create a PPT file topic is Respiratory distress , add detailed information and do not forget to put main issue , causes , sign and symptoms, investigation , clinical manifestations , investigating criteria , diagnostic tools , treatment and real life cases make this as a medical intern
Reading File
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Finding Sources
Finding Sources
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Finding Sources
I now have enough clinical content. Let me search for relevant medical images and then build the presentation.
Searching Images
acute respiratory distress syndrome ARDS chest X-ray bilateral opacities
Searching Images
respiratory distress clinical signs accessory muscle use tachypnea
I have all the clinical content and images I need. Now let me build the comprehensive PowerPoint presentation.
Running Command
ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace does not exist"
Running Command
mkdir -p /home/daytona/workspace/respiratory-distress-ppt
Writing File
~/respiratory-distress-ppt/build.js
const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");
// --- Fetch images ---
const imageUrls = [
"https://cdn.orris.care/cdss_images/pmc_clinical_VQA_12a1cb250fa88ebe2207de940afd3ed9bfb5b0060227d83c8998acc2dd75f76b.jpg", // ARDS CXR
"https://cdn.orris.care/cdss_images/pmc_clinical_VQA_2915910772fd3b3980e9b3b5f936042c1168bcc760892c686e0d41ac327e3be5.jpg", // ARDS progression
"https://cdn.orris.care/cdss_images/pmc_clinical_VQA_abe315d8f08a4df03f9ebbbfec8ea5afc483854ff33ae194bd2ad4b5067056fb.jpg", // Clinical signs
"https://cdn.orris.care/cdss_images/pmc_clinical_VQA_4d8986f462f78742b780572d802059ef1270c3a82222fef19debb3c7c2dbf9d9.jpg", // ARDS Berlin CXR
];
console.log("Fetching images...");
let images = [];
try {
const raw = execSync(
`node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
{ timeout: 60000 }
).toString();
images = JSON.parse(raw);
console.log("Images fetched:", images.map(i => i.error || "OK"));
} catch (e) {
console.log("Image fetch failed:", e.message);
images = imageUrls.map(() => ({ base64: null, error: "fetch failed" }));
}
// Color palette — deep navy + crimson accent + white
const NAVY = "0D1B2A";
const CRIMSON = "C0392B";
const TEAL = "1A7A8A";
const WHITE = "FFFFFF";
const OFFWHITE = "F2F6FA";
const LTGRAY = "D0D8E0";
const DARKGRAY = "2C3E50";
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Intern";
pres.title = "Respiratory Distress — Comprehensive Clinical Review";
// ──────────────────────────────────────────────────
// Helper: add a standard content slide with header bar
// ──────────────────────────────────────────────────
function contentSlide(title, sectionTag) {
const sl = pres.addSlide();
// Full background
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
// Left accent stripe
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: CRIMSON } });
// Header bar
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.95, fill: { color: NAVY } });
// Section tag chip
sl.addShape(pres.ShapeType.rect, { x: 8.0, y: 0.18, w: 1.78, h: 0.58, fill: { color: CRIMSON }, line: { color: CRIMSON } });
sl.addText(sectionTag, { x: 8.0, y: 0.18, w: 1.78, h: 0.58, fontSize: 9, bold: true, color: WHITE, align: "center", valign: "middle" });
// Slide title
sl.addText(title, { x: 0.35, y: 0.1, w: 7.5, h: 0.78, fontSize: 22, bold: true, color: WHITE, valign: "middle", margin: 0 });
return sl;
}
// Helper: bullet items array
function bullets(items, opts = {}) {
return items.map((item, i) => ({
text: item,
options: { bullet: { code: "2022" }, fontSize: opts.fontSize || 13, color: opts.color || DARKGRAY, breakLine: i < items.length - 1, bold: opts.bold || false, paraSpaceAfter: 4 }
}));
}
// Helper: sub-bullet
function subBullets(items, opts = {}) {
return items.map((item, i) => ({
text: " " + item,
options: { bullet: { code: "25E6" }, fontSize: opts.fontSize || 11.5, color: opts.color || "4A5568", breakLine: i < items.length - 1, paraSpaceAfter: 2 }
}));
}
// ══════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════
{
const sl = pres.addSlide();
// Full dark background
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY } });
// Crimson accent band
sl.addShape(pres.ShapeType.rect, { x: 0, y: 3.6, w: 10, h: 0.12, fill: { color: CRIMSON } });
// Decorative circle
sl.addShape(pres.ShapeType.ellipse, { x: 7.0, y: -1.2, w: 4.5, h: 4.5, fill: { color: TEAL }, line: { color: TEAL }, transparency: 75 });
sl.addText("RESPIRATORY DISTRESS", {
x: 0.5, y: 0.9, w: 9, h: 1.2,
fontSize: 40, bold: true, color: WHITE, align: "center", charSpacing: 3
});
sl.addText("A Comprehensive Clinical Review", {
x: 0.5, y: 2.0, w: 9, h: 0.6,
fontSize: 20, italic: true, color: LTGRAY, align: "center"
});
sl.addText("Causes · Signs & Symptoms · Investigations · Diagnosis · Treatment · Real-Life Cases", {
x: 0.5, y: 2.62, w: 9, h: 0.45,
fontSize: 12, color: "8BAACC", align: "center"
});
sl.addShape(pres.ShapeType.rect, { x: 3.5, y: 3.25, w: 3, h: 0.03, fill: { color: CRIMSON } });
sl.addText("Presented by: Medical Intern | Department of Medicine", {
x: 0.5, y: 3.85, w: 9, h: 0.4,
fontSize: 11, color: LTGRAY, align: "center"
});
sl.addText("May 2026", {
x: 0.5, y: 4.25, w: 9, h: 0.35,
fontSize: 10, color: "8BAACC", align: "center"
});
}
// ══════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ══════════════════════════════════════════════════
{
const sl = pres.addSlide();
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: OFFWHITE } });
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.95, fill: { color: NAVY } });
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: TEAL } });
sl.addText("TABLE OF CONTENTS", { x: 0.35, y: 0.1, w: 9.4, h: 0.78, fontSize: 22, bold: true, color: WHITE, valign: "middle", margin: 0 });
const sections = [
["01", "Overview & Main Issue", "What is Respiratory Distress?"],
["02", "Causes & Pathophysiology", "Pulmonary, Cardiac, Neuromuscular & More"],
["03", "Signs & Symptoms", "Clinical Presentation & Red Flags"],
["04", "Clinical Manifestations", "ARDS, Acute Respiratory Failure & Subtypes"],
["05", "Investigations", "Labs, Imaging, ABG & Bedside Tests"],
["06", "Diagnostic Criteria", "Berlin Definition · ARDS Severity Grading"],
["07", "Diagnostic Tools", "CXR, CT, Echocardiography, Spirometry"],
["08", "Treatment", "Oxygen, Ventilation, Pharmacology & ECMO"],
["09", "Real-Life Cases", "Three Clinical Scenarios"],
["10", "Summary & Key Takeaways", ""],
];
const cols = 2, rows = 5;
const cw = 4.6, rh = 0.84, sx = 0.35, sy = 1.05;
sections.forEach(([num, title, sub], idx) => {
const col = idx % cols;
const row = Math.floor(idx / cols);
const bx = sx + col * (cw + 0.2);
const by = sy + row * rh;
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: 0.72, fill: { color: WHITE }, line: { color: LTGRAY, pt: 1 }, shadow: { type: "outer", blur: 3, offset: 1, angle: 45, color: "AAAAAA", opacity: 0.2 } });
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: 0.42, h: 0.72, fill: { color: CRIMSON } });
sl.addText(num, { x: bx, y: by, w: 0.42, h: 0.72, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText(title, { x: bx + 0.48, y: by + 0.05, w: cw - 0.54, h: 0.35, fontSize: 11.5, bold: true, color: NAVY, margin: 0, valign: "top" });
if (sub) sl.addText(sub, { x: bx + 0.48, y: by + 0.38, w: cw - 0.54, h: 0.28, fontSize: 9, color: "667788", margin: 0, valign: "top" });
});
}
// ══════════════════════════════════════════════════
// SLIDE 3 — OVERVIEW & MAIN ISSUE
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Overview & Main Issue", "OVERVIEW");
// Definition box
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.05, w: 9.3, h: 1.05, fill: { color: "EBF4FA" }, line: { color: TEAL, pt: 1.5 } });
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.05, w: 0.08, h: 1.05, fill: { color: TEAL } });
sl.addText([
{ text: "DEFINITION ", options: { bold: true, color: TEAL, fontSize: 12 } },
{ text: "Respiratory distress is the physician-recognized combination of a patient's subjective sensation of dyspnea with objective signs of difficulty breathing — including tachypnea, accessory muscle use, nasal flaring, and hypoxemia. It represents a spectrum from mild breathlessness to life-threatening ventilatory failure.", options: { color: DARKGRAY, fontSize: 12 } }
], { x: 0.52, y: 1.08, w: 9.05, h: 1.0, valign: "middle", margin: 4 });
// Main Issue stats
sl.addText("WHY IT MATTERS", { x: 0.35, y: 2.2, w: 4.4, h: 0.3, fontSize: 11, bold: true, color: CRIMSON, margin: 0 });
sl.addText([
{ text: "Respiratory distress is the #1 reason for emergency department presentation.\n", options: { bold: true, color: DARKGRAY, fontSize: 12, breakLine: true } },
...bullets([
"Affects ~10% of all ICU admissions worldwide",
"ARDS alone carries a 35–46% mortality (mild to severe)",
"Delays in recognition of cause lead to preventable deaths",
"Requires rapid systematic assessment — every minute counts",
"Etiology spans pulmonary, cardiac, neuromuscular, metabolic & toxicological origins",
])
], { x: 0.35, y: 2.5, w: 5.5, h: 2.85, valign: "top", margin: 4 });
// Spectrum diagram
sl.addShape(pres.ShapeType.rect, { x: 6.1, y: 2.2, w: 3.55, h: 3.15, fill: { color: WHITE }, line: { color: LTGRAY, pt: 1 } });
sl.addText("SEVERITY SPECTRUM", { x: 6.1, y: 2.2, w: 3.55, h: 0.35, fontSize: 10, bold: true, color: NAVY, align: "center", valign: "middle" });
const levels = [
["Mild Dyspnea", "E8F4FD", "SpO₂ 94–98%"],
["Moderate Distress", "FFF3CD", "SpO₂ 88–93%"],
["Severe Distress", "FCE4E4", "SpO₂ < 88%"],
["Respiratory Failure", CRIMSON, "Intubation needed"],
];
levels.forEach(([label, color, detail], i) => {
sl.addShape(pres.ShapeType.rect, { x: 6.2, y: 2.62 + i * 0.63, w: 3.35, h: 0.52, fill: { color }, line: { color: LTGRAY, pt: 0.5 } });
sl.addText(label, { x: 6.22, y: 2.64 + i * 0.63, w: 1.9, h: 0.48, fontSize: 10.5, bold: true, color: color === CRIMSON ? WHITE : NAVY, valign: "middle", margin: 2 });
sl.addText(detail, { x: 8.14, y: 2.64 + i * 0.63, w: 1.35, h: 0.48, fontSize: 9.5, color: color === CRIMSON ? WHITE : "556677", valign: "middle", align: "right", margin: 2 });
});
}
// ══════════════════════════════════════════════════
// SLIDE 4 — CAUSES & PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Causes & Pathophysiology", "ETIOLOGY");
const categories = [
{ title: "PULMONARY", color: TEAL, items: ["Pneumonia (bacterial/viral/fungal)", "Acute Respiratory Distress Syndrome (ARDS)", "Asthma / COPD exacerbation", "Pulmonary embolism", "Pneumothorax", "Pleural effusion"] },
{ title: "CARDIAC", color: "1A6B3A", items: ["Acute decompensated heart failure", "Cardiogenic pulmonary edema", "Myocardial infarction", "Cardiac tamponade", "Arrhythmias"] },
{ title: "UPPER AIRWAY", color: CRIMSON, items: ["Foreign body obstruction", "Angioedema / anaphylaxis", "Epiglottitis", "Croup", "Tracheal compression (goiter/mass)"] },
{ title: "NEUROMUSCULAR", color: "7B3FA0", items: ["Guillain-Barré syndrome", "Myasthenia gravis", "Diaphragmatic paralysis", "Botulism / spinal cord injury"] },
{ title: "METABOLIC / TOXIC", color: "C07A00", items: ["Severe metabolic acidosis (Kussmaul)", "Drug overdose (opioids, benzodiazepines)", "Sepsis-induced ARDS", "Carbon monoxide poisoning"] },
{ title: "NEONATAL / PEDIATRIC", color: "1A5B8A", items: ["Neonatal RDS (surfactant deficiency)", "Transient tachypnea of newborn", "Bronchiolitis (RSV)", "Meconium aspiration"] },
];
const cw = 2.95, rh = 1.9, sx = 0.35, sy = 1.06;
categories.forEach(({ title, color, items }, idx) => {
const col = idx % 3, row = Math.floor(idx / 3);
const bx = sx + col * (cw + 0.18);
const by = sy + row * rh;
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: rh - 0.1, fill: { color: WHITE }, line: { color: LTGRAY, pt: 1 } });
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: 0.34, fill: { color } });
sl.addText(title, { x: bx, y: by, w: cw, h: 0.34, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText(bullets(items, { fontSize: 10.5 }), { x: bx + 0.08, y: by + 0.38, w: cw - 0.12, h: rh - 0.52, valign: "top", margin: 2 });
});
}
// ══════════════════════════════════════════════════
// SLIDE 5 — SIGNS & SYMPTOMS
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Signs & Symptoms", "CLINICAL FEATURES");
// Left column: Signs
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.05, w: 4.4, h: 0.36, fill: { color: NAVY } });
sl.addText("⚠ OBJECTIVE SIGNS", { x: 0.35, y: 1.05, w: 4.4, h: 0.36, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
const signGroups = [
{ label: "Respiratory", color: TEAL, items: ["Tachypnea (RR > 20 breaths/min)", "Use of accessory muscles (SCM, intercostals)", "Nasal flaring", "Paradoxical abdominal movement (diaphragmatic fatigue)", "Pursed-lip breathing", "Grunting (neonates)", "Stridor or wheeze"] },
{ label: "Cardiovascular", color: "1A6B3A", items: ["Tachycardia", "Hypotension (late sign)", "Pulsus paradoxus (tamponade/asthma)", "Jugular venous distension"] },
{ label: "Neurological / Systemic", color: CRIMSON, items: ["Agitation or confusion (hypoxemia)", "Decreased consciousness (hypercapnia)", "Diaphoresis", "Cyanosis (central/peripheral)", "Inability to speak in full sentences"] },
];
let curY = 1.47;
signGroups.forEach(({ label, color, items }) => {
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: curY, w: 0.12, h: items.length * 0.26 + 0.12, fill: { color } });
sl.addText(label.toUpperCase(), { x: 0.52, y: curY + 0.02, w: 4.1, h: 0.24, fontSize: 10, bold: true, color, margin: 0 });
curY += 0.28;
items.forEach(item => {
sl.addText([{ text: item, options: { bullet: { code: "2022" }, fontSize: 11, color: DARKGRAY } }], { x: 0.55, y: curY, w: 4.1, h: 0.25, margin: 0, valign: "middle" });
curY += 0.26;
});
curY += 0.06;
});
// Right column: Symptoms (subjective) + image
sl.addShape(pres.ShapeType.rect, { x: 4.9, y: 1.05, w: 4.75, h: 0.36, fill: { color: NAVY } });
sl.addText("💬 SUBJECTIVE SYMPTOMS", { x: 4.9, y: 1.05, w: 4.75, h: 0.36, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText(bullets([
"Dyspnea — 'can't get enough air'",
"Chest tightness or pressure",
"Breathlessness worse on exertion (or at rest)",
"Orthopnea (heart failure)",
"Paroxysmal nocturnal dyspnea",
"Cough — dry or productive",
"Pleuritic chest pain (PE, pneumonia)",
"Hemoptysis (TB, PE, lung Ca)",
"Wheezing (asthma, COPD, cardiac)",
"Fatigue & decreased exercise tolerance",
], { fontSize: 11.5 }), { x: 4.9, y: 1.47, w: 4.75, h: 2.4, valign: "top", margin: 4 });
// Image of clinical signs
if (images[2] && !images[2].error) {
sl.addImage({ data: images[2].base64, x: 4.9, y: 3.95, w: 2.4, h: 1.48 });
sl.addText("Cardinal signs of respiratory distress in a pediatric patient", { x: 7.35, y: 3.98, w: 2.3, h: 1.45, fontSize: 9, color: "667788", italic: true, valign: "middle", margin: 2 });
}
}
// ══════════════════════════════════════════════════
// SLIDE 6 — CLINICAL MANIFESTATIONS
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Clinical Manifestations", "MANIFESTATIONS");
const manifests = [
{
title: "Acute Respiratory Failure",
color: CRIMSON,
body: "Inability to maintain adequate oxygenation (PaO₂ < 60 mmHg on room air) or CO₂ elimination (PaCO₂ > 50 mmHg). Type 1 = hypoxemic; Type 2 = hypercapnic.",
sub: ["Tachypnea, accessory muscle use, confusion", "ABG: low PaO₂ ± elevated PaCO₂", "Triggers: pneumonia, PE, ARDS, COPD exac."],
},
{
title: "ARDS (Acute Respiratory Distress Syndrome)",
color: NAVY,
body: "Diffuse alveolar damage with non-cardiogenic pulmonary edema. Three phases: exudative (0–7d), proliferative (7–21d), fibrotic (>21d).",
sub: ["Bilateral infiltrates on CXR/CT", "PaO₂/FiO₂ ≤ 300 (Berlin criteria)", "Mortality 35% mild → 46% severe"],
},
{
title: "Cardiogenic Pulmonary Edema",
color: TEAL,
body: "Left ventricular failure raises pulmonary capillary wedge pressure > 18 mmHg, forcing fluid into alveoli. Causes hypoxemia and pink frothy sputum.",
sub: ["S3 gallop, JVD, peripheral edema", "CXR: butterfly pattern, Kerley B lines", "BNP > 500 pg/mL is diagnostic"],
},
{
title: "Obstructive Airway Disease",
color: "1A6B3A",
body: "Asthma / COPD exacerbation — bronchospasm, mucus plugging, and hyperinflation limit airflow and increase work of breathing.",
sub: ["Expiratory wheeze, prolonged I:E ratio", "PEFR < 50% predicted = severe", "ABG: early respiratory alkalosis"],
},
{
title: "Upper Airway Obstruction",
color: "C07A00",
body: "Stridor, drooling, muffled voice. Life-threatening: foreign body, angioedema, epiglottitis. Immediate airway management is priority.",
sub: ["Inspiratory stridor (extrathoracic obstruction)", "Lateral neck X-ray / nasopharyngoscopy", "NEVER perform oral exam if epiglottitis suspected"],
},
{
title: "Tension Pneumothorax",
color: "7B3FA0",
body: "Air under pressure in the pleural space collapses the ipsilateral lung and shifts mediastinum, causing obstructive shock. Clinical diagnosis — do not wait for CXR.",
sub: ["Absent breath sounds, tracheal deviation", "Distended neck veins + hypotension", "Immediate needle decompression (2nd ICS, MCL)"],
},
];
const cw = 3.0, rh = 1.82, sx = 0.35, sy = 1.05;
manifests.forEach(({ title, color, body, sub }, idx) => {
const col = idx % 3, row = Math.floor(idx / 3);
const bx = sx + col * (cw + 0.18);
const by = sy + row * rh;
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: rh - 0.1, fill: { color: WHITE }, line: { color: LTGRAY, pt: 0.8 } });
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: 0.32, fill: { color } });
sl.addText(title, { x: bx + 0.05, y: by, w: cw - 0.1, h: 0.32, fontSize: 9.5, bold: true, color: WHITE, valign: "middle", margin: 2 });
sl.addText(body, { x: bx + 0.06, y: by + 0.34, w: cw - 0.1, h: 0.58, fontSize: 9.5, color: DARKGRAY, valign: "top", margin: 2 });
sl.addText(subBullets(sub, { fontSize: 9.5 }), { x: bx + 0.06, y: by + 0.95, w: cw - 0.1, h: rh - 1.1, valign: "top", margin: 2 });
});
}
// ══════════════════════════════════════════════════
// SLIDE 7 — INVESTIGATIONS
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Investigations", "WORKUP");
// Two column layout
const leftItems = [
{ cat: "ARTERIAL BLOOD GAS (ABG)", color: CRIMSON, items: [
"PaO₂: oxygenation status (normal 80–100 mmHg)",
"PaCO₂: ventilatory status (normal 35–45 mmHg)",
"pH: acid-base balance (7.35–7.45)",
"HCO₃⁻: metabolic component (22–26 mEq/L)",
"A-a gradient: alveolar-arterial O₂ difference",
"P/F ratio: PaO₂/FiO₂ (ARDS severity marker)",
]},
{ cat: "PULSE OXIMETRY & SPIROMETRY", color: TEAL, items: [
"SpO₂ — rapid, non-invasive; insensitive for hypoventilation",
"Peak expiratory flow (PEFR) — asthma severity",
"Negative inspiratory force (NIF) — neuromuscular strength",
"FEV₁/FVC ratio — obstructive vs restrictive pattern",
]},
{ cat: "LABORATORY TESTS", color: NAVY, items: [
"CBC: leukocytosis (infection), anaemia (↓O₂ carrying capacity)",
"BNP / NT-proBNP: heart failure (>500 pg/mL diagnostic)",
"D-dimer: PE screening (high sensitivity, low specificity)",
"CRP / PCT: infection/sepsis markers",
"Troponin: myocardial ischemia",
"Lactate: tissue hypoperfusion / sepsis",
"Blood cultures + sputum culture: infectious aetiology",
]},
];
const rightItems = [
{ cat: "IMAGING", color: "1A6B3A", items: [
"Chest X-ray (CXR): first-line — infiltrates, effusion, PTX, cardiomegaly",
"HRCT chest: ARDS pattern, interstitial disease, PE",
"CT pulmonary angiography (CTPA): gold standard for PE",
"Lung ultrasound (LUS): B-lines (pulmonary edema), A-lines (normal/PTX)",
]},
{ cat: "CARDIAC INVESTIGATIONS", color: "7B3FA0", items: [
"ECG: arrhythmia, myocardial ischemia, right heart strain (PE)",
"Echocardiography: EF, wall motion, pericardial effusion, PASP",
"Right heart catheterization: PCWP (cardiogenic vs ARDS)",
]},
{ cat: "BEDSIDE PROCEDURES", color: "C07A00", items: [
"Point-of-care ultrasound (POCUS): RUSH protocol",
"Thoracentesis: large pleural effusion",
"Bronchoscopy + BAL: ARDS, diffuse alveolar damage, atypical infection",
"Nasopharyngoscopy: upper airway obstruction assessment",
]},
];
const cw = 4.45;
[leftItems, rightItems].forEach((col, ci) => {
let curY = 1.05;
col.forEach(({ cat, color, items }) => {
const bh = 0.28 + items.length * 0.27;
sl.addShape(pres.ShapeType.rect, { x: 0.35 + ci * (cw + 0.35), y: curY, w: cw, h: bh, fill: { color: WHITE }, line: { color: LTGRAY, pt: 0.8 } });
sl.addShape(pres.ShapeType.rect, { x: 0.35 + ci * (cw + 0.35), y: curY, w: cw, h: 0.28, fill: { color } });
sl.addText(cat, { x: 0.35 + ci * (cw + 0.35) + 0.06, y: curY, w: cw - 0.1, h: 0.28, fontSize: 10, bold: true, color: WHITE, valign: "middle", margin: 2 });
sl.addText(bullets(items, { fontSize: 10.2 }), { x: 0.35 + ci * (cw + 0.35) + 0.06, y: curY + 0.3, w: cw - 0.12, h: bh - 0.32, valign: "top", margin: 2 });
curY += bh + 0.1;
});
});
}
// ══════════════════════════════════════════════════
// SLIDE 8 — DIAGNOSTIC CRITERIA (ARDS Berlin + ABG)
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Investigating Criteria & Diagnostic Criteria", "CRITERIA");
// Berlin definition box
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.06, w: 5.2, h: 0.34, fill: { color: NAVY } });
sl.addText("BERLIN DEFINITION OF ARDS (2012)", { x: 0.35, y: 1.06, w: 5.2, h: 0.34, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
const berlinCriteria = [
["Timing", "Onset within 1 week of clinical insult OR new/worsening respiratory symptoms"],
["Imaging", "Bilateral opacities — not fully explained by effusions, lobar/lung collapse, or nodules"],
["Origin of edema", "Not fully explained by cardiac failure or fluid overload (echo may be needed)"],
["P/F Ratio", "Mild: 201–300 mmHg, Moderate: 101–200 mmHg, Severe: ≤100 mmHg (with PEEP ≥5)"],
];
berlinCriteria.forEach(([crit, detail], i) => {
const by = 1.46 + i * 0.58;
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: by, w: 5.2, h: 0.52, fill: { color: i % 2 === 0 ? "F0F5FF" : WHITE }, line: { color: LTGRAY, pt: 0.5 } });
sl.addText(crit, { x: 0.38, y: by + 0.04, w: 1.1, h: 0.44, fontSize: 10.5, bold: true, color: NAVY, valign: "middle", margin: 2 });
sl.addText(detail, { x: 1.52, y: by + 0.04, w: 3.98, h: 0.44, fontSize: 10.5, color: DARKGRAY, valign: "middle", margin: 2 });
});
// Severity table
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 3.8, w: 5.2, h: 0.28, fill: { color: CRIMSON } });
sl.addText("SEVERITY GRADING BY PaO₂/FiO₂", { x: 0.35, y: 3.8, w: 5.2, h: 0.28, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
const sevRows = [
["Mild", "201–300 mmHg", "CPAP/PEEP > 5 cmH₂O", "~27%"],
["Moderate", "101–200 mmHg", "PEEP ≥ 5 cmH₂O", "~32%"],
["Severe", "≤ 100 mmHg", "PEEP ≥ 5 cmH₂O", "~45%"],
];
const sevColors = ["E8F4FD", "FFF3CD", "FCE4E4"];
const hdrs = ["Severity", "PaO₂/FiO₂", "Ventilation", "Mortality"];
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 4.08, w: 5.2, h: 0.28, fill: { color: DARKGRAY } });
[0, 1, 2, 3].forEach(ci => {
const cwidths = [0.78, 1.38, 1.88, 1.08];
const cstarts = [0.37, 1.15, 2.53, 4.41];
sl.addText(hdrs[ci], { x: cstarts[ci], y: 4.1, w: cwidths[ci], h: 0.24, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
});
sevRows.forEach((row, ri) => {
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 4.36 + ri * 0.33, w: 5.2, h: 0.32, fill: { color: sevColors[ri] }, line: { color: LTGRAY, pt: 0.3 } });
const cstarts = [0.37, 1.15, 2.53, 4.41];
const cwidths = [0.76, 1.36, 1.86, 1.06];
row.forEach((cell, ci) => {
sl.addText(cell, { x: cstarts[ci], y: 4.38 + ri * 0.33, w: cwidths[ci], h: 0.28, fontSize: 9.5, color: DARKGRAY, align: "center", valign: "middle", margin: 0 });
});
});
// Right: ABG interpretation + Resp failure criteria
sl.addShape(pres.ShapeType.rect, { x: 5.75, y: 1.06, w: 3.9, h: 0.34, fill: { color: TEAL } });
sl.addText("ABG INTERPRETATION CRITERIA", { x: 5.75, y: 1.06, w: 3.9, h: 0.34, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText(bullets([
"pH < 7.35 → Acidosis (respiratory if ↑PaCO₂)",
"pH > 7.45 → Alkalosis (respiratory if ↓PaCO₂)",
"PaO₂ < 60 mmHg → Hypoxemic resp. failure",
"PaCO₂ > 50 mmHg → Hypercapnic resp. failure",
"A-a gradient > 10–15 mmHg → V/Q mismatch or shunt",
"Lactate > 2 mmol/L → Tissue hypoperfusion",
], { fontSize: 11 }), { x: 5.78, y: 1.45, w: 3.84, h: 1.8, valign: "top", margin: 4 });
sl.addShape(pres.ShapeType.rect, { x: 5.75, y: 3.35, w: 3.9, h: 0.34, fill: { color: CRIMSON } });
sl.addText("RESP. FAILURE DIAGNOSTIC CRITERIA", { x: 5.75, y: 3.35, w: 3.9, h: 0.34, fontSize: 10.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText(bullets([
"Type 1 (Hypoxemic): PaO₂ < 60 on room air, normal/low PaCO₂",
"Type 2 (Hypercapnic): PaCO₂ > 45 + respiratory acidosis",
"Type 3 (Peri-operative): atelectasis-related",
"Type 4 (Shock-related): ↓perfusion of resp. muscles",
"Indices: APACHE II, SOFA, Murray Lung Injury Score",
], { fontSize: 11 }), { x: 5.78, y: 3.72, w: 3.84, h: 1.68, valign: "top", margin: 4 });
}
// ══════════════════════════════════════════════════
// SLIDE 9 — DIAGNOSTIC TOOLS
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Diagnostic Tools", "DIAGNOSTICS");
const tools = [
{ name: "Chest X-Ray (CXR)", icon: "🫁", color: NAVY, body: "First-line imaging. Portable AP in ICU. Identifies bilateral infiltrates (ARDS), consolidation (PNA), pleural effusion, cardiomegaly, pneumothorax, Kerley B lines." },
{ name: "CT Chest / CTPA", icon: "🔬", color: TEAL, body: "Gold standard for PE (CTPA). HRCT for interstitial disease. CT detects occult pneumothorax, small effusions, mediastinal pathology, lung parenchymal detail." },
{ name: "Echocardiography", icon: "❤️", color: CRIMSON, body: "Differentiates cardiac from non-cardiac pulmonary edema. Assesses LV/RV function, PASP, pericardial effusion, valvular disease. PCWP > 18 = cardiogenic." },
{ name: "Lung Ultrasound (LUS)", icon: "📡", color: "1A6B3A", body: "B-lines → alveolar-interstitial syndrome (pulmonary edema). A-lines → normal lung or pneumothorax. Lung point sign = PTX. Consolidation with air bronchograms = PNA." },
{ name: "Spirometry / PEFR", icon: "💨", color: "C07A00", body: "FEV₁/FVC < 0.7 → obstructive (asthma, COPD). TLC normal/↑ = obstructive. FVC ↓ with normal ratio = restrictive. PEFR < 50% predicted = severe asthma exacerbation." },
{ name: "Bronchoscopy + BAL", icon: "🔍", color: "7B3FA0", body: "Direct visualisation of airways. BAL for culture, cytology, diffuse alveolar haemorrhage (hemosiderin-laden macrophages). Indicated when non-invasive workup is inconclusive." },
];
tools.forEach(({ name, icon, color, body }, idx) => {
const col = idx % 3, row = Math.floor(idx / 3);
const bx = 0.35 + col * 3.18, by = 1.05 + row * 2.22;
const bw = 3.0, bh = 2.12;
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: bw, h: bh, fill: { color: WHITE }, line: { color: LTGRAY, pt: 0.8 } });
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: bw, h: 0.36, fill: { color } });
sl.addText(`${icon} ${name}`, { x: bx + 0.05, y: by, w: bw - 0.1, h: 0.36, fontSize: 10, bold: true, color: WHITE, valign: "middle", margin: 2 });
sl.addText(body, { x: bx + 0.08, y: by + 0.4, w: bw - 0.14, h: bh - 0.46, fontSize: 10.5, color: DARKGRAY, valign: "top", margin: 2, wrap: true });
});
// ARDS CXR image
if (images[0] && !images[0].error) {
// Replace middle of bottom row with image
sl.addShape(pres.ShapeType.rect, { x: 6.84, y: 3.27, w: 2.8, h: 2.12, fill: { color: WHITE }, line: { color: LTGRAY, pt: 0.8 } });
sl.addImage({ data: images[0].base64, x: 6.84, y: 3.27, w: 2.8, h: 2.12 });
}
}
// ══════════════════════════════════════════════════
// SLIDE 10 — TREATMENT
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Treatment", "MANAGEMENT");
const txBlocks = [
{ title: "IMMEDIATE STABILISATION (ABC)", color: CRIMSON, items: [
"Airway: position, jaw thrust, suction, adjuncts",
"Breathing: supplemental O₂ (target SpO₂ 94–98%, or 88–92% in COPD)",
"Circulation: IV access, fluid resuscitation (cautious in ARDS)",
"Position: head-of-bed 30–45° to reduce aspiration",
"Continuous monitoring: SpO₂, RR, HR, BP, GCS",
]},
{ title: "OXYGEN THERAPY", color: TEAL, items: [
"Nasal cannula: 2–6 L/min → SpO₂ 90–95%",
"Simple face mask: 6–10 L/min → ~40–60% FiO₂",
"Non-rebreather mask: 10–15 L/min → ~60–90% FiO₂",
"High-flow nasal cannula (HFNC): up to 60 L/min, heated/humidified",
"Non-invasive ventilation (NIV/BiPAP): AECOPD, cardiogenic edema",
]},
{ title: "MECHANICAL VENTILATION (ARDS)", color: NAVY, items: [
"Lung-protective strategy: TV 4–8 mL/kg predicted body weight",
"Plateau pressure ≤ 30 cmH₂O",
"PEEP titrated to oxygenation (ARDSNet table)",
"PaO₂ target 55–80 mmHg; SpO₂ 88–95%",
"Permissive hypercapnia: pH 7.30–7.45 tolerated",
"Prone positioning (>16 h/day) → ↓mortality in severe ARDS (P/F < 150)",
]},
{ title: "PHARMACOLOGICAL THERAPY", color: "1A6B3A", items: [
"Bronchospasm: β₂-agonist (salbutamol), ipratropium, IV Mg²⁺",
"Cardiac edema: IV furosemide, vasodilators (GTN), inotropes",
"Infection: empiric antibiotics (CURB-65 guided)",
"PE: anticoagulation (LMWH/UFH); thrombolytics if haemodynamically unstable",
"Corticosteroids (ARDS): dexamethasone 6 mg/day improves outcomes",
"Sepsis: early antibiotics + source control within 1 hour",
]},
{ title: "ADVANCED / RESCUE THERAPIES", color: "7B3FA0", items: [
"Neuromuscular blockade (cisatracurium): moderate-severe ARDS, 48h",
"Inhaled NO / inhaled prostacyclin: pulmonary vasodilation",
"Recruitment manoeuvres: sustained inflation to re-open collapsed alveoli",
"ECMO (veno-venous): refractory ARDS failing all conventional measures",
"Tracheostomy: prolonged ventilation > 7–10 days anticipated",
]},
{ title: "AETIOLOGY-SPECIFIC TREATMENT", color: "C07A00", items: [
"Foreign body: Heimlich manoeuvre / bronchoscopic retrieval",
"Anaphylaxis: IM adrenaline 0.5 mg (1:1000) + antihistamine + steroids",
"Tension PTX: immediate needle decompression → chest tube",
"Cardiac tamponade: pericardiocentesis",
"Neuromuscular (MG/GBS): IVIG, plasmapheresis",
"Neonatal RDS: exogenous surfactant replacement therapy",
]},
];
const cw = 3.0, rh = 1.85, sx = 0.35, sy = 1.05;
txBlocks.forEach(({ title, color, items }, idx) => {
const col = idx % 3, row = Math.floor(idx / 3);
const bx = sx + col * (cw + 0.18);
const by = sy + row * rh;
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: rh - 0.1, fill: { color: WHITE }, line: { color: LTGRAY, pt: 0.8 } });
sl.addShape(pres.ShapeType.rect, { x: bx, y: by, w: cw, h: 0.3, fill: { color } });
sl.addText(title, { x: bx + 0.05, y: by, w: cw - 0.08, h: 0.3, fontSize: 9, bold: true, color: WHITE, valign: "middle", margin: 2 });
sl.addText(bullets(items, { fontSize: 10 }), { x: bx + 0.05, y: by + 0.32, w: cw - 0.1, h: rh - 0.44, valign: "top", margin: 2 });
});
}
// ══════════════════════════════════════════════════
// SLIDE 11 — REAL-LIFE CASES
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Real-Life Clinical Cases", "CASE STUDIES");
const cases = [
{
num: "01",
color: CRIMSON,
title: "Case 1: 68 y/o with ARDS post-Sepsis",
hx: "68M, DM, HTN. Admitted with 5-day fever, productive cough, confusion. BP 85/50, RR 32, SpO₂ 82% on room air, T 39.1°C.",
invest: "ABG: pH 7.28, PaO₂ 52, PaCO₂ 38, PaO₂/FiO₂ = 120. CXR: bilateral alveolar infiltrates. Cultures: Klebsiella pneumoniae sepsis.",
dx: "Sepsis-induced ARDS (moderate — Berlin PaO₂/FiO₂ 120)",
tx: "ICU admission. Intubation. Lung-protective ventilation (TV 6 mL/kg PBW, PEEP 12, Pplat ≤30). Prone positioning 18 h/day. Piperacillin-tazobactam. Dexamethasone 6 mg/d. Noradrenaline vasopressor. Survived after 12-day ICU course.",
},
{
num: "02",
color: TEAL,
title: "Case 2: 45 y/o with Acute Severe Asthma",
hx: "45F, known asthma, ran out of preventer inhaler. Sudden onset SOB, unable to complete sentences, expiratory wheeze bilaterally, SpO₂ 89%, PEFR 35% predicted.",
invest: "ABG early: pH 7.48, PaCO₂ 30 (respiratory alkalosis = early). ECG: sinus tachycardia. CXR: hyperinflation, no consolidation.",
dx: "Acute severe asthma exacerbation (near-fatal features: PEFR < 33%, silent chest = imminent arrest)",
tx: "Continuous nebulised salbutamol 5 mg. Ipratropium 0.5 mg. IV MgSO₄ 2 g over 20 min. IV hydrocortisone 200 mg. HFNC oxygen. Admitted to HDU; avoided intubation. Stepped down to ward in 48 h with step-up preventer therapy.",
},
{
num: "03",
color: NAVY,
title: "Case 3: 72 y/o with Cardiogenic Pulmonary Edema",
hx: "72M, IHD, non-compliant with diuretics. Orthopnea, PND, bilateral crackles to mid-zones, S3 gallop, JVD, peripheral oedema, SpO₂ 86% on air, HR 110, BP 160/95.",
invest: "BNP: 2,400 pg/mL. Echo: LVEF 25%, dilated LV, MR. CXR: bilateral pleural effusions, Kerley B lines, cardiomegaly, bat-wing infiltrates. ABG: PaO₂ 58, PaCO₂ 36.",
dx: "Acute decompensated heart failure / cardiogenic pulmonary edema",
tx: "IV furosemide 80 mg bolus → 10 mg/h infusion. GTN infusion 0.5–2 mcg/kg/min. BiPAP CPAP 10 cmH₂O (averted intubation). Fluid restriction. Fluid balance -2.5 L by day 2. Initiated sacubitril/valsartan on discharge. SpO₂ 97% on day 3.",
},
];
const rh = 1.48, sy = 1.05, sw = 9.28;
cases.forEach(({ num, color, title, hx, invest, dx, tx }, idx) => {
const by = sy + idx * (rh + 0.06);
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: by, w: sw, h: rh, fill: { color: WHITE }, line: { color: LTGRAY, pt: 0.8 } });
// Left badge
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: by, w: 0.55, h: rh, fill: { color } });
sl.addText(`CASE\n${num}`, { x: 0.35, y: by, w: 0.55, h: rh, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
// Title
sl.addShape(pres.ShapeType.rect, { x: 0.9, y: by, w: sw - 0.55, h: 0.28, fill: { color: color === CRIMSON ? "FEF0EF" : color === TEAL ? "EBF8FA" : "EEF2F8" } });
sl.addText(title, { x: 0.95, y: by, w: sw - 0.6, h: 0.28, fontSize: 10.5, bold: true, color, valign: "middle", margin: 2 });
// Content columns
const cols = [
{ label: "HX & EXAM", val: hx },
{ label: "INVESTIGATIONS", val: invest },
{ label: "Dx / Tx", val: `Dx: ${dx}\n\nTx: ${tx}` },
];
cols.forEach(({ label, val }, ci) => {
const cw = (sw - 0.58) / 3;
const cx = 0.9 + ci * (cw + 0.04);
sl.addText(label, { x: cx, y: by + 0.3, w: cw, h: 0.22, fontSize: 8.5, bold: true, color, valign: "top", margin: 2 });
sl.addText(val, { x: cx, y: by + 0.52, w: cw, h: rh - 0.55, fontSize: 9, color: DARKGRAY, valign: "top", margin: 2, wrap: true });
});
});
// ARDS CXR image beside cases (bottom right)
if (images[1] && !images[1].error) {
// Just add a visual note since space is tight
}
}
// ══════════════════════════════════════════════════
// SLIDE 12 — CXR IMAGING SLIDE
// ══════════════════════════════════════════════════
{
const sl = contentSlide("Radiological Evidence — ARDS on CXR", "IMAGING");
sl.addText("Classic ARDS Chest X-Ray Appearances", { x: 0.35, y: 1.08, w: 9.3, h: 0.3, fontSize: 13, bold: true, color: NAVY, margin: 0 });
const imgSlots = [images[0], images[1], images[3]];
const captions = [
"Bilateral diffuse opacities — ARDS in ICU patient on mechanical ventilation (endotracheal tube visible)",
"ARDS before/after CENPV treatment — progressive bilateral alveolar infiltrates and resolution",
"Classic ARDS pattern: bilateral patchy alveolar opacities, Berlin definition — non-cardiogenic pulmonary edema",
];
imgSlots.forEach((img, i) => {
const bx = 0.35 + i * 3.2;
if (img && !img.error) {
sl.addImage({ data: img.base64, x: bx, y: 1.45, w: 3.05, h: 2.2 });
} else {
sl.addShape(pres.ShapeType.rect, { x: bx, y: 1.45, w: 3.05, h: 2.2, fill: { color: LTGRAY } });
sl.addText("Image unavailable", { x: bx, y: 1.45, w: 3.05, h: 2.2, fontSize: 10, color: DARKGRAY, align: "center", valign: "middle" });
}
sl.addShape(pres.ShapeType.rect, { x: bx, y: 3.68, w: 3.05, h: 0.54, fill: { color: "F0F5FF" }, line: { color: LTGRAY, pt: 0.5 } });
sl.addText(captions[i], { x: bx + 0.04, y: 3.7, w: 2.97, h: 0.5, fontSize: 8.5, italic: true, color: "556677", valign: "middle", margin: 2 });
});
// Key radiological findings
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 4.3, w: 9.28, h: 0.28, fill: { color: NAVY } });
sl.addText("KEY RADIOLOGICAL FINDINGS IN ARDS", { x: 0.35, y: 4.3, w: 9.28, h: 0.28, fontSize: 10.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText([
{ text: "Bilateral opacities ", options: { bold: true, color: CRIMSON } },
{ text: "not fully explained by effusions or collapse | ", options: { color: DARKGRAY } },
{ text: "Normal cardiac size ", options: { bold: true, color: TEAL } },
{ text: "(unlike cardiogenic edema) | ", options: { color: DARKGRAY } },
{ text: "Air bronchograms ", options: { bold: true, color: NAVY } },
{ text: "visible in consolidation | ", options: { color: DARKGRAY } },
{ text: "Ground-glass opacities ", options: { bold: true, color: "7B3FA0" } },
{ text: "= early diffuse alveolar damage", options: { color: DARKGRAY } },
], { x: 0.38, y: 4.6, w: 9.22, h: 0.75, fontSize: 10, valign: "middle", margin: 4 });
}
// ══════════════════════════════════════════════════
// SLIDE 13 — KEY TAKEAWAYS / SUMMARY
// ══════════════════════════════════════════════════
{
const sl = pres.addSlide();
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY } });
sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: CRIMSON } });
sl.addShape(pres.ShapeType.rect, { x: 0, y: 3.5, w: 10, h: 0.08, fill: { color: CRIMSON } });
sl.addText("KEY TAKEAWAYS", { x: 0.35, y: 0.15, w: 9.3, h: 0.58, fontSize: 26, bold: true, color: WHITE, charSpacing: 2 });
sl.addText("What every medical intern must remember about Respiratory Distress", { x: 0.35, y: 0.72, w: 9.3, h: 0.3, fontSize: 13, italic: true, color: LTGRAY });
const takeaways = [
["01", "Respiratory distress is a CLINICAL diagnosis — act on clinical signs, don't wait for labs.", CRIMSON],
["02", "The 5-second ARDS Berlin criteria: <1 week onset | bilateral opacities | non-cardiogenic | P/F ≤300.", TEAL],
["03", "Lung-protective ventilation (4–8 mL/kg PBW, Pplat ≤30) saves lives in ARDS.", "1A6B3A"],
["04", "Prone positioning >16 h/day reduces ARDS mortality in severe disease (P/F <150).", "C07A00"],
["05", "Always differentiate cardiac from non-cardiac pulmonary edema — treatment is opposite!", "7B3FA0"],
["06", "Tension pneumothorax → clinical diagnosis → immediate needle decompression — never wait for CXR.", CRIMSON],
["07", "In sepsis-induced ARDS: early antibiotics + source control within 1 hour of recognition.", TEAL],
];
takeaways.forEach(([num, text, color], i) => {
const by = 1.12 + i * 0.33;
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: by, w: 9.28, h: 0.28, fill: { color: "0A2035" }, line: { color: color, pt: 0.8 } });
sl.addShape(pres.ShapeType.rect, { x: 0.35, y: by, w: 0.38, h: 0.28, fill: { color } });
sl.addText(num, { x: 0.35, y: by, w: 0.38, h: 0.28, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
sl.addText(text, { x: 0.78, y: by, w: 8.8, h: 0.28, fontSize: 11, color: WHITE, valign: "middle", margin: 4 });
});
sl.addText("Sources: Tintinalli's Emergency Medicine · Current Surgical Therapy 14e · Murray & Nadel's Textbook of Respiratory Medicine", {
x: 0.35, y: 5.1, w: 9.28, h: 0.3,
fontSize: 8, color: "8BAACC", italic: true
});
}
// ══════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════
const outPath = "/home/daytona/workspace/respiratory-distress-ppt/Respiratory_Distress_Medical_Intern.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
console.log("✅ Presentation saved to:", outPath);
}).catch(err => {
console.error("❌ Error saving:", err);
process.exit(1);
});
Running Command
cd /home/daytona/workspace/respiratory-distress-ppt && node build.js 2>&1
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