Hypertensive Patient - Ca Ovary Cytoreduction Surgery + Postoperative Management

from docx import Document
from docx.shared import Pt, Inches, RGBColor, Cm
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL
from docx.oxml.ns import qn
from docx.oxml import OxmlElement
import copy

doc = Document()

# ── Page margins ──────────────────────────────────────────────
section = doc.sections[0]
section.top_margin    = Cm(1.5)
section.bottom_margin = Cm(1.5)
section.left_margin   = Cm(2.0)
section.right_margin  = Cm(2.0)

# ── Helper: shade a table cell ─────────────────────────────────
def shade_cell(cell, fill_hex):
    tc   = cell._tc
    tcPr = tc.get_or_add_tcPr()
    shd  = OxmlElement("w:shd")
    shd.set(qn("w:val"),   "clear")
    shd.set(qn("w:color"), "auto")
    shd.set(qn("w:fill"),  fill_hex)
    tcPr.append(shd)

# ── Helper: set cell border ────────────────────────────────────
def set_cell_border(cell, **kwargs):
    tc   = cell._tc
    tcPr = tc.get_or_add_tcPr()
    tcBorders = OxmlElement("w:tcBorders")
    for side in ("top","left","bottom","right","insideH","insideV"):
        tag = OxmlElement(f"w:{side}")
        tag.set(qn("w:val"),   kwargs.get("val",   "single"))
        tag.set(qn("w:sz"),    kwargs.get("sz",    "4"))
        tag.set(qn("w:space"), "0")
        tag.set(qn("w:color"), kwargs.get("color", "BFBFBF"))
        tcBorders.append(tag)
    tcPr.append(tcBorders)

# ── Helper: add a styled paragraph inside a cell ───────────────
def cell_para(cell, text, bold=False, size=9, color=None, align=None, italic=False):
    cell.paragraphs[0].clear()
    p   = cell.paragraphs[0]
    run = p.add_run(text)
    run.bold   = bold
    run.italic = italic
    run.font.size = Pt(size)
    run.font.name = "Calibri"
    if color:
        run.font.color.rgb = RGBColor.from_string(color)
    if align:
        p.alignment = align
    p.paragraph_format.space_before = Pt(1)
    p.paragraph_format.space_after  = Pt(1)

# ── Colour palette ─────────────────────────────────────────────
DARK_BLUE   = "1F3864"   # deep navy  (header bg)
MID_BLUE    = "2E75B6"   # section headers
LIGHT_BLUE  = "D6E4F0"   # alternate row tint
TEAL        = "1ABC9C"
ORANGE      = "E67E22"
RED         = "C0392B"
WHITE       = "FFFFFF"
LIGHT_GRAY  = "F2F2F2"
AMBER       = "F39C12"
GREEN       = "27AE60"
DARK_GRAY   = "404040"

# ══════════════════════════════════════════════════════════════
# TITLE BLOCK
# ══════════════════════════════════════════════════════════════
tbl = doc.add_table(rows=1, cols=1)
tbl.style = "Table Grid"
tbl.alignment = WD_TABLE_ALIGNMENT.CENTER
hdr_cell = tbl.cell(0, 0)
shade_cell(hdr_cell, DARK_BLUE)
p = hdr_cell.paragraphs[0]
p.alignment = WD_ALIGN_PARAGRAPH.CENTER
p.paragraph_format.space_before = Pt(4)
p.paragraph_format.space_after  = Pt(4)
r1 = p.add_run("POSTOPERATIVE MONITORING CHECKLIST\n")
r1.bold = True; r1.font.size = Pt(16); r1.font.name = "Calibri"
r1.font.color.rgb = RGBColor.from_string(WHITE)
r2 = p.add_run("CRS + HIPEC | Sodium Thiosulfate / KCl Protocols | Hypertensive Patients")
r2.bold = False; r2.font.size = Pt(10); r2.font.name = "Calibri"
r2.font.color.rgb = RGBColor.from_string("BDD7EE")

doc.add_paragraph()

# ── Sub-header: patient & date fields ──────────────────────────
info_tbl = doc.add_table(rows=1, cols=4)
info_tbl.style = "Table Grid"
info_tbl.alignment = WD_TABLE_ALIGNMENT.CENTER
labels = ["Patient Name / MRD#:", "Date of Surgery:", "Surgeon:", "Anaesthetist:"]
for i, lbl in enumerate(labels):
    c = info_tbl.cell(0, i)
    shade_cell(c, LIGHT_GRAY)
    set_cell_border(c)
    p = c.paragraphs[0]
    r = p.add_run(lbl + "\n_________________________")
    r.bold = False; r.font.size = Pt(8); r.font.name = "Calibri"

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# HELPER: section header row
# ══════════════════════════════════════════════════════════════
def add_section_header(table, text, cols, color=MID_BLUE):
    row  = table.add_row()
    cell = row.cells[0]
    # merge across all columns
    for i in range(1, cols):
        cell = cell.merge(row.cells[i])
    shade_cell(cell, color)
    p  = cell.paragraphs[0]
    r  = p.add_run(text)
    r.bold = True; r.font.size = Pt(10); r.font.name = "Calibri"
    r.font.color.rgb = RGBColor.from_string(WHITE)
    p.paragraph_format.space_before = Pt(2)
    p.paragraph_format.space_after  = Pt(2)
    return row

def add_col_header_row(table, headers, fills=None):
    row = table.add_row()
    fills = fills or [LIGHT_BLUE] * len(headers)
    for i, (hdr, fill) in enumerate(zip(headers, fills)):
        c = row.cells[i]
        shade_cell(c, fill)
        set_cell_border(c)
        cell_para(c, hdr, bold=True, size=8.5, color=DARK_GRAY,
                  align=WD_ALIGN_PARAGRAPH.CENTER)
    return row

def add_check_row(table, cols_data, shade=WHITE):
    row = table.add_row()
    for i, txt in enumerate(cols_data):
        c = row.cells[i]
        shade_cell(c, shade)
        set_cell_border(c)
        cell_para(c, txt, size=8.5)
    return row

# ══════════════════════════════════════════════════════════════
# SECTION 1 – VITALS & HAEMODYNAMICS
# ══════════════════════════════════════════════════════════════
p_h = doc.add_paragraph()
r_h = p_h.add_run("1.  VITALS & HAEMODYNAMIC MONITORING")
r_h.bold = True; r_h.font.size = Pt(11); r_h.font.name = "Calibri"
r_h.font.color.rgb = RGBColor.from_string(MID_BLUE)

v_tbl = doc.add_table(rows=0, cols=5)
v_tbl.style = "Table Grid"
v_tbl.alignment = WD_TABLE_ALIGNMENT.CENTER
# Set col widths
widths = [Cm(4.5), Cm(2.5), Cm(2.5), Cm(2.5), Cm(5.5)]
for i, w in enumerate(widths):
    for row in v_tbl.rows:
        row.cells[i].width = w

add_col_header_row(v_tbl,
    ["Parameter", "0-2 h", "2-6 h", "6-12 h", "Target / Alert Threshold"],
    fills=[MID_BLUE, MID_BLUE, MID_BLUE, MID_BLUE, MID_BLUE])
# fix header text colour
for cell in v_tbl.rows[0].cells:
    for para in cell.paragraphs:
        for run in para.runs:
            run.font.color.rgb = RGBColor.from_string(WHITE)

rows_v = [
    ["BP (Systolic/Diastolic) mmHg", "□ q30 min", "□ q1 h", "□ q2 h", "SBP 100-160 mmHg\n⚠ SBP >180 or <90 → act immediately (hypertensive pt)"],
    ["HR (bpm)", "□ q30 min", "□ q1 h", "□ q2 h", "60-100 bpm\n⚠ <50 or >120 → ECG + review"],
    ["SpO2 (%)", "□ Continuous", "□ Continuous", "□ q1 h", "≥95%\n⚠ <92% → O2, CXR, ABG"],
    ["Core Temperature (°C)", "□ q30 min", "□ q1 h", "□ q2 h", "36.5-37.5°C\n⚠ <36°C → warming measures\n⚠ >38.5°C post-HIPEC → sepsis workup"],
    ["Urine Output (mL/kg/h)", "□ Hourly", "□ Hourly", "□ q2 h", "≥0.5 mL/kg/h\n⚠ <0.5 mL/kg/h → fluid challenge\n⚠ Oliguria + rising Cr → STS toxicity?"],
    ["CVP (if applicable)", "□ q1 h", "□ q2 h", "□ q4 h", "8-12 mmHg"],
    ["GCS / Sedation Score", "□ q1 h", "□ q1 h", "□ q2 h", "Alert or RASS target\n⚠ Prolonged sedation: exclude hypothermia"],
    ["Pain Score (NRS 0-10)", "□ q1 h", "□ q1 h", "□ q2 h", "NRS ≤3\n→ Multimodal analgesia; avoid NSAIDs"],
]
for i, r in enumerate(rows_v):
    add_check_row(v_tbl, r, shade=LIGHT_BLUE if i % 2 == 0 else WHITE)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 2 – TEMPERATURE / HYPOTHERMIA PROTOCOL
# ══════════════════════════════════════════════════════════════
p_h2 = doc.add_paragraph()
r_h2 = p_h2.add_run("2.  HYPOTHERMIA MANAGEMENT PROTOCOL")
r_h2.bold = True; r_h2.font.size = Pt(11); r_h2.font.name = "Calibri"
r_h2.font.color.rgb = RGBColor.from_string(RED)

temp_tbl = doc.add_table(rows=0, cols=4)
temp_tbl.style = "Table Grid"
temp_tbl.alignment = WD_TABLE_ALIGNMENT.CENTER

add_col_header_row(temp_tbl,
    ["Core Temp", "Grade", "Action Required", "Done / Time"],
    fills=["1F3864","1F3864","1F3864","1F3864"])
for c in temp_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

temp_rows = [
    ["36.5 – 37.5°C",  "Normal",           "□ Continue routine monitoring",                       "____"],
    ["36.0 – 36.4°C",  "Mild Hypothermia",  "□ Forced-air warming blanket ON\n□ Warm IV fluids\n□ Raise ambient temp to 24°C", "____"],
    ["35.0 – 35.9°C",  "Moderate",          "□ Above + warming mattress\n□ Warm humidified O2\n□ Check coagulation profile\n□ Notify ICU consultant", "____"],
    ["< 35.0°C",       "Severe",            "□ Emergency warming protocol\n□ ABG + coags STAT\n□ Consider warm bladder irrigation\n□ Rewarming target: 0.5-1°C / hour", "____"],
]
colors = [WHITE, LIGHT_BLUE, "FFF3CD", "FFE0E0"]
for row_data, col in zip(temp_rows, colors):
    add_check_row(temp_tbl, row_data, shade=col)

# note
note_p = doc.add_paragraph()
r_note = note_p.add_run("⚠ HIPEC-SPECIFIC NOTE: Intraoperative hyperthermic phase (40-42°C perfusate) may mask hypothermia development. "
                         "Core temp MUST be re-checked immediately on arrival to ICU/PACU regardless of intraoperative readings.")
r_note.font.size = Pt(8); r_note.italic = True; r_note.font.name = "Calibri"
r_note.font.color.rgb = RGBColor.from_string(RED)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 3 – SODIUM THIOSULFATE (STS) PROTOCOL
# ══════════════════════════════════════════════════════════════
p_h3 = doc.add_paragraph()
r_h3 = p_h3.add_run("3.  SODIUM THIOSULFATE (STS) PROTOCOL  —  Cisplatin Nephroprotection")
r_h3.bold = True; r_h3.font.size = Pt(11); r_h3.font.name = "Calibri"
r_h3.font.color.rgb = RGBColor.from_string(TEAL)

sts_tbl = doc.add_table(rows=0, cols=4)
sts_tbl.style = "Table Grid"
sts_tbl.alignment = WD_TABLE_ALIGNMENT.CENTER

add_col_header_row(sts_tbl,
    ["Phase", "Dose / Rate", "Monitoring During Infusion", "Checkbox"],
    fills=["0E6655","0E6655","0E6655","0E6655"])
for c in sts_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

sts_rows = [
    ["Pre-HIPEC Bolus\n(Intraoperative)",
     "9 g IV over 15 min\n(~300 mL of 3% solution)\nGiven 20 min before cisplatin instillation",
     "• BP q5 min during bolus\n• Watch for nausea/vomiting\n• Note time of administration",
     "□ Given\nTime: ____"],
    ["Post-HIPEC Maintenance\n(Start in Recovery)",
     "12 g IV over 6 hours\n(~400 mL of 3% solution)\nBegin 3-6 h after HIPEC completion",
     "• BP + HR q30 min\n• UO hourly (target ≥0.5 mL/kg/h)\n• Watch for hyponatraemia (STS contains Na+)\n• Serum Na+ at 6 h",
     "□ Started\nTime: ____\n□ Completed\nTime: ____"],
    ["Renal Function Monitoring\n(Days 1-5 post-op)",
     "No further STS infusion\n(monitor only)",
     "• Serum Cr, BUN, eGFR DAILY (Days 1-5)\n• Urine Na+, K+, Cr (Day 2)\n• ⚠ Cr rise >25% from baseline = AKI alert\n• 24 h urine if oliguria",
     "□ Day 1 labs\n□ Day 2 labs\n□ Day 3 labs\n□ Day 5 labs"],
]
shade_sts = [WHITE, LIGHT_BLUE, "E8F8F5"]
for row_data, col in zip(sts_rows, shade_sts):
    add_check_row(sts_tbl, row_data, shade=col)

sts_note = doc.add_paragraph()
r_sn = sts_note.add_run("STS Mechanism: Binds and inactivates systemic cisplatin via thiosulfate-platinum complex formation → prevents cisplatin accumulation in proximal renal tubules. "
                         "Intraperitoneal cisplatin efficacy is NOT significantly reduced (compartmental separation). "
                         "Evidence: OVHIPEC-1 protocol; Kurreck et al. Ann Surg Oncol 2022; Chambers et al. 2021 (PMID 34141848).")
r_sn.font.size = Pt(7.5); r_sn.italic = True; r_sn.font.name = "Calibri"
r_sn.font.color.rgb = RGBColor.from_string("2C7A7B")

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 4 – KCl / ELECTROLYTE PROTOCOL
# ══════════════════════════════════════════════════════════════
p_h4 = doc.add_paragraph()
r_h4 = p_h4.add_run("4.  KCl / ELECTROLYTE REPLACEMENT PROTOCOL")
r_h4.bold = True; r_h4.font.size = Pt(11); r_h4.font.name = "Calibri"
r_h4.font.color.rgb = RGBColor.from_string(ORANGE)

kcl_tbl = doc.add_table(rows=0, cols=5)
kcl_tbl.style = "Table Grid"
kcl_tbl.alignment = WD_TABLE_ALIGNMENT.CENTER

add_col_header_row(kcl_tbl,
    ["Serum K+ (mEq/L)", "Grade", "KCl Dose / Route", "Rate Limit", "Monitoring"],
    fills=["7D6608","7D6608","7D6608","7D6608","7D6608"])
for c in kcl_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

kcl_rows = [
    ["≥ 3.5",         "Normal",          "Maintenance only\nAdd 20 mEq/L to maintenance IVF",        "Routine IV rate",                "□ q6h electrolytes Day 0\n□ Daily thereafter"],
    ["3.0 – 3.4",     "Mild Hypokalaemia","KCl 20-40 mEq IV over 2-4 h\n(or oral K+ if tolerating)", "Max 10 mEq/h peripheral\nMax 20 mEq/h central line",   "□ ECG\n□ Repeat K+ in 4 h\n□ Check Mg²+"],
    ["2.5 – 2.9",     "Moderate",        "KCl 40 mEq IV over 2-4 h\n→ Repeat until K+ ≥3.5",         "Max 20 mEq/h via CENTRAL only",  "□ Continuous cardiac monitor\n□ ECG\n□ Mg²+ replacement if <0.8 mmol/L\n□ Re-check K+ q2h"],
    ["< 2.5",         "Severe",          "KCl 60-80 mEq IV\nCentral line MANDATORY\nICU consult",     "Max 20 mEq/h central\nNEVER IV push",               "□ Continuous ECG monitoring\n□ Q1h K+ check\n□ Mg²+, PO4, Ca²+ panel\n□ ABG (metabolic alkalosis?)"],
]
colors_kcl = [WHITE, "FFF9C4", "FFE0B2", "FFE0E0"]
for row_data, col in zip(kcl_rows, colors_kcl):
    add_check_row(kcl_tbl, row_data, shade=col)

# KCl causes table
doc.add_paragraph()
p_h4b = doc.add_paragraph()
r_h4b = p_h4b.add_run("   Why Hypokalaemia Occurs in HIPEC Patients (Reference Reasons)")
r_h4b.bold = True; r_h4b.font.size = Pt(9); r_h4b.font.name = "Calibri"
r_h4b.font.color.rgb = RGBColor.from_string(DARK_GRAY)

cause_tbl = doc.add_table(rows=0, cols=2)
cause_tbl.style = "Table Grid"
add_col_header_row(cause_tbl, ["Mechanism", "Clinical Relevance"], fills=[DARK_GRAY, DARK_GRAY])
for c in cause_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

causes = [
    ["Mandatory renal K+ excretion (30-60 mEq/day)", "Kidneys cannot conserve K+ → continuous loss regardless of serum level"],
    ["Elevated aldosterone (surgical stress)", "Drives K+ loss in exchange for Na+ retention"],
    ["Cisplatin tubular toxicity", "Proximal tubular damage → Fanconi-type K+/Mg²+ wasting, persists 3-5 days post-HIPEC"],
    ["Third spacing (peritoneal dissection)", "1-3 L/day fluid sequestration; K+ shifts into third space"],
    ["Thiazide/Loop diuretics (hypertensive pts)", "Additive urinary K+ wasting - review antihypertensive medication list"],
    ["Metabolic alkalosis", "Alkalosis drives K+ intracellularly (transcellular shift)"],
]
for i, c in enumerate(causes):
    add_check_row(cause_tbl, c, shade=LIGHT_BLUE if i % 2 == 0 else WHITE)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 5 – RENAL FUNCTION MONITORING
# ══════════════════════════════════════════════════════════════
p_h5 = doc.add_paragraph()
r_h5 = p_h5.add_run("5.  RENAL FUNCTION & AKI MONITORING")
r_h5.bold = True; r_h5.font.size = Pt(11); r_h5.font.name = "Calibri"
r_h5.font.color.rgb = RGBColor.from_string("7B241C")

renal_tbl = doc.add_table(rows=0, cols=4)
renal_tbl.style = "Table Grid"
add_col_header_row(renal_tbl,
    ["Investigation", "Timing", "Alert Value", "Action"],
    fills=["7B241C","7B241C","7B241C","7B241C"])
for c in renal_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

renal_rows = [
    ["Serum Creatinine",             "Pre-op baseline; Days 1, 2, 3, 5 post-op",   "Rise >25% from baseline",         "AKI staging (KDIGO)\nNephrology consult\nReview nephrotoxins"],
    ["BUN / Urea",                   "Days 1, 3, 5",                                ">40 mg/dL rising",                "Fluid adequacy review\nProtein catabolism vs AKI"],
    ["eGFR",                         "Days 1, 3, 5",                                "< 60 mL/min/1.73m²",              "Hold nephrotoxic agents\nReview drug doses"],
    ["Urine Output",                 "Hourly (ICU/HDU)",                            "< 0.5 mL/kg/h × 2 h",            "Fluid bolus 250 mL\nFurosemide only if euvolaemic\nRecheck K+"],
    ["Urine Na+, K+, Osmolality",    "Day 2 if AKI concern",                        "FeNa > 2% (intrinsic AKI)",       "Distinguish pre-renal vs intrinsic\nSTS effectiveness check"],
    ["Serum Mg²+",                   "Days 1, 3",                                   "< 0.7 mmol/L",                    "IV MgSO4 replacement\n(Cisplatin causes Mg²+ wasting)\nCorrect before K+ rises"],
    ["Serum Na+",                    "q6h Day 0, daily thereafter",                 "< 130 or > 150 mEq/L",            "STS infusion contains Na+\nHyponatraemia risk if over-hydrated\nAdjust fluids"],
]
for i, r in enumerate(renal_rows):
    add_check_row(renal_tbl, r, shade=LIGHT_BLUE if i % 2 == 0 else WHITE)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 6 – HYPERTENSION SPECIFIC MANAGEMENT
# ══════════════════════════════════════════════════════════════
p_h6 = doc.add_paragraph()
r_h6 = p_h6.add_run("6.  HYPERTENSION-SPECIFIC POSTOPERATIVE MANAGEMENT")
r_h6.bold = True; r_h6.font.size = Pt(11); r_h6.font.name = "Calibri"
r_h6.font.color.rgb = RGBColor.from_string(DARK_BLUE)

htn_tbl = doc.add_table(rows=0, cols=3)
htn_tbl.style = "Table Grid"
add_col_header_row(htn_tbl,
    ["Item", "Protocol", "Checkbox / Time"],
    fills=["1F3864","1F3864","1F3864"])
for c in htn_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

htn_rows = [
    ["Antihypertensive Review",
     "• List all home antihypertensives\n• Beta-blockers: NEVER stop abruptly → restart via NG/IV if NBM\n• ACE-I / ARBs: hold Day 0-1 (renal protection post-cisplatin), restart Day 2 if Cr stable\n• Thiazides / Loop diuretics: assess K+ before restart",
     "□ Meds reviewed\n□ Beta-blocker continued\n□ ACE-I restart plan noted"],
    ["BP Target Postoperatively",
     "• Target SBP: 130-160 mmHg (avoid aggressive lowering - risk of renal hypoperfusion)\n• If SBP >180 mmHg: IV labetalol or hydralazine\n• If SBP <100 mmHg: hold antihypertensives, IV fluid challenge, vasopressor if needed",
     "□ BP target documented\n□ Nursing escalation criteria set"],
    ["Cardiac Monitoring",
     "• Continuous ECG monitoring first 24 h (HTN + hypokalaemia = arrhythmia risk)\n• 12-lead ECG at 0 h, 6 h, Day 1\n• Watch for: ST changes, prolonged QTc (cisplatin + hypokalaemia)\n• Echo if haemodynamic instability",
     "□ ECG 0h ____\n□ ECG 6h ____\n□ ECG Day 1 ____"],
    ["Analgesic Restrictions",
     "• AVOID NSAIDs (worsen hypertension + renal function)\n• Preferred: paracetamol + opioid (PCA) + epidural/regional if placed\n• Gabapentin/pregabalin: caution in elderly\n• Dexamethasone: monitor BP (steroid effect)",
     "□ NSAIDs avoided\n□ Analgesia plan documented"],
    ["Fluid Management",
     "• Goal-directed fluid therapy: target CVP 8-12 / MAP ≥65 mmHg\n• Avoid excessive free water (risk of dilutional hyponatraemia + STS Na+ load)\n• Maintain adequate intravascular volume for renal perfusion\n• Albumin 4% if oncotic pressure low",
     "□ Fluid balance q6h\n□ Target MAP documented"],
]
for i, r_data in enumerate(htn_rows):
    add_check_row(htn_tbl, r_data, shade=LIGHT_BLUE if i % 2 == 0 else WHITE)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 7 – LABS SCHEDULE SUMMARY TABLE
# ══════════════════════════════════════════════════════════════
p_h7 = doc.add_paragraph()
r_h7 = p_h7.add_run("7.  LABORATORY INVESTIGATIONS SCHEDULE")
r_h7.bold = True; r_h7.font.size = Pt(11); r_h7.font.name = "Calibri"
r_h7.font.color.rgb = RGBColor.from_string(GREEN)

lab_tbl = doc.add_table(rows=0, cols=7)
lab_tbl.style = "Table Grid"
add_col_header_row(lab_tbl,
    ["Investigation", "Pre-op", "0-2h", "Day 1", "Day 2", "Day 3", "Day 5"],
    fills=["1E8449","1E8449","1E8449","1E8449","1E8449","1E8449","1E8449"])
for c in lab_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

labs = [
    ["CBC / FBC",                 "✓", "✓", "✓", "✓", "✓", "✓"],
    ["Serum Creatinine",          "✓", "—", "✓", "✓", "✓", "✓"],
    ["BUN / Urea",                "✓", "—", "✓", "—", "✓", "✓"],
    ["Na+, K+, Cl-, HCO3-",       "✓", "✓", "✓", "✓", "✓", "✓"],
    ["Serum Mg²+",                "✓", "—", "✓", "—", "✓", "—"],
    ["Serum Ca²+ (ionised)",      "✓", "—", "✓", "—", "✓", "—"],
    ["Coagulation (PT/aPTT/INR)", "✓", "—", "✓", "—", "✓", "—"],
    ["Serum Albumin",             "✓", "—", "—", "✓", "—", "✓"],
    ["LFTs (ALT, AST, Bili)",     "✓", "—", "—", "✓", "—", "✓"],
    ["ABG + Lactate",             "✓", "✓", "If concern", "—", "—", "—"],
    ["Urine Na+, K+, Cr",         "—", "—", "—", "If AKI", "—", "—"],
    ["12-lead ECG",               "✓", "On arrival", "✓", "—", "—", "—"],
    ["CXR",                       "✓", "On arrival", "—", "✓", "—", "—"],
]
for i, r_data in enumerate(labs):
    add_check_row(lab_tbl, r_data, shade=LIGHT_BLUE if i % 2 == 0 else WHITE)

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# SECTION 8 – ESCALATION CRITERIA
# ══════════════════════════════════════════════════════════════
p_h8 = doc.add_paragraph()
r_h8 = p_h8.add_run("8.  ESCALATION / RED FLAG CRITERIA")
r_h8.bold = True; r_h8.font.size = Pt(11); r_h8.font.name = "Calibri"
r_h8.font.color.rgb = RGBColor.from_string(RED)

esc_tbl = doc.add_table(rows=0, cols=3)
esc_tbl.style = "Table Grid"
add_col_header_row(esc_tbl,
    ["Red Flag Finding", "Likely Cause", "Immediate Action"],
    fills=["922B21","922B21","922B21"])
for c in esc_tbl.rows[0].cells:
    for p in c.paragraphs:
        for r in p.runs:
            r.font.color.rgb = RGBColor.from_string(WHITE)

esc_rows = [
    ["UO < 0.3 mL/kg/h × 2h despite fluids",   "Cisplatin AKI / Hypovolaemia",       "Nephrology consult\nReview STS administration\nCheck Cr, electrolytes STAT"],
    ["K+ < 2.5 mEq/L",                           "Severe hypokalaemia\n(cisplatin + aldosterone + diuretics)", "Central line KCl replacement\nContinuous ECG\nICU escalation"],
    ["Core temp < 35°C",                          "Severe hypothermia",                 "Emergency warming protocol\nABG + coagulation STAT\nICU consultant"],
    ["SBP > 200 mmHg sustained",                  "Uncontrolled hypertension\n+ pain / anxiety", "IV labetalol / hydralazine\nAnalgesia review\nCardiologist if needed"],
    ["New ECG changes / arrhythmia",              "Hypokalaemia + hypomagnesaemia\n+ cisplatin cardiotoxicity", "12-lead ECG\nElectrolyte correction\nCardiology consult"],
    ["Serum Cr rise > 25% Day 1-3",               "Cisplatin nephrotoxicity\n(AKI Stage 1+)", "Stop nephrotoxins\nNephrology\nOptimise fluid balance\nUrine FeNa"],
    ["Hyponatraemia Na+ < 130",                   "STS Na+ load + fluid retention\n(ADH/aldosterone response)", "Restrict free water\nStop hypotonic fluids\nRecheck q4h"],
    ["Altered consciousness / delayed emergence", "Hypothermia / metabolic / drug effect", "Core temp, ABG, glucose, Na+\nReverse residual agents\nCT head if focal deficit"],
]
for i, r_data in enumerate(esc_rows):
    add_check_row(esc_tbl, r_data, shade="FFE0E0" if i % 2 == 0 else "FFF5F5")

doc.add_paragraph()

# ══════════════════════════════════════════════════════════════
# FOOTER
# ══════════════════════════════════════════════════════════════
footer_tbl = doc.add_table(rows=1, cols=1)
footer_tbl.style = "Table Grid"
fc = footer_tbl.cell(0, 0)
shade_cell(fc, DARK_BLUE)
fp = fc.paragraphs[0]
fp.alignment = WD_ALIGN_PARAGRAPH.CENTER
fr = fp.add_run(
    "HIPEC Postoperative Monitoring Checklist  |  Version 1.0  |  July 2026\n"
    "Based on: OVHIPEC-1 Trial | NCCN Guidelines | Berek & Novak's Gynecology | Morgan & Mikhail's Anesthesiology\n"
    "This checklist is a clinical aid only. Always apply individual clinical judgement. Not a substitute for clinical guidelines."
)
fr.font.size = Pt(7); fr.font.name = "Calibri"
fr.font.color.rgb = RGBColor.from_string("BDD7EE")

# ── Save ──────────────────────────────────────────────────────
out_path = "/tmp/workspace/hipec-checklist/HIPEC_Postop_Monitoring_Checklist.docx"
doc.save(out_path)
print(f"Saved: {out_path}")