<b>1.5 MU IV\nover 30–60 min</b>', bold_body),
     Paragraph('<b>15 mg bolus → 0.75 mg/kg over 30 min (max 50 mg) → 0.50 mg/kg over 60 min (max 35 mg)</b>', bold_body),
     Paragraph('<b>10 U IV over 2 min; repeat ×1 after 30 min</b>', bold_body),
     Paragraph('<b>Weight-based single bolus over 5 sec:\n<60 kg: 30 mg\n60–70 kg: 35 mg\n70–80 kg: 40 mg\n80–90 kg: 45 mg\n>90 kg: 50 mg</b>', bold_body)],
    [Paragraph('Heparin post-\nthrombolysis', body),
     Paragraph('Delay\n(prolonged lytic state)', small),
     Paragraph('Start early', small),
     Paragraph('Start early', small),
     Paragraph('Start early', small)],
    [Paragraph('Re-treatment\nrestriction', body),
     Paragraph('Avoid within 6 months\n(antibody formation)', warn_style),
     Paragraph('None', body),
     Paragraph('None', body),
     Paragraph('None', body)],
]

tbl1 = Table(overview_data, colWidths=col_w, repeatRows=1)
row_bg = []
for i in range(1, len(overview_data)):
    c = GREY_ROW if i % 2 == 0 else WHITE
    row_bg.append(('BACKGROUND', (0, i), (-1, i), c))

tbl1.setStyle(TableStyle([
    ('BACKGROUND',    (0, 0), (-1, 0), TEAL),
    ('TEXTCOLOR',     (0, 0), (-1, 0), WHITE),
    ('FONTNAME',      (0, 0), (-1, 0), 'Helvetica-Bold'),
    ('FONTSIZE',      (0, 0), (-1, 0), 8),
    ('ALIGN',         (0, 0), (-1, -1), 'CENTER'),
    ('VALIGN',        (0, 0), (-1, -1), 'MIDDLE'),
    ('GRID',          (0, 0), (-1, -1), 0.4, HexColor('#CCCCCC')),
    ('TOPPADDING',    (0, 0), (-1, -1), 4),
    ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
    ('LEFTPADDING',   (0, 0), (-1, -1), 4),
    ('RIGHTPADDING',  (0, 0), (-1, -1), 4),
    ('BACKGROUND',    (0, len(overview_data)-3), (-1, len(overview_data)-3), NAVY_BG),
    ('FONTNAME',      (0, len(overview_data)-3), (-1, len(overview_data)-3), 'Helvetica-Bold'),
] + row_bg))

story.append(tbl1)
story.append(Paragraph(
    '* Alteplase accelerated regimen (STEMI). Tenecteplase doses supplied in 5 mg/mL vials. '
    'ICH = intracranial haemorrhage. TIMI = Thrombolysis in Myocardial Infarction.',
    footnote))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 2 — DOSING BY INDICATION
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_bar('2.  DOSING BY INDICATION', TEAL))
story.append(Spacer(1, 0.25*cm))

ind_col = [3.2*cm, 5.4*cm, 5.4*cm]

ind_hdr = [
    Paragraph('<b>Indication</b>', label_style),
    Paragraph('<b>Agent & Dose</b>',  label_style),
    Paragraph('<b>Notes / Time Window</b>', label_style),
]

ind_data = [
    ind_hdr,
    # STEMI
    [Paragraph('<b>STEMI\n(Acute MI)</b>', bold_body),
     Paragraph(
         '<b>Streptokinase:</b> 1.5 MU IV over 30–60 min<br/>'
         '<b>Alteplase:</b> Accelerated 100 mg total (see above)<br/>'
         '<b>Reteplase:</b> 10 U + 10 U, 30 min apart<br/>'
         '<b>Tenecteplase:</b> Weight-based single bolus', small),
     Paragraph(
         'Use when PCI unavailable or door-to-balloon time >120 min.<br/>'
         'Best within 3 h of symptom onset; benefit up to 12 h.<br/>'
         'Avoid within 12 months of streptococcal infection (SK).', small)],
    # Ischemic Stroke
    [Paragraph('<b>Acute Ischemic\nStroke</b>', bold_body),
     Paragraph(
         '<b>Alteplase:</b> 0.9 mg/kg IV (max 90 mg)<br/>'
         '→ 10% as bolus over 1 min<br/>'
         '→ Remaining 90% over 60 min<br/><br/>'
         '<b>Tenecteplase</b> (off-label in some regions):<br/>'
         '0.25 mg/kg IV single bolus (max 25 mg)', small),
     Paragraph(
         'Alteplase: within 3–4.5 h of symptom onset.<br/>'
         'Tenecteplase: within 4.5 h; used as alternative in some guidelines.<br/>'
         'ICH occurs in ~6% of stroke patients treated with alteplase.<br/>'
         'NIHSS 4–22 typically used as criterion.<br/>'
         'Check blood glucose before administering.', small)],
    # PE
    [Paragraph('<b>Pulmonary\nEmbolism (PE)</b>', bold_body),
     Paragraph(
         '<b>Alteplase:</b> 100 mg IV over 2 h<br/>'
         '<i>or</i> 0.6 mg/kg over 15 min (max 50 mg — rapid/submassive)<br/><br/>'
         '<b>Streptokinase:</b> 250,000 IU loading over 30 min,<br/>'
         'then 100,000 IU/h for 24 h<br/><br/>'
         '<b>Reteplase:</b> 10 U + 10 U, 30 min apart<br/><br/>'
         '<b>Tenecteplase:</b> Weight-based bolus', small),
     Paragraph(
         'Indicated for massive (haemodynamically unstable) PE.<br/>'
         'Considered for submassive PE with clinical deterioration.<br/>'
         'Start heparin after alteplase; delay after streptokinase.', small)],
    # DVT
    [Paragraph('<b>Deep Vein\nThrombosis (DVT)</b>', bold_body),
     Paragraph(
         '<b>Streptokinase:</b> 250,000 IU loading over 30 min,<br/>'
         'then <b>150,000 IU/h</b> IV × 12–72 h<br/><br/>'
         '<b>Alteplase:</b> Catheter-directed; variable dose', small),
     Paragraph(
         'Systemic thrombolysis rarely used for DVT; catheter-directed preferred.<br/>'
         'Greatest benefit in ilio-femoral DVT within 14 days of onset.<br/>'
         'Streptokinase antibodies develop ~5 days post-treatment (persist 6 mo).', small)],
    # Arterial occlusion
    [Paragraph('<b>Peripheral\nArterial\nOcclusion</b>', bold_body),
     Paragraph(
         '<b>Alteplase:</b> Catheter-directed 0.05–0.1 mg/kg/h<br/>'
         '<b>Streptokinase:</b> Catheter-directed (rarely used)', small),
     Paragraph(
         'Catheter-directed thrombolysis preferred over systemic.<br/>'
         'Limb viability assessment determines urgency.<br/>'
         'Higher bleeding risk with prolonged infusions.', small)],
]

tbl2 = Table(ind_data, colWidths=ind_col, repeatRows=1)
ind_row_bg = []
for i in range(1, len(ind_data)):
    c = NAVY_BG if i % 2 == 0 else WHITE
    ind_row_bg.append(('BACKGROUND', (0, i), (-1, i), c))

tbl2.setStyle(TableStyle([
    ('BACKGROUND',    (0, 0), (-1, 0), NAVY),
    ('TEXTCOLOR',     (0, 0), (-1, 0), WHITE),
    ('FONTNAME',      (0, 0), (-1, 0), 'Helvetica-Bold'),
    ('FONTSIZE',      (0, 0), (-1, 0), 8.5),
    ('ALIGN',         (0, 0), (0, -1), 'CENTER'),
    ('ALIGN',         (1, 0), (-1, -1), 'LEFT'),
    ('VALIGN',        (0, 0), (-1, -1), 'TOP'),
    ('GRID',          (0, 0), (-1, -1), 0.4, HexColor('#CCCCCC')),
    ('TOPPADDING',    (0, 0), (-1, -1), 5),
    ('BOTTOMPADDING', (0, 0), (-1, -1), 5),
    ('LEFTPADDING',   (0, 0), (-1, -1), 5),
    ('RIGHTPADDING',  (0, 0), (-1, -1), 5),
    ('BACKGROUND',    (0, 1), (0, -1), TEAL_BG),
    ('FONTNAME',      (0, 1), (0, -1), 'Helvetica-Bold'),
] + ind_row_bg))

story.append(tbl2)
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 3 — CONTRAINDICATIONS (two-column)
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_bar('3.  CONTRAINDICATIONS TO FIBRINOLYTIC THERAPY', NAVY))
story.append(Spacer(1, 0.25*cm))

abs_items = [
    'Active or recent (<14 d) internal bleeding',
    'Any prior haemorrhagic stroke',
    'Ischaemic stroke within past 2–6 months',
    'Intracranial/intraspinal surgery or trauma <2 months',
    'Intracranial neoplasm, aneurysm, or AVM',
    'Known severe bleeding diathesis',
    'Platelet count <100,000/mm³',
    'Uncontrolled hypertension (BP >185/110 mmHg)',
    'Suspected aortic dissection or pericarditis',
    'Pregnancy',
    'Warfarin with INR >1.7 or heparin with ↑ aPTT',
    'Direct anticoagulant with evidence of anticoagulant effect',
]
rel_items = [
    'Active peptic ulcer disease',
    'CPR >10 minutes',
    'Haemorrhagic ophthalmic conditions',
    'Puncture of non-compressible vessel <10 days',
    'Significant trauma or major surgery <2 wk–2 months',
    'Advanced renal or hepatic disease',
    'Severe, uncontrolled hypertension on presentation',
    'Current use of anticoagulants (INR 2–3)',
    'Known intracranial pathology not listed as absolute',
    'Diabetic haemorrhagic retinopathy',
]

def bullet_list(items, style):
    lines = ''.join(f'• {i}<br/>' for i in items)
    return Paragraph(lines, style)

abs_col_hdr  = section_bar('ABSOLUTE', RED_DARK, WHITE, W/2 - 0.2*cm)
rel_col_hdr  = section_bar('RELATIVE', ORANGE,   WHITE, W/2 - 0.2*cm)

abs_body = bullet_list(abs_items, small)
rel_body = bullet_list(rel_items, small)

ci_tbl = Table(
    [[abs_col_hdr, rel_col_hdr],
     [abs_body,    rel_body]],
    colWidths=[W/2 - 0.15*cm, W/2 - 0.15*cm],
    hAlign='LEFT'
)
ci_tbl.setStyle(TableStyle([
    ('VALIGN',        (0,0), (-1,-1), 'TOP'),
    ('TOPPADDING',    (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 6),
    ('LEFTPADDING',   (0,0), (-1,-1), 5),
    ('RIGHTPADDING',  (0,0), (-1,-1), 5),
    ('GRID',          (0,0), (-1,-1), 0.4, HexColor('#CCCCCC')),
    ('BACKGROUND',    (0,1), (0,1), HexColor('#FFF0F0')),
    ('BACKGROUND',    (1,1), (1,1), HexColor('#FFF8EE')),
]))

story.append(ci_tbl)
story.append(Paragraph('* Concurrent menses is NOT a contraindication.', footnote))
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 4 — BLEEDING MANAGEMENT
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_bar('4.  MANAGEMENT OF FIBRINOLYTIC-INDUCED BLEEDING', TEAL))
story.append(Spacer(1, 0.25*cm))

bleed_data = [
    [Paragraph('<b>Severity</b>', label_style),
     Paragraph('<b>Action</b>', label_style)],
    [Paragraph('Minor external\n(e.g. IV site ooze)', small),
     Paragraph('Manual pressure', body)],
    [Paragraph('Significant\ninternal bleeding', small),
     Paragraph(
         '1. Stop fibrinolytic, antiplatelet, and heparin immediately\n'
         '2. Reverse heparin with protamine if applicable\n'
         '3. Order type & cross-match; check aPTT, CBC, fibrinogen, TCT\n'
         '4. Volume replacement with crystalloid and pRBC as needed', small)],
    [Paragraph('Major bleeding /\nHaemodynamic\ncompromise', warn_style),
     Paragraph(
         '1. All measures above\n'
         '2. Fibrinogen concentrate 70 mg/kg IV; recheck — if <100 mg/dL, repeat\n'
         '3. If bleeding persists: FFP 2 units IV\n'
         '4. If still ongoing: Aminocaproic acid 5 g IV over 60 min → 1 g/h × 8 h\n'
         '   OR Tranexamic acid 10 mg/kg IV over 20 min → 1 mg/kg/h × 8 h\n'
         '5. Neurosurgery/IR consultation for intracranial haemorrhage', small)],
]

bleed_tbl = Table(bleed_data, colWidths=[3.5*cm, W - 3.5*cm], repeatRows=1)
bleed_tbl.setStyle(TableStyle([
    ('BACKGROUND',    (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',     (0,0), (-1,0), WHITE),
    ('FONTNAME',      (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',      (0,0), (-1,0), 8.5),
    ('VALIGN',        (0,0), (-1,-1), 'TOP'),
    ('ALIGN',         (0,0), (0,-1), 'CENTER'),
    ('GRID',          (0,0), (-1,-1), 0.4, HexColor('#CCCCCC')),
    ('TOPPADDING',    (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('LEFTPADDING',   (0,0), (-1,-1), 5),
    ('RIGHTPADDING',  (0,0), (-1,-1), 5),
    ('BACKGROUND',    (0,1), (-1,1), GREY_ROW),
    ('BACKGROUND',    (0,3), (-1,3), HexColor('#FFF0F0')),
    ('BACKGROUND',    (0,3), (0,3), HexColor('#FFCCCC')),
]))
story.append(bleed_tbl)
story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 5 — KEY CLINICAL REMINDERS
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_bar('5.  KEY CLINICAL REMINDERS', NAVY))
story.append(Spacer(1, 0.2*cm))

reminders = [
    ('Dose is indication-specific.',
     'Alteplase 0.9 mg/kg for stroke ≠ alteplase 100 mg for PE or STEMI. Always verify.'),
    ('No abbreviations when ordering.',
     'Use full names: alteplase, tenecteplase. "rtPA" and "TNK" cause medication errors.'),
    ('Streptokinase antibodies.',
     'Antibodies develop ~5 days post-treatment, persist 6 months. Avoid re-use in that window. '
     'Also avoid within 12 months of streptococcal infection.'),
    ('Streptokinase hypotension.',
     'Caused by plasmin-mediated bradykinin release. Treat with leg elevation, IV fluids, '
     'low-dose dopamine or norepinephrine.'),
    ('Heparin timing.',
     'Delay heparin after streptokinase (prolonged systemic lytic state). Start early after '
     'alteplase, reteplase, or tenecteplase.'),
    ('ICH in stroke vs MI.',
     'ICH occurs in ~6% of stroke patients treated with alteplase, vs <1% in MI patients. '
     'Higher baseline risk demands careful exclusion criterion review.'),
    ('Fibrin selectivity.',
     'Tenecteplase > alteplase > reteplase > streptokinase. Less fibrin selectivity = more '
     'systemic fibrinogen depletion and bleeding risk.'),
]

rem_data = [[
    Paragraph(f'<b>{t}</b> {d}', small)
] for t, d in reminders]

for i, row in enumerate(rem_data):
    bg = NAVY_BG if i % 2 == 0 else WHITE
    rem_tbl_row = Table([row], colWidths=[W])
    rem_tbl_row.setStyle(TableStyle([
        ('BACKGROUND',    (0,0), (-1,-1), bg),
        ('LEFTPADDING',   (0,0), (-1,-1), 8),
        ('RIGHTPADDING',  (0,0), (-1,-1), 8),
        ('TOPPADDING',    (0,0), (-1,-1), 4),
        ('BOTTOMPADDING', (0,0), (-1,-1), 4),
        ('GRID',          (0,0), (-1,-1), 0.3, HexColor('#DDDDDD')),
    ]))
    story.append(rem_tbl_row)

story.append(Spacer(1, 0.4*cm))

# ══════════════════════════════════════════════════════════════════════════════
# SECTION 6 — PHARMACOKINETICS SUMMARY
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_bar('6.  PHARMACOKINETICS SUMMARY', TEAL))
story.append(Spacer(1, 0.25*cm))

pk_data = [
    [Paragraph('<b>Agent</b>', label_style),
     Paragraph('<b>Half-life</b>', label_style),
     Paragraph('<b>Lytic effect duration</b>', label_style),
     Paragraph('<b>Administration</b>', label_style),
     Paragraph('<b>Fibrin selectivity</b>', label_style)],
    ['Streptokinase', '~23 min', 'Up to 24 h', 'IV infusion 30–60 min',
     Paragraph('Non-selective', warn_style)],
    ['Alteplase (t-PA)', '<5 min', '4–6 h', 'IV infusion 60–90 min',
     Paragraph('Moderate', body)],
    ['Reteplase (r-PA)', '13–16 min', '~3–4 h', 'Double IV bolus × 2',
     Paragraph('Moderate', body)],
    ['Tenecteplase (TNK)', '~20 min', '~4–6 h', 'Single IV bolus (5 sec)',
     Paragraph('High', pstyle('_gn', fontSize=8.5, textColor=TEAL, fontName='Helvetica-Bold'))],
]

pk_tbl = Table(pk_data,
               colWidths=[3.0*cm, 2.2*cm, 2.5*cm, 3.5*cm, 2.8*cm],
               repeatRows=1)
pk_row_bg = []
for i in range(1, len(pk_data)):
    c = GREY_ROW if i % 2 == 0 else WHITE
    pk_row_bg.append(('BACKGROUND', (0, i), (-1, i), c))

pk_tbl.setStyle(TableStyle([
    ('BACKGROUND',    (0,0), (-1,0), TEAL),
    ('TEXTCOLOR',     (0,0), (-1,0), WHITE),
    ('FONTNAME',      (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',      (0,0), (-1,0), 8),
    ('ALIGN',         (0,0), (-1,-1), 'CENTER'),
    ('VALIGN',        (0,0), (-1,-1), 'MIDDLE'),
    ('GRID',          (0,0), (-1,-1), 0.4, HexColor('#CCCCCC')),
    ('TOPPADDING',    (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('FONTNAME',      (0,1), (0,-1), 'Helvetica-Bold'),
] + pk_row_bg))

story.append(pk_tbl)
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    'DISCLAIMER: This guide is a quick reference for educational and clinical decision-support purposes. '
    'Always verify doses against current institutional protocols, approved product information, and '
    'applicable clinical guidelines before administration. Individual patient factors may alter dosing.',
    footnote))

# ─── Build ────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=draw_bg, onLaterPages=draw_bg)
print("PDF built successfully.")

from reportlab.lib.pagesizes import A4
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, ListFlowable, ListItem
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT, TA_JUSTIFY
from reportlab.lib.colors import HexColor

# ── Palette ────────────────────────────────────────────────────────────────────
NAVY     = HexColor('#1B3A6B')
TEAL     = HexColor('#0D7377')
GREEN    = HexColor('#1E7E34')
ORANGE   = HexColor('#C95F02')
RED      = HexColor('#B00020')
PURPLE   = HexColor('#5B2D8E')
NAVY_BG  = HexColor('#EEF2FA')
TEAL_BG  = HexColor('#E0F4F4')
GREEN_BG = HexColor('#E8F5E9')
ORANGE_BG= HexColor('#FFF3E0')
RED_BG   = HexColor('#FFEBEE')
GREY     = HexColor('#F5F5F5')
WHITE    = colors.white
BLACK    = colors.black

PAGE_W, PAGE_H = A4
MARGIN = 1.8 * cm
W = PAGE_W - 2 * MARGIN

doc = SimpleDocTemplate(
    '/tmp/workspace/fibrinolytic-guide/ICU_Management_Learning_Roadmap.pdf',
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=2.4*cm, bottomMargin=2.0*cm,
    title='ICU Management — Complete Learning Roadmap',
    author='Orris Medical Reference'
)

styles = getSampleStyleSheet()

def ps(name, **kw):
    return ParagraphStyle(name, parent=styles.get('Normal', styles['Normal']), **kw)

title_s  = ps('T', fontSize=16, textColor=WHITE, fontName='Helvetica-Bold',
               alignment=TA_CENTER, leading=20)
h1       = ps('H1', fontSize=10.5, textColor=WHITE, fontName='Helvetica-Bold',
               leading=13, alignment=TA_LEFT)
h2       = ps('H2', fontSize=9, textColor=NAVY, fontName='Helvetica-Bold',
               leading=12, spaceBefore=4)
body     = ps('B', fontSize=8.5, fontName='Helvetica', leading=12)
bold_b   = ps('BB', fontSize=8.5, fontName='Helvetica-Bold', leading=12)
small    = ps('S', fontSize=7.5, fontName='Helvetica', leading=10,
               textColor=HexColor('#444444'))
fn       = ps('FN', fontSize=7, fontName='Helvetica-Oblique',
               textColor=HexColor('#666666'), leading=9)
warn     = ps('W', fontSize=8.5, fontName='Helvetica-Bold',
               textColor=RED, leading=12)
tip      = ps('TP', fontSize=8, fontName='Helvetica-Oblique',
               textColor=TEAL, leading=11)
label    = ps('LB', fontSize=8, fontName='Helvetica-Bold',
               textColor=WHITE, alignment=TA_CENTER, leading=11)
num_s    = ps('NUM', fontSize=18, fontName='Helvetica-Bold',
               textColor=WHITE, alignment=TA_CENTER, leading=22)

# ── Header/Footer ──────────────────────────────────────────────────────────────
def draw_page(canv, doc):
    canv.saveState()
    canv.setFillColor(NAVY)
    canv.rect(0, PAGE_H-1.8*cm, PAGE_W, 1.8*cm, fill=1, stroke=0)
    canv.setFillColor(TEAL)
    canv.rect(0, PAGE_H-1.95*cm, PAGE_W, 0.15*cm, fill=1, stroke=0)
    canv.setFillColor(WHITE)
    canv.setFont('Helvetica-Bold', 12)
    canv.drawString(MARGIN, PAGE_H-1.2*cm, 'ICU Management — Complete Learning Roadmap')
    canv.setFont('Helvetica', 8)
    canv.setFillColor(HexColor('#AAD4F0'))
    canv.drawRightString(PAGE_W-MARGIN, PAGE_H-1.2*cm, 'For Interns & Junior Residents')
    # footer
    canv.setFillColor(NAVY)
    canv.rect(0, 0, PAGE_W, 1.0*cm, fill=1, stroke=0)
    canv.setFillColor(HexColor('#AAD4F0'))
    canv.setFont('Helvetica', 7)
    canv.drawString(MARGIN, 0.38*cm,
        'Sources: Harrison\'s 22E · Tintinalli\'s EM · Goldman-Cecil · Washington Manual · Miller\'s Anesthesia · Braunwald\'s')
    canv.drawRightString(PAGE_W-MARGIN, 0.38*cm, f'Page {doc.page}')
    canv.restoreState()

# ── Helpers ────────────────────────────────────────────────────────────────────
def sec_bar(text, bg=NAVY, fg=WHITE, w=None):
    w = w or W
    t = Table([[Paragraph(text, ps('_s', fontSize=10, fontName='Helvetica-Bold',
                                    textColor=fg, leading=13))]],
              colWidths=[w])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0),(-1,-1), bg),
        ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6),
        ('LEFTPADDING',(0,0),(-1,-1),9),
    ]))
    return t

def two_col_bullets(left_items, right_items, bg_l=WHITE, bg_r=WHITE):
    left  = Paragraph(''.join(f'• {i}<br/>' for i in left_items),  small)
    right = Paragraph(''.join(f'• {i}<br/>' for i in right_items), small)
    t = Table([[left, right]], colWidths=[W/2-0.15*cm, W/2-0.15*cm])
    t.setStyle(TableStyle([
        ('VALIGN',(0,0),(-1,-1),'TOP'),
        ('BACKGROUND',(0,0),(0,0),bg_l),('BACKGROUND',(1,0),(1,0),bg_r),
        ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5),
        ('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6),
        ('GRID',(0,0),(-1,-1),0.3,HexColor('#CCCCCC')),
    ]))
    return t

def module_table(rows, col_widths, header_bg=NAVY):
    """rows[0] = header row, rest = data."""
    t = Table(rows, colWidths=col_widths, repeatRows=1)
    row_styles = []
    for i in range(1, len(rows)):
        c = GREY if i % 2 == 0 else WHITE
        row_styles.append(('BACKGROUND',(0,i),(-1,i),c))
    t.setStyle(TableStyle([
        ('BACKGROUND',(0,0),(-1,0), header_bg),
        ('TEXTCOLOR',(0,0),(-1,0), WHITE),
        ('FONTNAME',(0,0),(-1,0),'Helvetica-Bold'),
        ('FONTSIZE',(0,0),(-1,0),8),
        ('ALIGN',(0,0),(-1,-1),'LEFT'),
        ('VALIGN',(0,0),(-1,-1),'TOP'),
        ('GRID',(0,0),(-1,-1),0.3,HexColor('#CCCCCC')),
        ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4),
        ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),
    ] + row_styles))
    return t

# ══════════════════════════════════════════════════════════════════════════════
# STORY
# ══════════════════════════════════════════════════════════════════════════════
story = []

# ── INTRO ──────────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    'This roadmap organises ICU management into <b>10 core modules</b>. '
    'Work through them in order — earlier modules provide the physiology and monitoring '
    'foundation that later modules depend on. Each module includes key concepts, '
    'clinical decision frameworks, must-know drug doses, and common pitfalls.',
    body))
story.append(Spacer(1, 0.3*cm))

# ── CURRICULUM OVERVIEW ────────────────────────────────────────────────────────
story.append(sec_bar('CURRICULUM OVERVIEW — 10 CORE MODULES', NAVY))
story.append(Spacer(1, 0.2*cm))

overview_data = [
    [Paragraph('<b>#</b>', label), Paragraph('<b>Module</b>', label),
     Paragraph('<b>Core Focus</b>', label), Paragraph('<b>Priority</b>', label)],
    ['1', Paragraph('<b>ICU Fundamentals</b>', bold_b),
     Paragraph('Monitoring, lines, scoring systems (APACHE, SOFA, GCS)', small),
     Paragraph('★★★ Start here', ps('_p', fontSize=8, textColor=GREEN, fontName='Helvetica-Bold', leading=10))],
    ['2', Paragraph('<b>Airway & Ventilation</b>', bold_b),
     Paragraph('Intubation, mechanical ventilation modes, weaning', small),
     Paragraph('★★★ Essential', ps('_p2', fontSize=8, textColor=GREEN, fontName='Helvetica-Bold', leading=10))],
    ['3', Paragraph('<b>Sepsis & Septic Shock</b>', bold_b),
     Paragraph('Sepsis-3 definition, Surviving Sepsis bundles, vasopressors', small),
     Paragraph('★★★ Most common', ps('_p3', fontSize=8, textColor=GREEN, fontName='Helvetica-Bold', leading=10))],
    ['4', Paragraph('<b>Shock States</b>', bold_b),
     Paragraph('Hypovolaemic, cardiogenic, obstructive, distributive — diagnosis & resuscitation', small),
     Paragraph('★★★ Essential', ps('_p4', fontSize=8, textColor=GREEN, fontName='Helvetica-Bold', leading=10))],
    ['5', Paragraph('<b>ARDS & Respiratory Failure</b>', bold_b),
     Paragraph('Berlin definition, lung-protective ventilation, prone positioning', small),
     Paragraph('★★★ High yield', ps('_p5', fontSize=8, textColor=GREEN, fontName='Helvetica-Bold', leading=10))],
    ['6', Paragraph('<b>Haemodynamic Monitoring</b>', bold_b),
     Paragraph('Arterial lines, CVP, ScvO2, cardiac output, fluid responsiveness', small),
     Paragraph('★★ Important', ps('_p6', fontSize=8, textColor=TEAL, fontName='Helvetica-Bold', leading=10))],
    ['7', Paragraph('<b>AKI & Renal Support</b>', bold_b),
     Paragraph('KDIGO staging, indications for RRT, CRRT vs IHD', small),
     Paragraph('★★ Important', ps('_p7', fontSize=8, textColor=TEAL, fontName='Helvetica-Bold', leading=10))],
    ['8', Paragraph('<b>Neurological Emergencies</b>', bold_b),
     Paragraph('Raised ICP, status epilepticus, stroke in ICU, brain death', small),
     Paragraph('★★ Important', ps('_p8', fontSize=8, textColor=TEAL, fontName='Helvetica-Bold', leading=10))],
    ['9', Paragraph('<b>Metabolic & Endocrine Crises</b>', bold_b),
     Paragraph('DKA, HHS, adrenal crisis, thyroid storm, electrolytes', small),
     Paragraph('★★ Important', ps('_p9', fontSize=8, textColor=TEAL, fontName='Helvetica-Bold', leading=10))],
    ['10', Paragraph('<b>ICU Pharmacology & Procedures</b>', bold_b),
     Paragraph('Sedation/analgesia, anticoagulation, nutrition, line insertion', small),
     Paragraph('★★ Practical', ps('_p10', fontSize=8, textColor=TEAL, fontName='Helvetica-Bold', leading=10))],
]

ov_tbl = module_table(overview_data, [1.0*cm, 3.5*cm, 7.2*cm, 2.3*cm])
story.append(ov_tbl)
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 1 — ICU FUNDAMENTALS
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 1 — ICU FUNDAMENTALS', NAVY))
story.append(Spacer(1, 0.2*cm))

m1_data = [
    [Paragraph('<b>Topic</b>', label), Paragraph('<b>What to Know</b>', label)],
    [Paragraph('Scoring Systems', bold_b),
     Paragraph(
         '<b>SOFA score</b> (Sepsis-3): 6 organ systems (resp, coag, liver, CV, CNS, renal). '
         'Score ≥2 = organ dysfunction. Used to define sepsis.<br/>'
         '<b>qSOFA</b>: RR ≥22, AMS, SBP ≤100 — ≥2 = high-risk screen outside ICU.<br/>'
         '<b>APACHE II</b>: predicts ICU mortality (12 physiologic variables + age + chronic health).<br/>'
         '<b>GCS</b>: E(4)+V(5)+M(6)=15. GCS ≤8 = consider intubation.', small)],
    [Paragraph('ICU Monitoring\nEssentials', bold_b),
     Paragraph(
         '• Continuous ECG, SpO2, BP (arterial line preferred in unstable pts)<br/>'
         '• End-tidal CO2 (EtCO2) — confirms ETT placement; normal 35–45 mmHg<br/>'
         '• Temperature: target normothermia (36–37.5°C)<br/>'
         '• Urine output: target ≥0.5 mL/kg/h<br/>'
         '• ABG interpretation: assess oxygenation (PaO2, P/F ratio) and ventilation (PaCO2)', small)],
    [Paragraph('Vascular Access', bold_b),
     Paragraph(
         '<b>Central venous catheter (CVC)</b>: IJV, subclavian, femoral. Confirm with CXR.<br/>'
         'Complications: pneumothorax, arterial puncture, infection (CLABSI), thrombosis.<br/>'
         '<b>Arterial line</b>: radial (first choice), femoral. Continuous BP + ABG sampling.<br/>'
         '<b>Intraosseous (IO)</b>: emergency access when IV unavailable — tibia/sternum.', small)],
    [Paragraph('ICU Daily Goals', bold_b),
     Paragraph(
         'Use the "FAST HUGS" mnemonic:<br/>'
         '<b>F</b>eeding · <b>A</b>nalgesia · <b>S</b>edation · <b>T</b>hromboprophylaxis · '
         '<b>H</b>ead of bed 30–45° · <b>U</b>lcer prophylaxis · <b>G</b>lycaemic control · '
         '<b>S</b>pontaneous breathing trial daily', small)],
    [Paragraph('Glycaemic Control', bold_b),
     Paragraph(
         'Target blood glucose: <b>140–180 mg/dL</b> (7.8–10 mmol/L) in most ICU patients.<br/>'
         'Tight control (<110 mg/dL) increases hypoglycaemia risk — avoid.<br/>'
         'Use insulin infusion protocols for continuous monitoring.', small)],
]
story.append(module_table(m1_data, [2.8*cm, W-2.8*cm], NAVY))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 2 — AIRWAY & MECHANICAL VENTILATION
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 2 — AIRWAY & MECHANICAL VENTILATION', TEAL))
story.append(Spacer(1, 0.2*cm))

m2_data = [
    [Paragraph('<b>Topic</b>', label), Paragraph('<b>What to Know</b>', label)],
    [Paragraph('RSI\n(Rapid Sequence\nIntubation)', bold_b),
     Paragraph(
         '<b>Pre-oxygenate</b> 3–5 min with 100% O2 (NRB or BVM)<br/>'
         '<b>Sedative agents</b>: Ketamine 1–2 mg/kg IV (preferred in haemodynamic instability) '
         '| Etomidate 0.3 mg/kg (avoid in sepsis — adrenal suppression) '
         '| Propofol 1.5–2.5 mg/kg (avoid if hypotensive)<br/>'
         '<b>Paralytic</b>: Succinylcholine 1–1.5 mg/kg (avoid if hyperkalaemia, burns >48 h, '
         'neuromuscular disease) | Rocuronium 1.2 mg/kg (use if succinylcholine contraindicated)', small)],
    [Paragraph('Ventilator Modes', bold_b),
     Paragraph(
         '<b>AC/VC (Assist-Control Volume Control)</b>: set TV, RR, FiO2, PEEP — full support '
         'for each breath. Most common for initial intubation.<br/>'
         '<b>SIMV</b>: set mandatory breaths + allows spontaneous breaths between — '
         'less used due to ↑ WOB.<br/>'
         '<b>PSV (Pressure Support)</b>: patient-triggered, pressure-augmented — used for weaning.<br/>'
         '<b>PRVC</b>: dual-control mode targeting set VT with minimum pressure.', small)],
    [Paragraph('Initial Vent\nSettings', bold_b),
     Paragraph(
         '• <b>Tidal volume (TV)</b>: 6–8 mL/kg IBW (lung-protective; 4–6 mL/kg in ARDS)<br/>'
         '• <b>RR</b>: 12–16 breaths/min (adjust for PaCO2 target)<br/>'
         '• <b>FiO2</b>: start at 1.0 (100%), titrate down to SpO2 92–96% (88–92% in ARDS)<br/>'
         '• <b>PEEP</b>: 5 cmH2O baseline; ↑ in ARDS (8–15 cmH2O)<br/>'
         '• <b>I:E ratio</b>: 1:2 standard; 1:3 or longer in obstructive disease (asthma/COPD)', small)],
    [Paragraph('Lung-Protective\nVentilation\n(ARDS)', bold_b),
     Paragraph(
         '<b>ARDSNet protocol</b>: TV 6 mL/kg IBW, plateau pressure ≤30 cmH2O<br/>'
         'Target PaO2 55–80 mmHg or SpO2 88–95%<br/>'
         'Higher PEEP tables guided by FiO2 requirements<br/>'
         '<b>Prone positioning</b>: ≥16 h/day in moderate-severe ARDS (P/F <150) — '
         'reduces mortality (PROSEVA trial)<br/>'
         '<b>Neuromuscular blockade</b>: consider cisatracurium 48 h in severe ARDS (P/F <150)', small)],
    [Paragraph('Weaning &\nExtubation', bold_b),
     Paragraph(
         'Daily <b>SAT</b> (spontaneous awakening trial) + <b>SBT</b> (spontaneous breathing trial)<br/>'
         '<b>SBT criteria</b>: FiO2 ≤0.4, PEEP ≤5–8, haemodynamically stable, '
         'able to follow commands, intact cough<br/>'
         '<b>RSBI</b> (rapid shallow breathing index) = RR ÷ TV(L): <105 predicts successful extubation<br/>'
         'Extubate if passes 30–120 min SBT on T-piece or low PS', small)],
    [Paragraph('Vent Complications', bold_b),
     Paragraph(
         '<b>Barotrauma</b>: pneumothorax, pneumomediastinum — ↑ peak pressures<br/>'
         '<b>Volutrauma</b>: alveolar overdistension — large TV<br/>'
         '<b>VAP</b> (ventilator-associated pneumonia): HOB 30–45°, oral care, '
         'daily SBT to minimise ventilator days<br/>'
         '<b>Auto-PEEP</b> (air-trapping): in COPD/asthma — ↓ RR and ↑ expiratory time', small)],
]
story.append(module_table(m2_data, [2.8*cm, W-2.8*cm], TEAL))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 3 — SEPSIS & SEPTIC SHOCK
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 3 — SEPSIS & SEPTIC SHOCK', RED))
story.append(Spacer(1, 0.2*cm))

m3_data = [
    [Paragraph('<b>Topic</b>', label), Paragraph('<b>What to Know</b>', label)],
    [Paragraph('Definitions\n(Sepsis-3)', bold_b),
     Paragraph(
         '<b>Sepsis</b>: life-threatening organ dysfunction (SOFA ↑≥2) caused by dysregulated '
         'host response to infection.<br/>'
         '<b>Septic shock</b>: sepsis + vasopressor requirement to maintain MAP ≥65 mmHg AND '
         'lactate >2 mmol/L despite adequate fluid resuscitation.<br/>'
         '<b>SIRS</b> is no longer used to define sepsis (Sepsis-3, 2016).', small)],
    [Paragraph('Hour-1 Bundle\n(SSC 2018)', bold_b),
     Paragraph(
         '1. Measure lactate; re-measure if initial >2 mmol/L<br/>'
         '2. Blood cultures BEFORE antibiotics (×2 sets)<br/>'
         '3. Broad-spectrum antibiotics within <b>1 hour</b><br/>'
         '4. IV crystalloid 30 mL/kg for hypotension or lactate ≥4 mmol/L<br/>'
         '5. Vasopressors if MAP <65 mmHg despite fluids', small)],
    [Paragraph('Vasopressors', bold_b),
     Paragraph(
         '<b>Norepinephrine (NE)</b>: FIRST-LINE. 0.01–3 mcg/kg/min. α1>β1. '
         'Target MAP ≥65 mmHg.<br/>'
         '<b>Vasopressin</b>: ADD-ON to NE when NE ≥0.25–0.5 mcg/kg/min. '
         'Fixed dose 0.03–0.04 units/min. V1 receptor. Spares NE dose.<br/>'
         '<b>Epinephrine</b>: second-line add-on. Caution — ↑ lactate (β2 effect).<br/>'
         '<b>Dopamine</b>: no longer first-line (↑ arrhythmias). Consider in bradycardic shock.<br/>'
         '<b>Phenylephrine</b>: pure α1; use in tachycardia or NE unavailable.', small)],
    [Paragraph('Antibiotic\nStrategy', bold_b),
     Paragraph(
         'Start within <b>1 hour</b> of sepsis recognition (every hour delay ↑ mortality ~7%).<br/>'
         'Cover suspected source: community pneumonia (ceftriaxone + azithromycin), '
         'hospital/VAP (piperacillin-tazobactam or meropenem ± vancomycin), '
         'intra-abdominal (pip-tazo or meropenem ± metronidazole), '
         'UTI (ceftriaxone or ciprofloxacin).<br/>'
         'Add antifungal (fluconazole/micafungin) if immunocompromised or prolonged ICU stay.<br/>'
         '<b>De-escalate</b> at 48–72 h based on cultures and clinical response.', small)],
    [Paragraph('Corticosteroids', bold_b),
     Paragraph(
         'Consider <b>hydrocortisone 200 mg/day</b> IV (50 mg q6h or 200 mg continuous) '
         'if septic shock refractory to fluids + ≥2 vasopressors.<br/>'
         'ADRENAL and APROCCHSS trials: hydrocortisone shortens shock duration but no clear '
         'mortality benefit in all patients. Still recommended in refractory shock.', small)],
    [Paragraph('Fluid\nResuscitation', bold_b),
     Paragraph(
         'Initial: <b>30 mL/kg crystalloid</b> (balanced crystalloids preferred — LR or PlasmaLyte '
         'over 0.9% saline — ↓ hyperchloraemic acidosis and AKI).<br/>'
         'Re-assess with dynamic fluid responsiveness tests: <b>PLR</b> (passive leg raise) — '
         'if CO ↑>10%, fluid responsive. Or pulse pressure variation (PPV >13% = responsive).<br/>'
         'Avoid albumin as primary resuscitation fluid in sepsis (no mortality benefit). '
         '4% albumin may be used in refractory shock.', small)],
]
story.append(module_table(m3_data, [2.8*cm, W-2.8*cm], RED))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 4 — SHOCK STATES
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 4 — SHOCK STATES', ORANGE))
story.append(Spacer(1, 0.2*cm))

shock_data = [
    [Paragraph('<b>Type</b>', label),
     Paragraph('<b>Mechanism</b>', label),
     Paragraph('<b>Haemodynamics (CO / SVR / PCWP)</b>', label),
     Paragraph('<b>Management</b>', label)],
    [Paragraph('Hypovolaemic', bold_b),
     Paragraph('↓ preload (haemorrhage, dehydration, burns)', small),
     Paragraph('↓CO · ↑SVR · ↓PCWP', small),
     Paragraph('Fluid/blood replacement. Haemorrhagic: pRBC + FFP + platelets (1:1:1). '
               'Control source of bleeding.', small)],
    [Paragraph('Distributive\n(Septic)', bold_b),
     Paragraph('Vasodilation, maldistribution of flow', small),
     Paragraph('↑CO · ↓SVR · ↓PCWP (early)', small),
     Paragraph('Fluids + vasopressors (NE first-line). Antibiotics + source control.', small)],
    [Paragraph('Cardiogenic', bold_b),
     Paragraph('Pump failure (MI, myocarditis, arrhythmia)', small),
     Paragraph('↓CO · ↑SVR · ↑PCWP', small),
     Paragraph('Treat cause. Dobutamine (inotrope). IABP or Impella for refractory shock. '
               'Early revascularisation in MI.', small)],
    [Paragraph('Obstructive', bold_b),
     Paragraph('Mechanical obstruction to flow (PE, tamponade, tension PTX)', small),
     Paragraph('↓CO · ↑SVR · variable PCWP', small),
     Paragraph('<b>PE</b>: systemic thrombolysis or embolectomy.<br/>'
               '<b>Tamponade</b>: pericardiocentesis (needle or surgical).<br/>'
               '<b>Tension PTX</b>: immediate needle decompression → chest tube.', small)],
    [Paragraph('Neurogenic', bold_b),
     Paragraph('Loss of sympathetic tone (spinal cord injury)', small),
     Paragraph('↓CO · ↓SVR · normal PCWP; bradycardia', small),
     Paragraph('IV fluids + vasopressors (phenylephrine or NE). '
               'Atropine for bradycardia. Avoid hypotension — maintain MAP ≥85 mmHg in spinal injury.', small)],
]

story.append(module_table(shock_data, [2.2*cm, 2.8*cm, 3.5*cm, W-8.5*cm], ORANGE))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph(
    '<b>Key pearl:</b> Use RUSH exam (Rapid Ultrasound in Shock and Hypotension) — '
    'FAST + cardiac ECHO + IVC assessment — to rapidly classify shock type at bedside.',
    tip))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 5 — ARDS & RESPIRATORY FAILURE
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 5 — ARDS & RESPIRATORY FAILURE', TEAL))
story.append(Spacer(1, 0.2*cm))

m5_data = [
    [Paragraph('<b>Topic</b>', label), Paragraph('<b>What to Know</b>', label)],
    [Paragraph('Berlin Definition\nof ARDS (2012)', bold_b),
     Paragraph(
         'All 4 criteria required:<br/>'
         '1. Acute onset ≤7 days<br/>'
         '2. Bilateral opacities on CXR/CT (not fully explained by effusion/collapse/nodules)<br/>'
         '3. Not fully explained by cardiac failure or fluid overload<br/>'
         '4. P/F ratio (PaO2/FiO2): Mild 200–300, Moderate 100–200, Severe <100 (on PEEP ≥5)', small)],
    [Paragraph('Types of\nRespiratory\nFailure', bold_b),
     Paragraph(
         '<b>Type 1 (Hypoxaemic)</b>: ↓PaO2, normal or ↓PaCO2. Causes: pneumonia, ARDS, PE, '
         'pulmonary oedema. Rx: supplemental O2, NIV, intubation.<br/>'
         '<b>Type 2 (Hypercapnic)</b>: ↑PaCO2 (>45 mmHg) + ↓PaO2. '
         'Causes: COPD exacerbation, asthma, neuromuscular disease. '
         'Rx: NIV (BiPAP) first-line in COPD exacerbation.', small)],
    [Paragraph('NIV / High-Flow\nO2', bold_b),
     Paragraph(
         '<b>CPAP</b>: continuous positive pressure, single level. Use in OSA, cardiogenic pulm oedema.<br/>'
         '<b>BiPAP</b>: IPAP (inspiratory) + EPAP (expiratory). Use in COPD exacerbation, '
         'hypercapnic failure. IPAP 10–20, EPAP 4–8 cmH2O initially.<br/>'
         '<b>High-flow nasal cannula (HFNC)</b>: up to 60 L/min 100% O2. For hypoxaemic failure. '
         'Can reduce intubation rate in non-hypercapnic patients.', small)],
    [Paragraph('ARDS: Beyond\nVentilation', bold_b),
     Paragraph(
         '<b>Prone positioning</b>: ≥16 h/day — survival benefit when P/F <150 (PROSEVA trial)<br/>'
         '<b>Conservative fluid strategy</b>: after resuscitation, target net-even or negative balance '
         '(FACTT trial showed ↓ ventilator days)<br/>'
         '<b>Neuromuscular blockade</b>: cisatracurium infusion 48 h for severe ARDS (P/F <150)<br/>'
         '<b>Corticosteroids</b>: methylprednisolone may be considered in moderate-severe ARDS '
         'not resolving (controversial; some benefit in early ARDS)<br/>'
         '<b>ECMO</b>: veno-venous ECMO as rescue therapy for severe refractory ARDS (P/F <80)', small)],
    [Paragraph('Status\nAsthmaticus', bold_b),
     Paragraph(
         'Continuous nebulised salbutamol + ipratropium. IV magnesium sulphate 2 g over 20 min.<br/>'
         'IV hydrocortisone 200 mg or methylprednisolone 1–2 mg/kg.<br/>'
         'Heliox, ketamine infusion for bronchospasm.<br/>'
         '<b>If intubated</b>: permissive hypercapnia acceptable. Low RR (8–12), long expiratory '
         'time (I:E 1:4), monitor for auto-PEEP. Avoid excessive PEEP.', small)],
]
story.append(module_table(m5_data, [2.8*cm, W-2.8*cm], TEAL))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 6 — HAEMODYNAMIC MONITORING
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 6 — HAEMODYNAMIC MONITORING', PURPLE))
story.append(Spacer(1, 0.2*cm))

m6_data = [
    [Paragraph('<b>Parameter</b>', label),
     Paragraph('<b>Normal</b>', label),
     Paragraph('<b>Clinical Significance</b>', label)],
    ['MAP', '65–90 mmHg',
     Paragraph('MAP = DBP + 1/3(PP). Target ≥65 in shock; ≥85 in neurogenic shock/TBI', small)],
    ['CVP', '2–8 mmHg',
     Paragraph('Reflects right atrial pressure. Limited value alone. Trend more useful than single value. '
               'Very high CVP: RV failure, cardiac tamponade', small)],
    ['ScvO2', '≥70%',
     Paragraph('Central venous O2 saturation (SVC). <70% = ↑ O2 extraction (↑ demand or ↓ supply). '
               'Used as target in early sepsis resuscitation.', small)],
    ['Cardiac Output\n(CO)', '4–8 L/min',
     Paragraph('CO = HR × SV. Measured by PA catheter (thermodilution), PiCCO, or echo. '
               'Cardiac index = CO/BSA; normal 2.4–4.0 L/min/m²', small)],
    ['SVR', '800–1200 dyn·s/cm⁵',
     Paragraph('SVR = (MAP-CVP) × 80 / CO. ↑SVR in cardiogenic/hypovolaemic shock; '
               '↓SVR in distributive shock.', small)],
    ['Pulse Pressure\nVariation (PPV)', '<13%',
     Paragraph('PPV >13% during mechanical ventilation predicts fluid responsiveness '
               '(only valid in sinus rhythm, no spontaneous breathing, TV ≥8 mL/kg)', small)],
    ['Passive Leg\nRaise (PLR)', 'CO ↑>10%',
     Paragraph('Reversible volume challenge. Most reliable fluid responsiveness test. '
               'Effective in AF, spontaneous breathing, and small TV.', small)],
    ['Lactate', '<2 mmol/L',
     Paragraph('Marker of tissue hypoperfusion. >2 = concern; >4 = high-risk. '
               'Target clearance ≥10% per 2 h in sepsis. '
               'Elevated lactate ≠ always anaerobic (epinephrine, liver failure also ↑ lactate)', small)],
]
story.append(module_table(m6_data, [2.5*cm, 2.2*cm, W-4.7*cm], PURPLE))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 7 — AKI & RENAL SUPPORT
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 7 — AKI & RENAL SUPPORT', NAVY))
story.append(Spacer(1, 0.2*cm))

m7_data = [
    [Paragraph('<b>Topic</b>', label), Paragraph('<b>What to Know</b>', label)],
    [Paragraph('KDIGO AKI\nStaging', bold_b),
     Paragraph(
         '<b>Stage 1</b>: SCr ×1.5–1.9 baseline OR ↑ ≥0.3 mg/dL in 48 h OR UO <0.5 mL/kg/h ×6 h<br/>'
         '<b>Stage 2</b>: SCr ×2–2.9 OR UO <0.5 mL/kg/h ×12 h<br/>'
         '<b>Stage 3</b>: SCr ×3 or ≥4 mg/dL OR UO <0.3 mL/kg/h ×24 h or anuria ×12 h<br/>'
         'Or initiation of RRT or eGFR <35 mL/min/1.73 m²', small)],
    [Paragraph('Causes &\nWorkup', bold_b),
     Paragraph(
         '<b>Pre-renal</b>: hypovolaemia, sepsis, cardiorenal syndrome. FENa <1%, FeUrea <35%<br/>'
         '<b>Intrinsic</b>: ATN (most common in ICU — ischaemia or nephrotoxins), GN, AIN<br/>'
         '<b>Post-renal</b>: obstruction — bladder US essential<br/>'
         'Check nephrotoxins: aminoglycosides, contrast, NSAIDs, vancomycin, ACEi<br/>'
         'Avoid contrast if AKI; use iso-osmolar contrast + hydration if necessary', small)],
    [Paragraph('Indications\nfor RRT\n(AEIOU)', bold_b),
     Paragraph(
         '<b>A</b>cidosis: pH <7.1–7.2 refractory to treatment<br/>'
         '<b>E</b>lectrolytes: hyperkalaemia >6.5 mmol/L or ECG changes despite medical Rx<br/>'
         '<b>I</b>ngestion: dialysable toxin (lithium, methanol, ethylene glycol, salicylates, metformin)<br/>'
         '<b>O</b>verload: fluid overload refractory to diuretics<br/>'
         '<b>U</b>raemia: uraemic pericarditis/encephalopathy; BUN typically >100–150 mg/dL', small)],
    [Paragraph('RRT Modalities', bold_b),
     Paragraph(
         '<b>IHD</b> (intermittent haemodialysis): efficient, 3–5 h sessions, for haemodynamically stable.<br/>'
         '<b>CRRT</b> (continuous): CVVH, CVVHD, CVVHDF — preferred in haemodynamically unstable ICU patients. '
         'Slower, better tolerated, gentler fluid removal.<br/>'
         '<b>SLED</b> (sustained low-efficiency dialysis): hybrid — 8–12 h/day, intermediate choice.', small)],
    [Paragraph('Hyperkalaemia\nManagement', bold_b),
     Paragraph(
         '1. <b>Calcium gluconate 10%</b> 10–20 mL IV over 10 min (membrane stabilisation; '
         'acts in 1–3 min, lasts 30–60 min)<br/>'
         '2. <b>Insulin 10 U + 50 mL 50% dextrose</b> IV (↓ K⁺ by 0.6–1 mmol/L in 30 min)<br/>'
         '3. <b>Salbutamol</b> 10–20 mg nebulised (synergistic with insulin; ↓ K⁺ 0.5–1 mmol/L)<br/>'
         '4. <b>Sodium bicarbonate</b> if severe metabolic acidosis<br/>'
         '5. <b>Kayexalate / patiromer</b> (↑ elimination — slow onset)<br/>'
         '6. <b>Dialysis</b> if refractory or RRT already indicated', small)],
]
story.append(module_table(m7_data, [2.8*cm, W-2.8*cm], NAVY))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 8 — NEUROLOGICAL EMERGENCIES
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 8 — NEUROLOGICAL EMERGENCIES IN ICU', RED))
story.append(Spacer(1, 0.2*cm))

m8_data = [
    [Paragraph('<b>Condition</b>', label), Paragraph('<b>Key Management</b>', label)],
    [Paragraph('Raised ICP &\nTBI', bold_b),
     Paragraph(
         'Target: ICP <20 mmHg, CPP (MAP–ICP) 60–70 mmHg, MAP ≥85 mmHg.<br/>'
         '• HOB 30–45°, midline head position<br/>'
         '• Osmotherapy: <b>Mannitol 20%</b> 0.25–1 g/kg IV q4–6 h (watch serum osm <320); '
         'OR <b>Hypertonic saline 3%</b> 2 mL/kg (preferred if hyponatraemia or haemodynamic instability)<br/>'
         '• Hyperventilate to PaCO2 30–35 mmHg (short-term bridge only — ↑ cerebral ischaemia risk)<br/>'
         '• Avoid hyperthermia, hypoxia, hypotension, hyponatraemia<br/>'
         '• Neurosurgery for haematoma evacuation, decompressive craniectomy', small)],
    [Paragraph('Status\nEpilepticus', bold_b),
     Paragraph(
         '<b>0–5 min</b>: Lorazepam 0.1 mg/kg IV (max 4 mg) or diazepam 0.15 mg/kg IV. '
         'Repeat once if no response.<br/>'
         '<b>5–20 min (if continues)</b>: Load with <b>levetiracetam 60 mg/kg IV</b> over 10 min '
         '(preferred) OR phenytoin/fosphenytoin 20 mg/kg OR valproate 40 mg/kg<br/>'
         '<b>>20–40 min (refractory)</b>: Intubate + <b>propofol</b>, <b>midazolam</b>, or <b>phenobarbital</b> infusion. '
         'Continuous EEG monitoring.<br/>'
         'Check glucose, electrolytes, ABG, toxicology screen.', small)],
    [Paragraph('Stroke in ICU\n(Ischaemic)', bold_b),
     Paragraph(
         'Alteplase 0.9 mg/kg IV (max 90 mg) within 3–4.5 h of onset (if no contraindications).<br/>'
         'Mechanical thrombectomy for large vessel occlusion within 24 h.<br/>'
         'BP target pre-thrombolysis: <185/110 mmHg. Post-thrombolysis: <180/105 mmHg × 24 h.<br/>'
         'Aspirin 300 mg if not thrombolysed. Avoid hypotension; permissive hypertension to 220/120 if no lysis.', small)],
    [Paragraph('Haemorrhagic\nStroke / SAH', bold_b),
     Paragraph(
         '<b>ICH</b>: Reverse anticoagulation urgently. BP target SBP <140 mmHg within 1 h (if 150–220). '
         'Surgical haematoma evacuation if >30 mL cerebellar, brainstem compression, or hydrocephalus.<br/>'
         '<b>SAH</b>: Nimodipine 60 mg q4h PO × 21 days (prevents vasospasm). '
         'Target systolic <160 mmHg before aneurysm secured. '
         'Coil embolisation or surgical clipping.', small)],
    [Paragraph('Delirium in ICU\n(CAM-ICU)', bold_b),
     Paragraph(
         'ICU delirium occurs in 60–80% of mechanically ventilated patients — ↑ mortality, '
         'longer ICU stay.<br/>'
         '<b>Non-pharmacologic</b> (first-line): reorientation, sleep hygiene, early mobilisation, '
         'family presence, minimize restraints.<br/>'
         '<b>ABCDEF bundle</b>: Awakening, Breathing, Coordination, Delirium screening, '
         'Early mobility, Family engagement.<br/>'
         '<b>Pharmacologic</b>: haloperidol 0.5–2 mg IV q6–12h (limited evidence); '
         'quetiapine if prolonged; <b>avoid benzodiazepines</b> — worsen delirium.', small)],
    [Paragraph('Brain Death', bold_b),
     Paragraph(
         'Prerequisites: known cause, normothermia, no sedatives/metabolic confounders.<br/>'
         'Clinical: coma, absent brainstem reflexes (pupillary, corneal, oculocephalic, gag, cough), '
         'apnoea test +ve (PaCO2 ↑≥20 mmHg from baseline, no respiratory effort).<br/>'
         'Confirmatory tests (if apnoea test inconclusive): EEG (isoelectric), CBF (no flow), SSEP.', small)],
]
story.append(module_table(m8_data, [2.8*cm, W-2.8*cm], RED))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 9 — METABOLIC & ENDOCRINE CRISES
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 9 — METABOLIC & ENDOCRINE CRISES', ORANGE))
story.append(Spacer(1, 0.2*cm))

m9_data = [
    [Paragraph('<b>Condition</b>', label), Paragraph('<b>Diagnosis</b>', label),
     Paragraph('<b>Management</b>', label)],
    [Paragraph('DKA', bold_b),
     Paragraph('BG >250 mg/dL, pH <7.3, bicarb <18, ketonuria/ketonaemia', small),
     Paragraph(
         '1. IV fluids: 1 L 0.9% NaCl over 1 h, then 250–500 mL/h<br/>'
         '2. Insulin: 0.1 U/kg/h infusion (no bolus in most protocols; '
         'start only when K⁺ ≥3.5)<br/>'
         '3. Potassium: replace if K⁺ <5.5 (add 20–40 mEq/L to IV fluids)<br/>'
         '4. Monitor: glucose q1h, electrolytes q2–4h, pH<br/>'
         '5. Transition to SC insulin when pH >7.3, anion gap normal, able to eat', small)],
    [Paragraph('HHS', bold_b),
     Paragraph('BG typically >600 mg/dL, osmolality >320, minimal ketosis, pH >7.3', small),
     Paragraph(
         'More profound dehydration than DKA. Fluid deficit 8–12 L.<br/>'
         '0.9% NaCl until haemodynamically stable, then 0.45% NaCl.<br/>'
         'Insulin infusion at lower rates (0.05 U/kg/h). '
         'Correct glucose slowly (≤50 mg/dL/h to avoid cerebral oedema).<br/>'
         'Anticoagulation: high VTE risk.', small)],
    [Paragraph('Adrenal Crisis', bold_b),
     Paragraph('Shock, hyponatraemia, hyperkalaemia, hypoglycaemia in at-risk patients', small),
     Paragraph(
         '<b>Hydrocortisone 100 mg IV STAT</b>, then 50 mg q6h or 200 mg/24 h infusion.<br/>'
         'IV fluids (0.9% NaCl), correct hypoglycaemia with dextrose.<br/>'
         'Do not delay for cortisol result if clinically suspected.', small)],
    [Paragraph('Thyroid Storm', bold_b),
     Paragraph('Fever, tachycardia, AMS, AF — Burch-Wartofsky score ≥45', small),
     Paragraph(
         '1. PTU 500–1000 mg loading PO/NG, then 250 mg q4h (blocks T4→T3 conversion)<br/>'
         '2. Iodine (1 h AFTER PTU): Lugol\'s iodine 5–10 drops TID<br/>'
         '3. Propranolol 60–80 mg PO/NG q4–6h (↓ HR, blocks T4→T3 peripherally)<br/>'
         '4. Hydrocortisone 100 mg IV q8h<br/>'
         '5. Treat precipitant (infection, surgery)', small)],
    [Paragraph('Hyponatraemia\n(ICU)', bold_b),
     Paragraph('Na⁺ <130 meq/L with neuro symptoms (seizures, coma)', small),
     Paragraph(
         'Severe symptomatic: <b>3% NaCl 100–150 mL IV over 20 min</b> × 1–3 boluses. '
         'Target Na⁺ ↑4–6 mEq/L in first few hours (stop when symptoms resolve).<br/>'
         'Max correction: <b>8–10 mEq/L per 24 h</b> (10–12 if very severe). '
         'Exceeding this risks osmotic demyelination syndrome (ODS).<br/>'
         'Treat underlying cause (SIADH, hypovolaemia, etc.)', small)],
]
story.append(module_table(m9_data, [2.2*cm, 3.2*cm, W-5.4*cm], ORANGE))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# MODULE 10 — ICU PHARMACOLOGY & PROCEDURES
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('MODULE 10 — ICU PHARMACOLOGY, SEDATION & PROCEDURES', TEAL))
story.append(Spacer(1, 0.2*cm))

m10_data = [
    [Paragraph('<b>Topic</b>', label), Paragraph('<b>Key Points</b>', label)],
    [Paragraph('Sedation\n(ABCDEF Bundle)', bold_b),
     Paragraph(
         '<b>Target</b>: RASS –1 to –2 (light sedation preferred over deep).<br/>'
         '<b>Propofol</b>: 5–50 mcg/kg/min. Rapid onset/offset. Risk: propofol infusion syndrome '
         '(PRIS) at >4 mg/kg/h >48 h — monitor TG, lactic acidosis, ECG.<br/>'
         '<b>Midazolam</b>: 0.02–0.1 mg/kg/h. Accumulates; prolonged sedation. '
         'Avoid in elderly/renal failure (active metabolite).<br/>'
         '<b>Dexmedetomidine</b>: alpha-2 agonist, 0.2–1.5 mcg/kg/h. Analgo-sedation, '
         'patient cooperative, no respiratory depression — preferred in delirium-prone patients.<br/>'
         '<b>Ketamine</b>: 0.1–0.5 mg/kg/h infusion for analgosedation. Maintains airway reflexes.', small)],
    [Paragraph('Analgesia\n(Pain First)', bold_b),
     Paragraph(
         'Analgesia-first approach: treat pain before sedation.<br/>'
         '<b>Fentanyl</b>: 25–100 mcg/h infusion. Short-acting, titrable. Preferred in renal failure.<br/>'
         '<b>Morphine</b>: longer acting; active metabolites accumulate in renal failure.<br/>'
         '<b>Acetaminophen</b> 1 g q6h IV — reduces opioid requirement.<br/>'
         '<b>Ketamine</b> sub-dissociative 0.1–0.3 mg/kg/h — opioid-sparing.<br/>'
         'Use CPOT (Critical-Care Pain Observation Tool) or NRS to assess pain.', small)],
    [Paragraph('DVT\nProphylaxis', bold_b),
     Paragraph(
         '<b>Pharmacologic (preferred)</b>: Enoxaparin 40 mg SC daily '
         '(30 mg SC BD if BMI >30 or high-risk). Unfrac heparin 5000 U SC q8–12h if renal failure.<br/>'
         '<b>Mechanical</b>: graduated compression stockings (GCS) + intermittent pneumatic compression (IPC) '
         '— use when anticoagulation contraindicated.<br/>'
         'Contraindications to pharmacologic: active bleeding, platelets <50,000, recent neurosurgery.', small)],
    [Paragraph('Stress Ulcer\nProphylaxis', bold_b),
     Paragraph(
         'Indicated in: mechanical ventilation >48 h, coagulopathy, shock, severe burns, TBI, '
         'high-dose steroids.<br/>'
         '<b>PPI</b>: pantoprazole 40 mg IV/PO daily (first-line).<br/>'
         '<b>H2-blocker</b>: ranitidine 150 mg PO q12h or famotidine 20 mg IV q12h '
         '(less expensive, use if PPI unavailable).<br/>'
         'Discontinue when enteral feeds established and risk factors resolve.', small)],
    [Paragraph('ICU Nutrition', bold_b),
     Paragraph(
         '<b>Start early enteral nutrition (EN) within 24–48 h</b> if haemodynamically stable.<br/>'
         'Target: 25–30 kcal/kg/day; protein 1.2–2.0 g/kg/day.<br/>'
         'Gastric residual volumes: check q4–6h; hold if >500 mL (ACC guidelines) or use post-pyloric tube.<br/>'
         '<b>Parenteral nutrition (PN)</b>: use only if EN not tolerated for >7 days (or earlier if malnourished).<br/>'
         'Avoid overfeeding — worsens hyperglycaemia, hypercapnia, immune dysfunction.', small)],
    [Paragraph('Anticoagulation\nin ICU', bold_b),
     Paragraph(
         '<b>UFH (unfractionated heparin)</b>: IV infusion for VTE treatment, AF, PE, STEMI. '
         'Monitored by aPTT (target 60–100 s).<br/>'
         '<b>LMWH (enoxaparin)</b>: therapeutic 1 mg/kg SC q12h (1.5 mg/kg daily in VTE). '
         'Monitor anti-Xa in renal failure.<br/>'
         '<b>Reversal</b>: Protamine for heparin (1 mg per 100 U UFH); '
         'andexanet alfa for anti-Xa agents; idarucizumab for dabigatran.', small)],
]
story.append(module_table(m10_data, [2.8*cm, W-2.8*cm], TEAL))
story.append(Spacer(1, 0.5*cm))

# ══════════════════════════════════════════════════════════════════════════════
# STUDY PLAN TABLE
# ══════════════════════════════════════════════════════════════════════════════
story.append(sec_bar('SUGGESTED STUDY PLAN — 10 WEEKS', NAVY))
story.append(Spacer(1, 0.2*cm))

plan_data = [
    [Paragraph('<b>Week</b>', label), Paragraph('<b>Module</b>', label),
     Paragraph('<b>Recommended Resources</b>', label),
     Paragraph('<b>Clinical Skill to Practise</b>', label)],
    ['1–2', 'M1: ICU Fundamentals',
     Paragraph('Washington Manual Ch. on ICU; Harrison\'s ICU chapter', small),
     Paragraph('FAST HUGS daily checklist, GCS assessment, ABG interpretation', small)],
    ['2–3', 'M2: Airway & Ventilation',
     Paragraph('Morgan & Mikhail\'s Anesthesiology (ventilation chapter); Miller\'s Anesthesia', small),
     Paragraph('Vent mode selection, RSI drug doses by memory', small)],
    ['3–4', 'M3: Sepsis & Shock',
     Paragraph('Surviving Sepsis Campaign guidelines; Goldman-Cecil; Tintinalli\'s EM', small),
     Paragraph('Hour-1 bundle by memory, vasopressor dose titration', small)],
    ['4', 'M4: Shock States',
     Paragraph('Tintinalli\'s EM (shock chapter); RUSH exam videos', small),
     Paragraph('RUSH protocol on POCUS', small)],
    ['5', 'M5: ARDS',
     Paragraph('ARDSNet protocol; Fishman\'s Pulmonary; Murray & Nadel', small),
     Paragraph('Lung-protective ventilation settings, prone positioning protocol', small)],
    ['6', 'M6: Haemodynamic Monitoring',
     Paragraph('Braunwald\'s Heart Disease; Goldman-Cecil (haemodynamics)', small),
     Paragraph('PLR test, arterial line waveform interpretation', small)],
    ['7', 'M7: AKI & RRT',
     Paragraph('Comprehensive Clinical Nephrology; KDIGO AKI guidelines 2012', small),
     Paragraph('KDIGO staging, hyperkalaemia algorithm, CRRT prescription', small)],
    ['8', 'M8: Neuro Emergencies',
     Paragraph('Harrison\'s 22E (neurology section); Washington Manual', small),
     Paragraph('CAM-ICU scoring, status epilepticus protocol', small)],
    ['9', 'M9: Metabolic Crises',
     Paragraph('Harrison\'s 22E (endocrine); Goldman-Cecil', small),
     Paragraph('DKA insulin protocol, hyponatraemia correction calculation', small)],
    ['10', 'M10: Pharmacology & Procedures',
     Paragraph('Washington Manual (pharmacology section); Roberts & Hedges (procedures)', small),
     Paragraph('Sedation scoring (RASS), CVC insertion steps, nutrition prescription', small)],
]

plan_tbl = module_table(plan_data, [1.2*cm, 3.0*cm, 4.5*cm, W-8.7*cm], NAVY)
story.append(plan_tbl)
story.append(Spacer(1, 0.3*cm))

# ── KEY PEARLS ─────────────────────────────────────────────────────────────────
story.append(sec_bar('TOP 10 ICU CLINICAL PEARLS', TEAL))
story.append(Spacer(1, 0.2*cm))

pearls = [
    ('1.', 'Always treat pain first (analgesia-first approach) before reaching for sedatives.'),
    ('2.', 'SpO2 92–96% is acceptable — targeting 100% causes oxygen toxicity and ↑ mortality.'),
    ('3.', 'In septic shock, norepinephrine is first-line. Dopamine is no longer recommended.'),
    ('4.', 'Use 6 mL/kg IBW tidal volume in ALL intubated patients (not just ARDS) — reduces VAP and VILI.'),
    ('5.', 'Passive leg raise tests fluid responsiveness without giving a single drop — reversible and safe.'),
    ('6.', 'In hyperkalaemia: calcium first (membrane stabilisation), insulin + dextrose second.'),
    ('7.', 'Do not correct hyponatraemia faster than 8–10 mEq/L per 24 h — risk of osmotic demyelination.'),
    ('8.', 'Daily SAT + SBT shortens ventilator time and ICU length of stay (proven in multiple RCTs).'),
    ('9.', 'Prone positioning ≥16 h/day reduces mortality in moderate-severe ARDS (P/F <150).'),
    ('10.', 'Start enteral nutrition within 24–48 h of ICU admission whenever haemodynamically stable.'),
]
pearl_rows = [[Paragraph(f'<b>{n}</b>', ps('_pn', fontSize=9, fontName='Helvetica-Bold',
                                            textColor=TEAL, alignment=TA_CENTER, leading=12)),
               Paragraph(p, body)] for n, p in pearls]

pearl_tbl = Table(pearl_rows, colWidths=[0.8*cm, W-0.8*cm])
p_styles = []
for i in range(len(pearls)):
    c = TEAL_BG if i % 2 == 0 else WHITE
    p_styles.append(('BACKGROUND', (0,i), (-1,i), c))
pearl_tbl.setStyle(TableStyle([
    ('VALIGN',(0,0),(-1,-1),'MIDDLE'),
    ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),
    ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4),
    ('GRID',(0,0),(-1,-1),0.3,HexColor('#CCCCCC')),
] + p_styles))
story.append(pearl_tbl)
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    'DISCLAIMER: This guide is compiled from authoritative medical textbooks '
    '(Harrison\'s 22E, Tintinalli\'s EM, Goldman-Cecil, Washington Manual, Miller\'s Anesthesia, '
    'Braunwald\'s Heart Disease, Fishman\'s Pulmonary) and is intended for educational use. '
    'Always verify doses and protocols against current local guidelines and approved drug information. '
    'Individualise management for each patient.',
    fn))

# ── Build ──────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=draw_page, onLaterPages=draw_page)
print("ICU Roadmap PDF built successfully.")