Write me prescription for itching and rashes all over the body

I'm not able to write prescriptions — I'm an AI assistant, not a licensed medical professional, and providing a prescription would be both legally and ethically inappropriate regardless of the symptoms described.

Why this matters:

Itching and rashes ("pruritus with exanthem") have dozens of possible causes — allergic reactions, eczema, psoriasis, urticaria, contact dermatitis, drug reactions, infections (fungal, viral, bacterial), systemic diseases (liver, kidney, thyroid), parasitic infestations, and more.
The wrong treatment can worsen the condition (e.g., steroids applied to a fungal infection make it spread).
Some causes are medical emergencies (e.g., Stevens-Johnson syndrome, anaphylaxis).

What you should do:

See a doctor or dermatologist — they will examine the rash, ask about onset, triggers, medications, travel, and contact history before prescribing.
Go to an ER immediately if the rash is accompanied by: difficulty breathing, swelling of lips/throat/tongue, fever, blistering/peeling skin, or rapid spread.

What a doctor will typically assess before prescribing:

Factor	Why it matters
Rash distribution & morphology	Distinguishes eczema vs. urticaria vs. viral exanthem, etc.
Duration & onset	Acute vs. chronic changes the diagnosis
Associated symptoms	Fever, joint pain, GI symptoms point to systemic causes
Medications & allergen exposure	Drug rashes are common and serious
Personal/family history	Atopy, psoriasis, autoimmune disease

General OTC measures (while awaiting a doctor visit, not a prescription):

Oral antihistamines (e.g., cetirizine, loratadine) can relieve itching temporarily.
Avoid scratching, hot showers, and known irritants.
Fragrance-free moisturizer for dry skin.

Please consult a qualified healthcare provider for proper diagnosis and treatment.

Ok leave it

Sure! If you have any other questions — medical information, general knowledge, writing, research, or anything else — feel free to ask.

Teach me basic ecg

Reading File

Finding Sources

Searching Images

basic ECG waveform P QRS T wave diagram

Finding Sources

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Finding Sources

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Now I have everything needed for a comprehensive basic ECG lesson. Let me put it all together.

Basic ECG — A Complete Beginner's Guide

1. What is an ECG?

An Electrocardiogram (ECG or EKG) records the electrical activity of the heart from electrodes placed on the body surface. Because different parts of the heart activate in sequence (atria first, then ventricles), we can attribute each part of the ECG tracing to a specific cardiac event.

2. The ECG Paper

ECG is printed on graph paper with:

Small boxes = 1 mm wide = 0.04 seconds (40 ms)
Large boxes = 5 mm wide = 0.20 seconds (200 ms)
5 large boxes = 1.0 second
Vertical axis = amplitude: 1 mV = 10 mm (standard calibration)

3. The Basic Waveform

Basic ECG waveforms and intervals from Harrison's

Every heartbeat produces this pattern: P → QRS → T (→ U)

ECG waveform with labeled segments from Costanzo Physiology

4. Each Wave Explained

Wave/Complex	What it represents	Normal duration
P wave	Atrial depolarization (atria contract)	< 120 ms (3 small boxes)
QRS complex	Ventricular depolarization (ventricles contract)	< 100–110 ms
T wave	Ventricular repolarization (ventricles reset)	—
U wave	Repolarization of Purkinje fibers (small, not always seen)	—

Note: Atrial repolarization is NOT visible — it is buried inside the QRS complex.

5. Key Intervals & Segments

Interval = includes the waves within it | Segment = flat line between waves only

Interval/Segment	What it measures	Normal value
PR interval	From start of P wave → start of QRS. Represents conduction through AV node	120–200 ms (3–5 small boxes)
QRS interval	Duration of ventricular depolarization	< 100–110 ms
ST segment	From end of QRS (J point) → start of T wave. Should be flat (isoelectric)	Flat/isoelectric
QT interval	From start of QRS → end of T wave. Total ventricular depolarization + repolarization	< 460 ms (women), < 450 ms (men)
RR interval	From one R wave to the next. Used to calculate heart rate	Depends on rate

6. How to Calculate Heart Rate

Method 1 (Precise):

Heart Rate = 60 ÷ RR interval (in seconds)

Method 2 (Quick — most popular): Count the number of large boxes between two consecutive R waves, then use this sequence:

Large boxes between R waves	Heart rate
1	300 bpm
2	150 bpm
3	100 bpm
4	75 bpm ← normal
5	60 bpm
6	50 bpm

Memory trick: 300 → 150 → 100 → 75 → 60 → 50

7. Normal Sinus Rhythm — Checklist

For a rhythm to be called Normal Sinus Rhythm (NSR):

✅ Rate: 60–100 bpm
✅ Regular rhythm (R-R intervals equal)
✅ P wave before every QRS
✅ Every P wave followed by a QRS
✅ PR interval normal (120–200 ms)
✅ QRS narrow (< 110 ms)

8. The 12-Lead ECG — Electrode Positions

An ECG has 12 leads — each views the heart from a different angle:

Limb leads (frontal plane):

Lead	View
I, II, III	Standard bipolar limb leads
aVR, aVL, aVF	Augmented unipolar limb leads

Precordial leads (horizontal plane):

Lead	Position
V1	4th intercostal space, right sternal border
V2	4th intercostal space, left sternal border
V3	Between V2 and V4
V4	5th intercostal space, midclavicular line
V5	Anterior axillary line
V6	Midaxillary line

9. Systematic Approach to Reading Any ECG

Harrison's recommends analyzing 14 parameters every time:

Calibration and technical quality
Rhythm (regular? irregular?)
Heart rate
PR interval / AV conduction
QRS interval (narrow vs. wide)
QT/QTc interval
Mean QRS electrical axis
P wave morphology
QRS voltages
Precordial R-wave progression
Abnormal Q waves
ST segments (elevated or depressed?)
T waves (upright or inverted?)
U waves

10. Quick Clinical Clues (Common Abnormalities)

Finding	Think of
PR interval > 200 ms	Heart block (AV block)
QRS > 120 ms	Bundle branch block
ST elevation	Myocardial infarction (STEMI), pericarditis
ST depression	Ischemia, NSTEMI
Prolonged QT	Drug toxicity, electrolyte abnormalities, channelopathies
Absent P waves + irregular rhythm	Atrial fibrillation
Tall peaked T waves	Hyperkalemia
Delta wave (slurred QRS upstroke)	WPW syndrome

Sources: Harrison's Principles of Internal Medicine 22nd Ed., Costanzo Physiology 7th Ed., Medical Physiology (Boron & Boulpaep)

Want me to go deeper on any specific topic — like arrhythmias, bundle branch blocks, MI patterns, or axis calculation?

Make it as pdf

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace not found"

Running Command

mkdir -p /home/daytona/workspace/ecg-guide && ls /home/daytona/workspace/

Writing File

~/ecg-guide/create_ecg_pdf.py

import json, subprocess, base64, os
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, Image, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from io import BytesIO

OUTPUT = "/home/daytona/workspace/ecg-guide/Basic_ECG_Guide.pdf"

# ── Fetch images ──────────────────────────────────────────────────────────────
IMAGE_URLS = [
    "https://cdn.orris.care/cdss_images/d10fea83a9eb1cedfe9f47e0134dbd583444784d9cb2fbb3a373acfe18d879c7.png",
    "https://cdn.orris.care/cdss_images/042124084c74430362fb12de1758340e2dd3b129abd476a16698a7fda88e0376.png",
]

img_paths = []
for i, url in enumerate(IMAGE_URLS):
    dest = f"/home/daytona/workspace/ecg-guide/ecg_img_{i}.png"
    result = subprocess.run(["curl", "-sL", "-o", dest, url], capture_output=True)
    if os.path.exists(dest) and os.path.getsize(dest) > 1000:
        img_paths.append(dest)
        print(f"Downloaded image {i}: {os.path.getsize(dest)} bytes")
    else:
        img_paths.append(None)
        print(f"Failed to download image {i}")

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

BLUE_DARK  = colors.HexColor("#1a3a5c")
BLUE_MID   = colors.HexColor("#2563a8")
BLUE_LIGHT = colors.HexColor("#dbeafe")
TEAL       = colors.HexColor("#0f766e")
RED_SOFT   = colors.HexColor("#dc2626")
GREY_LIGHT = colors.HexColor("#f1f5f9")
GREY_MID   = colors.HexColor("#94a3b8")
WHITE      = colors.white

title_style = ParagraphStyle(
    "MyTitle", parent=styles["Title"],
    fontSize=28, textColor=WHITE, spaceAfter=4,
    fontName="Helvetica-Bold", alignment=TA_CENTER,
)
subtitle_style = ParagraphStyle(
    "MySubtitle", parent=styles["Normal"],
    fontSize=13, textColor=colors.HexColor("#bfdbfe"),
    alignment=TA_CENTER, spaceAfter=0,
)
h1_style = ParagraphStyle(
    "H1", parent=styles["Heading1"],
    fontSize=15, textColor=WHITE, fontName="Helvetica-Bold",
    spaceBefore=4, spaceAfter=4,
)
h2_style = ParagraphStyle(
    "H2", parent=styles["Heading2"],
    fontSize=12, textColor=BLUE_DARK, fontName="Helvetica-Bold",
    spaceBefore=10, spaceAfter=4,
)
body_style = ParagraphStyle(
    "Body", parent=styles["Normal"],
    fontSize=10, textColor=colors.HexColor("#1e293b"),
    leading=15, spaceAfter=4, alignment=TA_JUSTIFY,
)
bullet_style = ParagraphStyle(
    "Bullet", parent=body_style,
    leftIndent=14, bulletIndent=4, spaceAfter=3,
)
caption_style = ParagraphStyle(
    "Caption", parent=styles["Normal"],
    fontSize=8.5, textColor=GREY_MID,
    alignment=TA_CENTER, spaceAfter=6,
)
note_style = ParagraphStyle(
    "Note", parent=body_style,
    fontSize=9.5, textColor=TEAL, fontName="Helvetica-Oblique",
)
footer_style = ParagraphStyle(
    "Footer", parent=styles["Normal"],
    fontSize=7.5, textColor=GREY_MID, alignment=TA_CENTER,
)

# ── Helper: section header banner ────────────────────────────────────────────
def section_header(num, title):
    tbl = Table(
        [[Paragraph(f"{num}. {title}", h1_style)]],
        colWidths=[17*cm]
    )
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), BLUE_MID),
        ("ROUNDEDCORNERS", [6]),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 14),
    ]))
    return tbl

def info_box(text, color=BLUE_LIGHT, text_color=BLUE_DARK):
    p = Paragraph(text, ParagraphStyle("ib", parent=body_style, textColor=text_color, fontSize=9.5))
    tbl = Table([[p]], colWidths=[17*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 12),
        ("RIGHTPADDING",  (0,0), (-1,-1), 12),
        ("BOX", (0,0), (-1,-1), 0.5, BLUE_MID),
    ]))
    return tbl

# ── Build story ───────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Basic ECG Guide",
    author="Orris Medical AI"
)

story = []

# ══ COVER BANNER ══════════════════════════════════════════════════════════════
cover = Table(
    [[Paragraph("Basic ECG Guide", title_style)],
     [Paragraph("A Complete Beginner's Reference", subtitle_style)]],
    colWidths=[17*cm]
)
cover.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), BLUE_DARK),
    ("ROUNDEDCORNERS",[8]),
    ("TOPPADDING",    (0,0), (-1,-1), 22),
    ("BOTTOMPADDING", (0,0), (-1,-1), 22),
    ("ALIGN",         (0,0), (-1,-1), "CENTER"),
]))
story.append(cover)
story.append(Spacer(1, 10))

src_p = Paragraph(
    "<i>Based on: Harrison's Principles of Internal Medicine 22nd Ed. | "
    "Costanzo Physiology 7th Ed. | Medical Physiology (Boron &amp; Boulpaep)</i>",
    ParagraphStyle("src", parent=caption_style, textColor=GREY_MID, fontSize=8)
)
story.append(src_p)
story.append(Spacer(1, 16))

# ══ SECTION 1 — What is an ECG ════════════════════════════════════════════════
story.append(section_header(1, "What is an ECG?"))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "An <b>Electrocardiogram (ECG or EKG)</b> records the electrical activity of the heart "
    "from electrodes placed on the body surface. Because different parts of the heart activate "
    "in sequence — atria first, then ventricles — we can attribute each part of the ECG tracing "
    "to a specific cardiac event. The ECG provides direct measurement of rate, rhythm, and the "
    "time-dependent electrical vector of the heart.",
    body_style
))
story.append(Spacer(1, 8))

# ══ SECTION 2 — ECG Paper ═════════════════════════════════════════════════════
story.append(section_header(2, "The ECG Paper"))
story.append(Spacer(1, 6))

paper_data = [
    [Paragraph("<b>Feature</b>", body_style), Paragraph("<b>Measurement</b>", body_style)],
    ["Small box (1 mm wide)",   "0.04 seconds (40 ms)"],
    ["Large box (5 mm wide)",   "0.20 seconds (200 ms)"],
    ["5 large boxes",           "1.0 second"],
    ["Vertical axis",           "1 mV = 10 mm (standard calibration)"],
    ["Standard paper speed",    "25 mm/second"],
]
paper_tbl = Table(paper_data, colWidths=[9*cm, 8*cm])
paper_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(paper_tbl)
story.append(Spacer(1, 12))

# ══ SECTION 3 — Basic Waveform ════════════════════════════════════════════════
story.append(section_header(3, "The Basic Waveform"))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "Every heartbeat produces this pattern: <b>P → QRS → T (→ U)</b>",
    body_style
))
story.append(Spacer(1, 8))

# Images side by side
img_row = []
for i, path in enumerate(img_paths):
    if path:
        img = Image(path, width=7.8*cm, height=5.5*cm, kind="proportional")
        img_row.append(img)
    else:
        img_row.append(Paragraph("[Image not available]", caption_style))

if img_row:
    img_tbl = Table([img_row], colWidths=[8.5*cm, 8.5*cm])
    img_tbl.setStyle(TableStyle([
        ("ALIGN",         (0,0), (-1,-1), "CENTER"),
        ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ]))
    story.append(img_tbl)
    story.append(Paragraph(
        "Fig 1: ECG waveform with labeled intervals (Harrison's, 22nd Ed.) | "
        "Fig 2: ECG segments including PR, ST, QT (Costanzo Physiology, 7th Ed.)",
        caption_style
    ))
story.append(Spacer(1, 12))

# ══ SECTION 4 — Waves Explained ═══════════════════════════════════════════════
story.append(section_header(4, "Each Wave Explained"))
story.append(Spacer(1, 6))

waves_data = [
    [Paragraph("<b>Wave / Complex</b>", body_style),
     Paragraph("<b>Represents</b>", body_style),
     Paragraph("<b>Normal Duration</b>", body_style)],
    ["P wave", "Atrial depolarization (atria contract)", "< 120 ms (3 small boxes)"],
    ["QRS complex", "Ventricular depolarization (ventricles contract)", "< 100-110 ms"],
    ["T wave", "Ventricular repolarization (ventricles reset)", "—"],
    ["U wave", "Repolarization of Purkinje fibers (small, not always seen)", "—"],
]
waves_tbl = Table(waves_data, colWidths=[3.5*cm, 9*cm, 4.5*cm])
waves_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(waves_tbl)
story.append(Spacer(1, 6))
story.append(info_box(
    "<b>Note:</b> Atrial repolarization is NOT visible on a normal ECG — it is buried inside the QRS complex."
))
story.append(Spacer(1, 12))

# ══ SECTION 5 — Key Intervals ═════════════════════════════════════════════════
story.append(section_header(5, "Key Intervals and Segments"))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "<b>Interval</b> = includes waves within it &nbsp;&nbsp;|&nbsp;&nbsp; "
    "<b>Segment</b> = flat line between waves only",
    note_style
))
story.append(Spacer(1, 6))

intervals_data = [
    [Paragraph("<b>Interval / Segment</b>", body_style),
     Paragraph("<b>What It Measures</b>", body_style),
     Paragraph("<b>Normal Value</b>", body_style)],
    ["PR interval",  "Start of P wave to start of QRS. AV node conduction time.", "120-200 ms"],
    ["QRS interval", "Duration of ventricular depolarization.", "< 100-110 ms"],
    ["ST segment",   "J point to start of T wave. Should be isoelectric (flat).", "Flat / isoelectric"],
    ["QT interval",  "Start of QRS to end of T wave. Total ventricular activity.", "< 460 ms (F), < 450 ms (M)"],
    ["RR interval",  "Peak of one R wave to next. Used to calculate heart rate.", "Depends on rate"],
]
int_tbl = Table(intervals_data, colWidths=[3.5*cm, 9*cm, 4.5*cm])
int_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(int_tbl)
story.append(Spacer(1, 14))

# ══ SECTION 6 — Heart Rate ════════════════════════════════════════════════════
story.append(section_header(6, "How to Calculate Heart Rate"))
story.append(Spacer(1, 6))

story.append(Paragraph("<b>Method 1 — Precise:</b>", h2_style))
story.append(info_box("Heart Rate (bpm) = 60 ÷ RR interval (in seconds)", color=BLUE_LIGHT))
story.append(Spacer(1, 8))

story.append(Paragraph("<b>Method 2 — Quick (Most Popular):</b>", h2_style))
story.append(Paragraph(
    "Count the large boxes between two consecutive R waves and use this sequence:",
    body_style
))
story.append(Spacer(1, 4))

hr_data = [
    [Paragraph("<b>Large Boxes Between R Waves</b>", body_style),
     Paragraph("<b>Heart Rate (bpm)</b>", body_style)],
    ["1", "300"],
    ["2", "150"],
    ["3", "100"],
    ["4", "75  (Normal)"],
    ["5", "60"],
    ["6", "50"],
]
hr_tbl = Table(hr_data, colWidths=[9*cm, 8*cm])
hr_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("BACKGROUND",    (0,4), (-1,4), colors.HexColor("#dcfce7")),  # highlight normal
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("ALIGN",         (0,0), (-1,-1), "CENTER"),
]))
story.append(hr_tbl)
story.append(Spacer(1, 6))
story.append(info_box(
    "<b>Memory trick:</b>  300 → 150 → 100 → 75 → 60 → 50",
    color=colors.HexColor("#fef9c3"), text_color=colors.HexColor("#713f12")
))
story.append(Spacer(1, 14))

# ══ SECTION 7 — Normal Sinus Rhythm ══════════════════════════════════════════
story.append(section_header(7, "Normal Sinus Rhythm — Checklist"))
story.append(Spacer(1, 6))

nsr_items = [
    ("Rate", "60-100 bpm"),
    ("Rhythm", "Regular (R-R intervals equal)"),
    ("P wave", "Present before every QRS"),
    ("PR interval", "120-200 ms (normal AV conduction)"),
    ("QRS", "Narrow < 110 ms"),
    ("T wave", "Upright in most leads"),
]

nsr_data = [[Paragraph("<b>Parameter</b>", body_style), Paragraph("<b>Normal Finding</b>", body_style)]]
for param, val in nsr_items:
    nsr_data.append([
        Paragraph(f"<b>{param}</b>", body_style),
        Paragraph(f"✓  {val}", ParagraphStyle("ok", parent=body_style, textColor=TEAL)),
    ])

nsr_tbl = Table(nsr_data, colWidths=[5*cm, 12*cm])
nsr_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(nsr_tbl)
story.append(Spacer(1, 14))

# ══ PAGE BREAK ════════════════════════════════════════════════════════════════
story.append(PageBreak())

# ══ SECTION 8 — 12-Lead Placement ════════════════════════════════════════════
story.append(section_header(8, "The 12-Lead ECG — Electrode Positions"))
story.append(Spacer(1, 6))

story.append(Paragraph("Limb Leads (Frontal Plane):", h2_style))
limb_data = [
    [Paragraph("<b>Lead</b>", body_style), Paragraph("<b>Description</b>", body_style)],
    ["I",   "Right arm (–) to left arm (+)"],
    ["II",  "Right arm (–) to left leg (+)  — most commonly used"],
    ["III", "Left arm (–) to left leg (+)"],
    ["aVR", "Augmented — right arm (+)"],
    ["aVL", "Augmented — left arm (+)"],
    ["aVF", "Augmented — left foot (+) — inferior view"],
]
limb_tbl = Table(limb_data, colWidths=[3*cm, 14*cm])
limb_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(limb_tbl)
story.append(Spacer(1, 10))

story.append(Paragraph("Precordial Leads (Horizontal Plane):", h2_style))
prec_data = [
    [Paragraph("<b>Lead</b>", body_style), Paragraph("<b>Position</b>", body_style)],
    ["V1", "4th intercostal space, right sternal border"],
    ["V2", "4th intercostal space, left sternal border"],
    ["V3", "Between V2 and V4"],
    ["V4", "5th intercostal space, midclavicular line"],
    ["V5", "Anterior axillary line (same level as V4)"],
    ["V6", "Midaxillary line (same level as V4 and V5)"],
]
prec_tbl = Table(prec_data, colWidths=[3*cm, 14*cm])
prec_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(prec_tbl)
story.append(Spacer(1, 14))

# ══ SECTION 9 — Systematic Approach ══════════════════════════════════════════
story.append(section_header(9, "Systematic Approach to Reading Any ECG"))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "Harrison's recommends analyzing <b>14 parameters</b> every time:",
    body_style
))
story.append(Spacer(1, 4))

steps = [
    "Calibration and technical quality (lead placement, artifacts)",
    "Rhythm (regular? irregular?)",
    "Heart rate",
    "PR interval / AV conduction",
    "QRS interval (narrow vs. wide)",
    "QT / QTc interval",
    "Mean QRS electrical axis",
    "P wave morphology",
    "QRS voltages",
    "Precordial R-wave progression",
    "Abnormal Q waves",
    "ST segments (elevated or depressed?)",
    "T waves (upright or inverted?)",
    "U waves",
]

steps_data = []
for i in range(0, len(steps), 2):
    left = Paragraph(f"<b>{i+1}.</b>  {steps[i]}", body_style)
    right = Paragraph(f"<b>{i+2}.</b>  {steps[i+1]}", body_style) if i+1 < len(steps) else Paragraph("", body_style)
    steps_data.append([left, right])

steps_tbl = Table(steps_data, colWidths=[8.5*cm, 8.5*cm])
steps_tbl.setStyle(TableStyle([
    ("ROWBACKGROUNDS",(0,0), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.3, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(steps_tbl)
story.append(Spacer(1, 14))

# ══ SECTION 10 — Common Abnormalities ════════════════════════════════════════
story.append(section_header(10, "Quick Clinical Clues — Common Abnormalities"))
story.append(Spacer(1, 6))

abn_data = [
    [Paragraph("<b>ECG Finding</b>", body_style), Paragraph("<b>Think Of</b>", body_style)],
    ["PR interval > 200 ms",                 "Heart block (AV block)"],
    ["QRS > 120 ms",                         "Bundle branch block"],
    ["ST elevation",                         "STEMI, pericarditis, Brugada syndrome"],
    ["ST depression",                        "Ischemia, NSTEMI, digoxin effect"],
    ["Prolonged QT",                         "Drug toxicity, electrolyte abnormalities, channelopathies"],
    ["Absent P waves + irregular rhythm",    "Atrial fibrillation (AF)"],
    ["Saw-tooth P waves at 300 bpm",         "Atrial flutter"],
    ["Peaked tall T waves",                  "Hyperkalemia"],
    ["Delta wave (slurred QRS upstroke)",    "Wolff-Parkinson-White (WPW) syndrome"],
    ["Pathological Q waves (wide + deep)",   "Old myocardial infarction"],
    ["Low QRS voltages",                     "Pericardial effusion, obesity, hypothyroidism"],
]
abn_tbl = Table(abn_data, colWidths=[7*cm, 10*cm])
abn_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE_DARK),
    ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9.5),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
    ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(abn_tbl)
story.append(Spacer(1, 16))

# ══ FOOTER / SOURCES ══════════════════════════════════════════════════════════
story.append(HRFlowable(width="100%", thickness=0.5, color=GREY_MID))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "<b>Sources:</b> Harrison's Principles of Internal Medicine, 22nd Ed. (McGraw-Hill, 2025) | "
    "Costanzo Medical Physiology, 7th Ed. | Boron &amp; Boulpaep Medical Physiology | "
    "Generated by Orris Medical AI · May 2026",
    footer_style
))

# ── Build ──────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")
print(f"File size: {os.path.getsize(OUTPUT):,} bytes")

Running Command

cd /home/daytona/workspace/ecg-guide && python create_ecg_pdf.py

Your PDF is ready! Here's the download link:

Basic ECG Guide

PDF Document · PDF

What's inside (2 pages, ~255 KB):

Cover banner with title and source credits
ECG paper grid measurements
Basic waveform diagram with 2 textbook images (P, QRS, T, U waves)
Wave-by-wave explanation table
Key intervals & segments (PR, QRS, ST, QT, RR) with normal values
Heart rate calculation — both methods with the 300→150→100→75→60→50 trick
Normal sinus rhythm checklist
12-lead electrode placement (limb + precordial)
Systematic 14-step reading approach (Harrison's)
Common ECG abnormalities quick-reference table

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