Orris

Ppt on burns and first aud managenent as per surgery R2 resident

Reading File
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Finding Sources
Finding Sources
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Running Command

mkdir -p /home/daytona/workspace/burns-ppt && ls /home/daytona/workspace/burns-ppt

Writing File

~/burns-ppt/burns.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Burns & First Aid Management";
pres.author = "Surgery R2 Resident";

// ─── THEME ────────────────────────────────────────────────────────────────────
const C = {
  bg:        "1A1A2E",   // deep navy
  accent:    "E94560",   // vivid red-orange (burns)
  gold:      "F5A623",   // amber/gold
  teal:      "0F9B8E",   // teal
  lightGray: "D0D3E0",
  white:     "FFFFFF",
  darkText:  "1A1A2E",
  card:      "16213E",   // slightly lighter navy
  cardBord:  "E94560",
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function addSlide(opts = {}) {
  const s = pres.addSlide();
  // background
  if (opts.dark !== false) {
    s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.bg }, line: { width: 0 } });
  } else {
    s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F4F6FB" }, line: { width: 0 } });
  }
  return s;
}

function sectionBar(s, label, yPos = 0) {
  s.addShape(pres.ShapeType.rect, { x: 0, y: yPos, w: "100%", h: 0.5, fill: { color: C.accent }, line: { width: 0 } });
  s.addText(label.toUpperCase(), {
    x: 0.3, y: yPos, w: 9, h: 0.5,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri",
    valign: "middle", margin: 0
  });
}

function slideTitle(s, title, subtitle = "", dark = true) {
  const textColor = dark ? C.white : C.darkText;
  s.addText(title, {
    x: 0.4, y: 0.15, w: 9.2, h: 0.65,
    fontSize: 22, bold: true, color: textColor, fontFace: "Calibri",
    valign: "middle"
  });
  if (subtitle) {
    s.addText(subtitle, {
      x: 0.4, y: 0.72, w: 9.2, h: 0.35,
      fontSize: 12, color: C.gold, fontFace: "Calibri", italic: true,
      valign: "middle"
    });
  }
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.1, w: 9.2, h: 0.04, fill: { color: C.accent }, line: { width: 0 } });
}

function card(s, x, y, w, h, opts = {}) {
  s.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: opts.fill || C.card }, line: { color: opts.border || C.accent, width: 1.5 } });
}

function bullets(s, items, x, y, w, h, opts = {}) {
  const fontSize = opts.fontSize || 13;
  const color = opts.color || C.lightGray;
  s.addText(
    items.map((item, i) => ({
      text: item,
      options: { bullet: { code: "2022" }, breakLine: i < items.length - 1, color, fontSize, fontFace: "Calibri" }
    })),
    { x, y, w, h, valign: "top" }
  );
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 1 β€” TITLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();

  // fire accent bar left
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: "100%", fill: { color: C.accent }, line: { width: 0 } });

  // gradient-feel right panel
  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0, w: 3.5, h: "100%", fill: { color: C.card }, line: { width: 0 } });

  s.addText("BURNS", {
    x: 0.4, y: 0.6, w: 6, h: 1.4,
    fontSize: 72, bold: true, color: C.accent, fontFace: "Calibri", charSpacing: 8
  });
  s.addText("& FIRST AID MANAGEMENT", {
    x: 0.4, y: 1.95, w: 6, h: 0.7,
    fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 2
  });

  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 2.78, w: 5.5, h: 0.05, fill: { color: C.gold }, line: { width: 0 } });

  s.addText("Surgery Residency β€” R2 Level", {
    x: 0.4, y: 2.95, w: 5.5, h: 0.4,
    fontSize: 14, color: C.gold, fontFace: "Calibri", italic: true
  });

  s.addText([
    { text: "Reference: Schwartz's Principles of Surgery (11e)", options: { breakLine: true } },
    { text: "Sabiston Textbook of Surgery", options: { breakLine: true } },
    { text: "Bailey & Love's Short Practice of Surgery (28e)" }
  ], {
    x: 6.6, y: 1.2, w: 3.2, h: 1.4,
    fontSize: 10, color: C.lightGray, fontFace: "Calibri", italic: true, valign: "top"
  });

  s.addText("June 2026", { x: 6.6, y: 4.9, w: 3, h: 0.4, fontSize: 11, color: C.teal, fontFace: "Calibri" });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 2 β€” EPIDEMIOLOGY & OVERVIEW
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  slideTitle(s, "Epidemiology & Overview");

  const stats = [
    { num: "~180,000", label: "Global Deaths/year" },
    { num: "#4", label: "Most Common Trauma" },
    { num: "75%", label: "From Household Accidents" },
    { num: "90%", label: "In LMICs" },
  ];

  stats.forEach((st, i) => {
    const x = 0.4 + i * 2.3;
    card(s, x, 1.25, 2.1, 1.5, { border: C.gold });
    s.addText(st.num, { x: x + 0.05, y: 1.3, w: 2.0, h: 0.7, fontSize: 22, bold: true, color: C.gold, fontFace: "Calibri", align: "center" });
    s.addText(st.label, { x: x + 0.05, y: 1.95, w: 2.0, h: 0.6, fontSize: 11, color: C.lightGray, fontFace: "Calibri", align: "center" });
  });

  sectionBar(s, "Common Causes", 2.95);
  const causes = [
    ["Thermal (Flame/Scalds)", "Most common β€” flame burns in adults, scalds in children <5 yrs"],
    ["Chemical Burns", "Acids/alkalis β€” alkalis penetrate deeper (liquefaction necrosis)"],
    ["Electrical Burns", "Entry/exit wounds; iceberg effect; arrhythmia risk"],
    ["Radiation Burns", "UV (sunburn) to ionizing radiation β€” may cause delayed effects"],
  ];
  causes.forEach((c, i) => {
    const y = 3.5 + i * 0.5;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: y, w: 0.12, h: 0.32, fill: { color: C.accent }, line: { width: 0 } });
    s.addText(c[0], { x: 0.6, y: y, w: 2.8, h: 0.35, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
    s.addText(c[1], { x: 3.5, y: y, w: 6.1, h: 0.35, fontSize: 11, color: C.lightGray, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 3 β€” CLASSIFICATION BY DEPTH
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide({ dark: false });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F2F8" }, line: { width: 0 } });

  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.55, fill: { color: C.bg }, line: { width: 0 } });
  s.addText("BURN CLASSIFICATION β€” DEPTH", {
    x: 0.4, y: 0, w: 9.2, h: 0.55,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.55, w: "100%", h: 0.06, fill: { color: C.accent }, line: { width: 0 } });

  const degrees = [
    {
      label: "1st Degree\n(Superficial)",
      color: "FDEBD0",
      border: "F0A500",
      features: ["Epidermis only", "Erythema, pain, dry", "No blisters", "Heals in 3–5 days", "Not included in TBSA %"],
      example: "Sunburn"
    },
    {
      label: "2nd Degree\nSuperficial Partial",
      color: "FADBD8",
      border: "E94560",
      features: ["Epidermis + papillary dermis", "Blisters, moist, painful", "Blanches with pressure", "Heals in 10–14 days", "Included in TBSA %"],
      example: "Scalds, flash burns"
    },
    {
      label: "2nd Degree\nDeep Partial",
      color: "EBDEF0",
      border: "8E44AD",
      features: ["Into reticular dermis", "Less pain (↓nerve ends)", "Pale/mottled, less blanching", "Heals 3–9 weeks", "Often needs grafting"],
      example: "Prolonged scald/flame"
    },
    {
      label: "3rd Degree\n(Full Thickness)",
      color: "D5D8DC",
      border: "2C3E50",
      features: ["Through entire dermis", "Painless, leathery/charred", "No blanching", "Does NOT heal without graft", "Always needs surgery"],
      example: "Flame, electrical, chemical"
    },
  ];

  degrees.forEach((d, i) => {
    const x = 0.3 + i * 2.38;
    s.addShape(pres.ShapeType.rect, { x, y: 0.8, w: 2.25, h: 4.55, fill: { color: d.color }, line: { color: d.border, width: 2.5 } });
    s.addShape(pres.ShapeType.rect, { x, y: 0.8, w: 2.25, h: 0.7, fill: { color: d.border }, line: { width: 0 } });
    s.addText(d.label, { x: x + 0.05, y: 0.82, w: 2.15, h: 0.66, fontSize: 11.5, bold: true, color: "FFFFFF", fontFace: "Calibri", align: "center", valign: "middle" });
    const fItems = d.features.map((f, j) => ({ text: f, options: { bullet: { code: "2022" }, breakLine: j < d.features.length - 1, fontSize: 10.5, color: "1A1A2E", fontFace: "Calibri" } }));
    s.addText(fItems, { x: x + 0.1, y: 1.55, w: 2.1, h: 2.9, valign: "top" });
    s.addText("e.g.: " + d.example, { x: x + 0.07, y: 4.95, w: 2.1, h: 0.35, fontSize: 9.5, italic: true, color: d.border, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 4 β€” RULE OF NINES / BSA ESTIMATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  slideTitle(s, "Estimating Burn Size β€” TBSA", "Rule of Nines & Lund-Browder Chart");

  // Left side β€” rule of nines table
  sectionBar(s, "Rule of Nines (Wallace) β€” Adults", 1.22);

  const regions = [
    ["Head & Neck", "9%"],
    ["Each Upper Limb", "9% Γ— 2 = 18%"],
    ["Anterior Trunk", "18%"],
    ["Posterior Trunk", "18%"],
    ["Each Lower Limb", "18% Γ— 2 = 36%"],
    ["Perineum/Genitalia", "1%"],
    ["TOTAL", "100%"],
  ];

  regions.forEach((r, i) => {
    const y = 1.8 + i * 0.42;
    const bg = i === regions.length - 1 ? C.accent : (i % 2 === 0 ? C.card : "1E2540");
    s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 3.8, h: 0.38, fill: { color: bg }, line: { width: 0 } });
    s.addText(r[0], { x: 0.55, y, w: 2.6, h: 0.38, fontSize: 11.5, color: i === regions.length - 1 ? C.white : C.lightGray, bold: i === regions.length - 1, fontFace: "Calibri", valign: "middle" });
    s.addText(r[1], { x: 3.1, y, w: 1.1, h: 0.38, fontSize: 11.5, color: i === regions.length - 1 ? C.white : C.gold, bold: true, fontFace: "Calibri", valign: "middle", align: "center" });
  });

  // Right side β€” key points
  sectionBar(s, "Key Rules & Lund-Browder", 1.22);
  const ruleNotes = [
    { x: 4.8, y: 1.8, title: "Palmer Method", text: "Patient's palm (inc. fingers) = ~1% TBSA β€” useful for irregular/scattered burns" },
    { x: 4.8, y: 2.8, title: "Children (Lund-Browder)", text: "Head = 18% at birth (decreases with age). Each leg = 14% at birth (increases with age). Use age-adjusted chart for <15 yrs." },
    { x: 4.8, y: 3.95, title: "Exclude", text: "Superficial (1st degree) burns are NOT counted in TBSA calculation" },
    { x: 4.8, y: 4.7, title: "Significance", text: ">20% TBSA β†’ IV resuscitation mandatory. >40% TBSA β†’ 2 large-bore IVs" },
  ];
  ruleNotes.forEach((n) => {
    card(s, n.x, n.y, 5.1, n.y <= 2.8 ? 0.82 : (n.y === 3.95 ? 0.65 : 0.62), { fill: C.card, border: C.teal });
    s.addText(n.title + ": ", { x: n.x + 0.12, y: n.y + 0.05, w: 4.8, h: 0.3, fontSize: 11.5, bold: true, color: C.teal, fontFace: "Calibri" });
    s.addText(n.text, { x: n.x + 0.12, y: n.y + 0.3, w: 4.8, h: n.y <= 2.8 ? 0.45 : 0.35, fontSize: 10.5, color: C.lightGray, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 5 β€” FIRST AID MANAGEMENT (SCENE / PRE-HOSPITAL)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide({ dark: false });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "FFFBF4" }, line: { width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.55, fill: { color: C.bg }, line: { width: 0 } });
  s.addText("FIRST AID MANAGEMENT", { x: 0.4, y: 0, w: 9.2, h: 0.55, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.55, w: "100%", h: 0.06, fill: { color: C.accent }, line: { width: 0 } });

  const steps = [
    { num: "1", title: "STOP the burning process", color: "E94560", desc: 'Remove from source. Burning clothes β†’ "Stop, Drop, Roll". Remove all clothing & jewellery (except adherent). Chemical burns: brush off dry chemical first, then copious irrigation.' },
    { num: "2", title: "COOL the burn", color: "0F9B8E", desc: "Cool running water 15–20 min (15–20Β°C) within 3 hours of injury. Do NOT use ice, ice water, or butter β€” causes vasoconstriction & deeper injury. Cover with clean non-fluffy material (cling film β€” longitudinally, not circumferentially)." },
    { num: "3", title: "COVER the wound", color: "F5A623", desc: 'Sterile or clean dressing. Cling film is ideal (non-adherent, reduces pain, allows assessment). Avoid fluffy cotton. Do NOT burst blisters at the scene.' },
    { num: "4", title: "WARM the patient", color: "8E44AD", desc: "Especially for large burns (>20% TBSA) β€” hypothermia worsens outcome. Wrap in clean blankets after cooling. Avoid prolonged cooling of large burns." },
    { num: "5", title: "TRANSFER / REFER", color: "2980B9", desc: "ABA criteria: >10–20% TBSA, full thickness, face/hands/feet/genitalia, electrical/chemical, inhalation injury, extremes of age, circumferential burns β†’ Burn Unit." },
  ];

  steps.forEach((st, i) => {
    const y = 0.75 + i * 0.95;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.55, h: 0.7, fill: { color: st.color }, line: { width: 0 } });
    s.addText(st.num, { x: 0.3, y, w: 0.55, h: 0.7, fontSize: 22, bold: true, color: "FFFFFF", fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(st.title, { x: 0.95, y: y + 0.05, w: 3.5, h: 0.35, fontSize: 13, bold: true, color: st.color, fontFace: "Calibri", valign: "middle" });
    s.addText(st.desc, { x: 0.95, y: y + 0.35, w: 8.75, h: 0.55, fontSize: 10, color: "1A1A2E", fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 6 β€” INITIAL HOSPITAL EVALUATION (ATLS / PRIMARY SURVEY)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  slideTitle(s, "Initial Hospital Evaluation β€” ATLS Approach");

  const abcde = [
    {
      letter: "A", title: "AIRWAY", color: C.accent,
      points: ["Hoarse voice / stridor / wheezing β†’ intubate EARLY", "Orotracheal intubation preferred", "Singed nasal hairs / perioral burns β†’ examine oropharynx", "Fiberoptic bronchoscopy = gold standard for uncertain airway"]
    },
    {
      letter: "B", title: "BREATHING", color: "3498DB",
      points: ["100% Oβ‚‚ via non-rebreather mask", "Suspect inhalation injury in enclosed space fires", "CXR + ABG + carboxyhemoglobin level", "HFPV / lung-protective ventilation for ARDS (6 mL/kg)"]
    },
    {
      letter: "C", title: "CIRCULATION", color: C.teal,
      points: ["2 large-bore peripheral IVs (can place through burn)", "IV access through burned skin is safe", "IO access if venous access fails", "Foley catheter β€” monitor urine output"]
    },
    {
      letter: "D", title: "DISABILITY", color: C.gold,
      points: ["GCS, pupils", "CO poisoning β†’ confusion/coma", "Electrical burns β†’ ECG monitoring", "Cyanide toxicity β†’ severe lactic acidosis"]
    },
    {
      letter: "E", title: "EXPOSURE", color: "9B59B6",
      points: ["Full exposure β€” log roll for posterior burns", "Prevent hypothermia β€” wrap in warm blankets", "Remove ALL clothing & jewellery", "Radiology: CXR urgent; extremity X-rays can wait (avoid hypothermia)"]
    },
  ];

  abcde.forEach((item, i) => {
    const x = 0.3 + i * 1.88;
    card(s, x, 1.22, 1.77, 4.2, { fill: C.card, border: item.color });
    s.addShape(pres.ShapeType.rect, { x, y: 1.22, w: 1.77, h: 0.55, fill: { color: item.color }, line: { width: 0 } });
    s.addText(item.letter, { x: x, y: 1.22, w: 0.5, h: 0.55, fontSize: 22, bold: true, color: "FFFFFF", fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(item.title, { x: x + 0.5, y: 1.22, w: 1.25, h: 0.55, fontSize: 11, bold: true, color: "FFFFFF", fontFace: "Calibri", valign: "middle", align: "center" });
    const pts = item.points.map((p, j) => ({ text: p, options: { bullet: { code: "2022" }, breakLine: j < item.points.length - 1, fontSize: 9.5, color: C.lightGray, fontFace: "Calibri" } }));
    s.addText(pts, { x: x + 0.1, y: 1.84, w: 1.6, h: 3.5, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 7 β€” FLUID RESUSCITATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide({ dark: false });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "EAF4FB" }, line: { width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.55, fill: { color: C.bg }, line: { width: 0 } });
  s.addText("FLUID RESUSCITATION", { x: 0.4, y: 0, w: 9.2, h: 0.55, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.55, w: "100%", h: 0.06, fill: { color: C.teal }, line: { width: 0 } });

  // Parkland Formula box β€” center stage
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.72, w: 5.4, h: 1.55, fill: { color: "16213E" }, line: { color: C.teal, width: 3 } });
  s.addText("Parkland Formula (Most Widely Used)", { x: 0.55, y: 0.74, w: 5.0, h: 0.38, fontSize: 13, bold: true, color: C.teal, fontFace: "Calibri" });
  s.addText("4 mL Γ— Weight (kg) Γ— %TBSA", { x: 0.55, y: 1.1, w: 5.0, h: 0.55, fontSize: 22, bold: true, color: C.gold, fontFace: "Calibri", align: "center" });
  s.addText("Lactated Ringer's (Hartmann's) in first 24 hrs", { x: 0.55, y: 1.63, w: 5.0, h: 0.4, fontSize: 11.5, color: C.lightGray, fontFace: "Calibri", italic: true });

  // Modified Brooke
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 2.38, w: 5.4, h: 0.9, fill: { color: "16213E" }, line: { color: C.accent, width: 2 } });
  s.addText("Modified Brooke Formula (Alternative)", { x: 0.55, y: 2.4, w: 5.0, h: 0.32, fontSize: 11.5, bold: true, color: C.accent, fontFace: "Calibri" });
  s.addText("2 mL Γ— Weight (kg) Γ— %TBSA  (LR)", { x: 0.55, y: 2.7, w: 5.0, h: 0.45, fontSize: 16, bold: true, color: C.white, fontFace: "Calibri" });

  // Administration schedule
  sectionBar(s, "Administration Schedule", 3.42);
  s.addText([
    { text: "50% in first 8 hrs from TIME OF BURN (not from hospital arrival)", options: { bullet: { code: "2022" }, breakLine: true, fontSize: 12, color: "1A1A2E" } },
    { text: "50% in next 16 hrs", options: { bullet: { code: "2022" }, breakLine: true, fontSize: 12, color: "1A1A2E" } },
    { text: "Children: add maintenance D5W (dextrose) to the above for pediatric patients", options: { bullet: { code: "2022" }, fontSize: 12, color: "1A1A2E" } },
  ], { x: 0.4, y: 3.95, w: 5.3, h: 1.45 });

  // Monitoring targets β€” right column
  sectionBar(s, "Monitoring Endpoints", 0.72);
  const targets = [
    ["Urine Output", ">0.5 mL/kg/hr adults\n1 mL/kg/hr in children <30 kg"],
    ["MAP", ">60 mmHg"],
    ["Warning", "Over-resuscitation β†’ abdominal compartment, pulmonary edema"],
    ["Colloids", "Consider albumin after 24 hrs in large burns"],
  ];
  // override sectionBar y for right column
  s.addShape(pres.ShapeType.rect, { x: 6.1, y: 0.72, w: 3.7, h: 0.45, fill: { color: C.accent }, line: { width: 0 } });
  s.addText("MONITORING ENDPOINTS", { x: 6.2, y: 0.72, w: 3.5, h: 0.45, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  targets.forEach((t, i) => {
    const y = 1.25 + i * 0.98;
    s.addShape(pres.ShapeType.rect, { x: 6.1, y, w: 3.7, h: 0.88, fill: { color: i % 2 === 0 ? "D6EAF8" : "EBF5FB" }, line: { color: "AED6F1", width: 1 } });
    s.addText(t[0] + ":", { x: 6.2, y: y + 0.04, w: 3.5, h: 0.28, fontSize: 11, bold: true, color: "1A1A2E", fontFace: "Calibri" });
    s.addText(t[1], { x: 6.2, y: y + 0.3, w: 3.5, h: 0.5, fontSize: 10.5, color: "1A1A2E", fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 8 β€” INHALATION INJURY
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  slideTitle(s, "Inhalation Injury", "Triad: CO Poisoning | Thermal Airway Injury | Smoke Inhalation");

  const zones = [
    {
      title: "CO Poisoning",
      color: C.accent,
      points: [
        "CO has 200Γ— affinity for Hb vs Oβ‚‚ β†’ forms HbCO",
        "Pulse oximetry FALSELY normal β€” measure HbCO on ABG",
        "Symptoms: headache β†’ confusion β†’ seizure β†’ coma",
        "Tx: 100% Oβ‚‚ (half-life HbCO: 4–5 hrs room air β†’ 60–90 min on 100% Oβ‚‚)",
        "Hyperbaric Oβ‚‚ reserved for: coma, cardiac involvement, pregnancy"
      ]
    },
    {
      title: "Upper Airway (Thermal) Injury",
      color: C.gold,
      points: [
        "Supraglottic β€” heated air cooled at vocal cords",
        "Rapid mucosal edema β†’ stridor, hoarseness",
        "Intubate EARLY (edema worsens over 12–24 hrs)",
        "Fiberoptic bronchoscopy = gold standard if uncertain",
        "Signs: facial burns, singed nasal hairs, carbonaceous sputum"
      ]
    },
    {
      title: "Lower Airway / Cyanide Toxicity",
      color: C.teal,
      points: [
        "Smoke particles <2 ΞΌm reach alveoli β†’ chemical pneumonitis",
        "Tracheobronchitis β†’ bronchospasm β†’ ARDS",
        "Cyanide: inhibits cytochrome oxidase β†’ severe lactic acidosis",
        "Classic signs (bitter almond breath) unreliable β€” treat empirically",
        "Tx: Hydroxocobalamin (B12 precursor) + sodium thiosulfate + 100% Oβ‚‚"
      ]
    },
  ];

  zones.forEach((z, i) => {
    const x = 0.3 + i * 3.25;
    card(s, x, 1.22, 3.1, 4.25, { fill: C.card, border: z.color });
    s.addShape(pres.ShapeType.rect, { x, y: 1.22, w: 3.1, h: 0.5, fill: { color: z.color }, line: { width: 0 } });
    s.addText(z.title, { x: x + 0.1, y: 1.22, w: 2.9, h: 0.5, fontSize: 12.5, bold: true, color: "FFFFFF", fontFace: "Calibri", align: "center", valign: "middle" });
    const pts = z.points.map((p, j) => ({ text: p, options: { bullet: { code: "2022" }, breakLine: j < z.points.length - 1, fontSize: 10.5, color: C.lightGray, fontFace: "Calibri" } }));
    s.addText(pts, { x: x + 0.12, y: 1.8, w: 2.9, h: 3.55, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 9 β€” BURN WOUND CARE & TOPICAL AGENTS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide({ dark: false });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F8F9FA" }, line: { width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.55, fill: { color: C.bg }, line: { width: 0 } });
  s.addText("BURN WOUND CARE & TOPICAL AGENTS", { x: 0.4, y: 0, w: 9.2, h: 0.55, fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.55, w: "100%", h: 0.06, fill: { color: C.accent }, line: { width: 0 } });

  const agents = [
    { name: "Silver Sulfadiazine\n(SSD)", color: "2980B9", pros: "Broad-spectrum antimicrobial, easy application", cons: "Transient neutropenia, delays re-epithelialization, avoid in sulfa allergy/pregnancy" },
    { name: "Mafenide Acetate", color: "8E44AD", pros: "Penetrates eschar well, useful for ear cartilage burns", cons: "Painful, carbonic anhydrase inhibitor β†’ metabolic acidosis" },
    { name: "Silver Nitrate\n0.5%", color: "2C3E50", pros: "Broad spectrum, low resistance", cons: "Discolors everything; electrolyte imbalance (hyponatremia, hypokalemia)" },
    { name: "Bacitracin / Petrolatum Gauze", color: "27AE60", pros: "Face/minor burns; gentle; easy to remove", cons: "Limited antimicrobial spectrum" },
    { name: "Honey Dressings\n(Manuka)", color: C.gold, pros: "Antibacterial; promotes re-epithelialization; evidence for superficial partial burns", cons: "Messy; not for large full-thickness burns" },
  ];

  s.addText("Important: NO prophylactic systemic antibiotics β€” promotes resistant organisms & fungal infection", {
    x: 0.4, y: 0.68, w: 9.2, h: 0.42, fontSize: 11.5, bold: true, color: C.accent, fontFace: "Calibri",
    fill: { color: "FFF0F0" }, align: "center"
  });

  // Header row
  const cols = [0.3, 3.0, 6.1];
  const headers = ["Agent", "Advantages", "Disadvantages / Cautions"];
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: cols[i], y: 1.18, w: i < 2 ? 2.6 : 3.55, h: 0.38, fill: { color: C.bg }, line: { width: 0 } });
    s.addText(h, { x: cols[i] + 0.1, y: 1.18, w: 2.5, h: 0.38, fontSize: 11.5, bold: true, color: C.gold, fontFace: "Calibri", valign: "middle" });
  });

  agents.forEach((a, i) => {
    const y = 1.6 + i * 0.76;
    const rowBg = i % 2 === 0 ? "EAECEE" : "FBFCFC";
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.35, h: 0.68, fill: { color: rowBg }, line: { width: 0 } });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.1, h: 0.68, fill: { color: a.color }, line: { width: 0 } });
    s.addText(a.name, { x: 0.45, y: y + 0.04, w: 2.4, h: 0.6, fontSize: 11, bold: true, color: "1A1A2E", fontFace: "Calibri", valign: "middle" });
    s.addText(a.pros, { x: 2.95, y: y + 0.04, w: 3.0, h: 0.6, fontSize: 10, color: "1A1A2E", fontFace: "Calibri", valign: "top" });
    s.addText(a.cons, { x: 6.0, y: y + 0.04, w: 3.6, h: 0.6, fontSize: 10, color: "1A1A2E", fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 10 β€” SURGICAL MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  slideTitle(s, "Surgical Management of Burns");

  sectionBar(s, "Principles of Early Excision & Grafting", 1.22);

  s.addText([
    { text: "Key principle: ", options: { bold: true, color: C.gold, fontSize: 13 } },
    { text: "Early tangential excision (within 48–72 hrs) + skin grafting of full-thickness and deep partial-thickness burns improves survival and reduces infection risk", options: { color: C.lightGray, fontSize: 13 } }
  ], { x: 0.4, y: 1.72, w: 9.2, h: 0.5, fontFace: "Calibri" });

  const surgtopics = [
    {
      title: "Tangential Excision",
      color: C.accent,
      points: [
        "Sequential shaving of burn eschar until viable tissue (punctate bleeding)",
        "Blood loss can be significant β€” warm tourniquet, epinephrine-soaked gauze",
        "Limit session to <20% TBSA or 2 hrs to avoid hypothermia/coagulopathy"
      ]
    },
    {
      title: "Fascial Excision",
      color: C.teal,
      points: [
        "Reserved for very deep / infected burns",
        "Removes all tissue down to fascia",
        "Lower blood loss but greater cosmetic deformity",
        "Used for electrical burns to expose deep tissue damage"
      ]
    },
    {
      title: "Wound Coverage",
      color: C.gold,
      points: [
        "Split-thickness skin graft (STSG) β€” gold standard for large burns",
        "Full-thickness graft (FTSG) β€” face, hands, joints (better cosmesis)",
        "Mesh grafts (1.5:1 to 4:1) expand coverage in large burns",
        "Cultured epithelial autograft (CEA) β€” severe burns where donor limited"
      ]
    },
    {
      title: "Escharotomy",
      color: "9B59B6",
      points: [
        "For circumferential full-thickness burns",
        "Prevents compartment syndrome (limbs) & chest wall restriction",
        "Medial and lateral longitudinal incisions to fascia",
        "Fasciotomy if compartment syndrome develops despite escharotomy"
      ]
    },
  ];

  surgtopics.forEach((t, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.35 + col * 4.8;
    const y = 2.35 + row * 1.58;
    card(s, x, y, 4.55, 1.45, { fill: C.card, border: t.color });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.55, h: 0.38, fill: { color: t.color }, line: { width: 0 } });
    s.addText(t.title, { x: x + 0.1, y, w: 4.35, h: 0.38, fontSize: 12, bold: true, color: "FFFFFF", fontFace: "Calibri", valign: "middle" });
    const pts = t.points.map((p, j) => ({ text: p, options: { bullet: { code: "2022" }, breakLine: j < t.points.length - 1, fontSize: 9.5, color: C.lightGray, fontFace: "Calibri" } }));
    s.addText(pts, { x: x + 0.12, y: y + 0.42, w: 4.3, h: 0.97, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 11 β€” SPECIAL BURNS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide({ dark: false });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F4F6FB" }, line: { width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.55, fill: { color: C.bg }, line: { width: 0 } });
  s.addText("SPECIAL BURNS", { x: 0.4, y: 0, w: 9.2, h: 0.55, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.55, w: "100%", h: 0.06, fill: { color: C.gold }, line: { width: 0 } });

  const specials = [
    {
      title: "CHEMICAL BURNS",
      color: "8E44AD",
      icon: "βš—",
      points: [
        "Acids: coagulation necrosis β€” self-limiting depth",
        "Alkalis: liquefaction necrosis β€” penetrate DEEPER, ongoing injury",
        "Treatment: Brush off dry powder first, then IRRIGATE 30–60 min",
        "Do NOT use neutralizing agents (exothermic reaction)",
        "HF acid: topical/IV Ca gluconate (chelates F⁻)"
      ]
    },
    {
      title: "ELECTRICAL BURNS",
      color: "E74C3C",
      icon: "⚑",
      points: [
        "Iceberg effect: visible wound underestimates deep injury",
        "Entry & exit wounds; deep muscle necrosis along current path",
        "Myoglobinuria β†’ acute renal failure (target UO 1–2 mL/kg/hr)",
        "ECG monitoring mandatory β€” arrhythmias, cardiac arrest",
        "Fasciotomy often needed; tetanus prophylaxis"
      ]
    },
    {
      title: "BURNS IN CHILDREN",
      color: "27AE60",
      icon: "πŸ‘Ά",
      points: [
        "Thin skin β†’ more severe burns from same exposure",
        "Larger BSA/mass β†’ greater insensible losses, hypothermia risk",
        "Lund-Browder chart for TBSA (not rule of nines)",
        "Maintenance IV fluid (D5LR) added to resuscitation fluid",
        "Child abuse: consider if history inconsistent with pattern"
      ]
    },
    {
      title: "CIRCUMFERENTIAL BURNS",
      color: "2980B9",
      icon: "πŸ”„",
      points: [
        "Full-thickness circumferential β†’ tourniquet effect",
        "Limbs: pulseless, paraesthesia β†’ escharotomy urgently",
        "Chest: inadequate ventilation β†’ bilateral chest escharotomy",
        "Medial + lateral longitudinal incisions through eschar",
        "Performed in ED / ICU (no need for OR if no sensation)"
      ]
    },
  ];

  specials.forEach((sp, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 0.72 + row * 2.52;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 2.35, fill: { color: "FFFFFF" }, line: { color: sp.color, width: 2 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.5, fill: { color: sp.color }, line: { width: 0 } });
    s.addText(sp.title, { x: x + 0.1, y, w: 4.4, h: 0.5, fontSize: 13, bold: true, color: "FFFFFF", fontFace: "Calibri", valign: "middle" });
    const pts = sp.points.map((p, j) => ({ text: p, options: { bullet: { code: "2022" }, breakLine: j < sp.points.length - 1, fontSize: 10.5, color: "1A1A2E", fontFace: "Calibri" } }));
    s.addText(pts, { x: x + 0.12, y: y + 0.55, w: 4.35, h: 1.75, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 12 β€” COMPLICATIONS & PROGNOSIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  slideTitle(s, "Complications & Prognosis");

  // Left: Complications
  sectionBar(s, "Early Complications", 1.22);
  const earlyComps = [
    ["Hypovolemic Shock", "Inadequate resuscitation β†’ organ failure"],
    ["Sepsis", "Leading cause of death after 48 hrs; Pseudomonas, Staph, Candida"],
    ["ARDS / Inhalation", "Lung-protective ventilation; HFPV shows benefit"],
    ["AKI", "Myoglobinuria (electrical); inadequate resuscitation"],
    ["Ileus / Curling's Ulcer", "Stress ulcer prophylaxis (PPI/H2 blocker) mandatory"],
  ];
  earlyComps.forEach((c, i) => {
    const y = 1.72 + i * 0.5;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 4.7, h: 0.44, fill: { color: i % 2 === 0 ? C.card : "1E2540" }, line: { width: 0 } });
    s.addText(c[0], { x: 0.5, y, w: 2.0, h: 0.44, fontSize: 11.5, bold: true, color: C.accent, fontFace: "Calibri", valign: "middle" });
    s.addText(c[1], { x: 2.55, y, w: 2.5, h: 0.44, fontSize: 10.5, color: C.lightGray, fontFace: "Calibri", valign: "middle" });
  });

  sectionBar(s, "Late Complications", 4.25);
  const lateComps = [
    ["Hypertrophic Scar", "Pressure garments 23 hrs/day Γ— 1–2 yrs; laser; steroid injection"],
    ["Contractures", "Splinting + physiotherapy; release + grafting if function impaired"],
    ["Heterotopic Ossification", "Prophylaxis: indomethacin; surgery after maturation (~18 months)"],
  ];
  lateComps.forEach((c, i) => {
    const y = 4.75 + i * 0.46;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 4.7, h: 0.4, fill: { color: i % 2 === 0 ? C.card : "1E2540" }, line: { width: 0 } });
    s.addText(c[0], { x: 0.5, y, w: 2.0, h: 0.4, fontSize: 11, bold: true, color: C.gold, fontFace: "Calibri", valign: "middle" });
    s.addText(c[1], { x: 2.55, y, w: 2.5, h: 0.4, fontSize: 10, color: C.lightGray, fontFace: "Calibri", valign: "middle" });
  });

  // Right: Prognostic indices
  sectionBar(s, "Prognosis β€” Baux Score", 1.22);
  card(s, 5.5, 1.72, 4.15, 2.1, { fill: C.card, border: C.gold });
  s.addText("BAUX SCORE", { x: 5.65, y: 1.78, w: 3.85, h: 0.38, fontSize: 16, bold: true, color: C.gold, fontFace: "Calibri", align: "center" });
  s.addText("Age + %TBSA burned", { x: 5.65, y: 2.18, w: 3.85, h: 0.45, fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
  s.addText("Score β‰ˆ approximate mortality %\nModified Baux (adds 17 for inhalation injury)", { x: 5.65, y: 2.65, w: 3.85, h: 0.55, fontSize: 10.5, color: C.lightGray, fontFace: "Calibri", italic: true, align: "center" });

  card(s, 5.5, 3.92, 4.15, 1.72, { fill: C.card, border: C.teal });
  s.addText("ABA Referral Criteria to Burn Center", { x: 5.65, y: 3.98, w: 3.85, h: 0.38, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri", align: "center" });
  const aba = [
    ">10% TBSA partial thickness (>15% in children)",
    "Any full-thickness burn",
    "Burns: face, hands, feet, genitalia, joints",
    "Electrical or chemical burns",
    "Inhalation injury; circumferential burns",
    "Extremes of age; significant comorbidities"
  ];
  const abaItems = aba.map((a, i) => ({ text: a, options: { bullet: { code: "2022" }, breakLine: i < aba.length - 1, fontSize: 10, color: C.lightGray, fontFace: "Calibri" } }));
  s.addText(abaItems, { x: 5.65, y: 4.38, w: 3.85, h: 1.22, valign: "top" });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 13 β€” NUTRITION & ICU CARE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide({ dark: false });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F2F8" }, line: { width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.55, fill: { color: C.bg }, line: { width: 0 } });
  s.addText("NUTRITION, ICU CARE & ADJUNCTS", { x: 0.4, y: 0, w: 9.2, h: 0.55, fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.55, w: "100%", h: 0.06, fill: { color: C.teal }, line: { width: 0 } });

  const blocks = [
    {
      title: "Nutritional Support",
      color: "27AE60",
      items: [
        "Start enteral nutrition EARLY (within 6 hrs) β€” via NG/NJ if needed",
        "Burns are hypermetabolic β€” REE ↑ 150–200% of baseline",
        "High-protein diet: 1.5–2 g/kg/day protein",
        "Target: maintain weight, prevent muscle wasting",
        "Curreri formula: 25 kcal/kg + 40 kcal/%TBSA/day",
        "Supplemental glutamine, Vitamin C, Zinc, Vitamin D"
      ]
    },
    {
      title: "Analgesia & Sedation",
      color: "8E44AD",
      items: [
        "Pain is a major component β€” multimodal approach",
        "Background: opioids (IV morphine/fentanyl) + paracetamol Β± NSAID",
        "Procedural (wound care): IV ketamine or short-acting opioid",
        "Anxiolysis: benzodiazepines (midazolam)",
        "Develop opioid weaning plan from day 1",
        "Regional anaesthesia where feasible"
      ]
    },
    {
      title: "ICU & Infection Control",
      color: C.accent,
      items: [
        "NO prophylactic systemic antibiotics",
        "Wound surveillance cultures; treat when culture + clinical signs",
        "DVT prophylaxis (LMWH as soon as safe)",
        "Stress ulcer prophylaxis (PPIs / H2 blockers)",
        "Tight glycaemic control: target glucose 6–10 mmol/L",
        "Early physiotherapy & occupational therapy"
      ]
    },
  ];

  blocks.forEach((b, i) => {
    const x = 0.3 + i * 3.25;
    s.addShape(pres.ShapeType.rect, { x, y: 0.72, w: 3.1, h: 4.75, fill: { color: "FFFFFF" }, line: { color: b.color, width: 2 } });
    s.addShape(pres.ShapeType.rect, { x, y: 0.72, w: 3.1, h: 0.48, fill: { color: b.color }, line: { width: 0 } });
    s.addText(b.title, { x: x + 0.1, y: 0.72, w: 2.9, h: 0.48, fontSize: 12.5, bold: true, color: "FFFFFF", fontFace: "Calibri", valign: "middle" });
    const pts = b.items.map((p, j) => ({ text: p, options: { bullet: { code: "2022" }, breakLine: j < b.items.length - 1, fontSize: 10.5, color: "1A1A2E", fontFace: "Calibri" } }));
    s.addText(pts, { x: x + 0.12, y: 1.26, w: 2.9, h: 4.12, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
//  SLIDE 14 β€” SUMMARY / KEY TAKEAWAYS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.bg }, line: { width: 0 } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.22, h: "100%", fill: { color: C.accent }, line: { width: 0 } });

  s.addText("KEY TAKEAWAYS", { x: 0.5, y: 0.15, w: 9, h: 0.6, fontSize: 26, bold: true, color: C.accent, fontFace: "Calibri", charSpacing: 4 });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.78, w: 9, h: 0.05, fill: { color: C.gold }, line: { width: 0 } });

  const keys = [
    { num: "01", text: "First Aid: Cool with running water 15–20 min (20Β°C). NEVER ice or butter. Cover with cling film. Keep patient warm." },
    { num: "02", text: "Classification: 1st (epidermis only), 2nd partial-thickness (superficial/deep), 3rd full-thickness. Only 2nd & 3rd count in TBSA." },
    { num: "03", text: "TBSA: Rule of Nines (adults), Lund-Browder (children). Palm method for irregular burns (~1% per palm)." },
    { num: "04", text: "Fluids: Parkland β€” 4 mLΓ—kgΓ—%TBSA (LR). Give 50% in first 8 hrs from time of burn. Target UO: 0.5–1 mL/kg/hr." },
    { num: "05", text: "Airway: Intubate EARLY in inhalation injury. CO poisoning β€” 100% Oβ‚‚ (pulse ox unreliable). HbCO on ABG." },
    { num: "06", text: "Surgery: Early tangential excision + STSG within 48–72 hrs for deep partial / full-thickness burns." },
    { num: "07", text: "Refer to Burn Center: >10% TBSA, full-thickness, face/hands/genitalia, electrical/chemical, inhalation injury." },
  ];

  keys.forEach((k, i) => {
    const y = 0.95 + i * 0.66;
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// ══════════════════════════════════════════════════════════════════════════════
//  WRITE FILE
// ══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/burns-ppt/Burns_FirstAid_Management_R2.pptx" })
  .then(() => console.log("SUCCESS: PPT written"))
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Running Command

cd /home/daytona/workspace/burns-ppt && node burns.js 2>&1

Running Command

ls -lh /home/daytona/workspace/burns-ppt/

Your presentation is ready! πŸ”₯

Burns FirstAid Management R2

Presentation Β· PPTX

What's inside β€” 14 slides, R2-level depth

SlideContent
1Title slide β€” bold surgical theme
2Epidemiology & Causes β€” thermal, chemical, electrical, radiation
3Burn Depth Classification β€” 4-column card layout: 1st β†’ 3rd degree with clinical features
4TBSA Estimation β€” Rule of Nines table + Lund-Browder notes + Palmer method
5First Aid Management β€” 5-step numbered layout (Stop β†’ Cool β†’ Cover β†’ Warm β†’ Transfer)
6Initial Hospital Eval (ATLS) β€” A-B-C-D-E column cards with clinical pearls
7Fluid Resuscitation β€” Parkland formula front-and-center + Modified Brooke + urine output targets
8Inhalation Injury β€” CO poisoning / upper airway / cyanide toxicity as 3 columns
9Topical Agents β€” Silver sulfadiazine, Mafenide, AgNO3, Bacitracin, Honey β€” table format
10Surgical Management β€” Tangential excision, fascial excision, wound coverage, escharotomy
11Special Burns β€” Chemical, Electrical, Pediatric, Circumferential burns
12Complications & Prognosis β€” Baux Score, ABA referral criteria
13Nutrition & ICU Care β€” Enteral feeding, analgesia, infection control
14Key Takeaways β€” 7 high-yield numbered points
Sources: Schwartz's Principles of Surgery (11e), Sabiston Textbook of Surgery, Bailey & Love's Short Practice of Surgery (28e)

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Burns FirstAid Management R2

Presentation Β· PPTX

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Find recent clinical guidelines on burn center transfer criteria

Searching PubMed

"burn center" AND "transfer criteria" AND guidelines

Searching the Web

American Burn Association burn center referral transfer criteria guidelines 2023 2024 2025

Finding Sources
Searching PubMed

"burn" AND "referral" AND "triage" AND "guidelines"

Reading Web Page

https://www.ameriburn.org/burn-care-team/resources/guideline…

Reading Article

PMID: 38051821

Searching PubMed

"burn center" AND referral AND criteria

Reading File
Reading Article

PMID: 41678190

Reading Article

PMID: 41239977

Reading Article

PMID: 32123911

Here is a comprehensive, up-to-date summary of burn center transfer/referral criteria guidelines.

Burn Center Transfer/Referral Criteria β€” Current Clinical Guidelines

1. ABA Guidelines for Burn Patient Referral (Current β€” 2025 Edition)

The American Burn Association's current guidelines (updated and available at ameriburn.org, copyright 2025) replace the old binary "transfer/no-transfer" model with a three-tier framework:
CategoryImmediate Consultation + Consider TransferConsultation Recommended
Thermal BurnsFull-thickness burns; Partial thickness β‰₯10% TBSA; Any deep partial/full-thickness on face, hands, genitalia, feet, perineum, or over joints; Comorbidities or concomitant trauma; Poorly controlled painPartial-thickness <10% TBSA; All potentially deep burns of any size
Inhalation InjuryAll suspected inhalation injuriesFacial flash burns, singed nasal hairs, smoke exposure (without confirmed inhalation)
Pediatrics (≀14 yrs or <30 kg)All pediatric burns may benefit from referral (pain, dressing needs, rehab, non-accidental trauma)β€”
Chemical BurnsAll chemical injuriesβ€”
Electrical BurnsAll high-voltage (β‰₯1,000V) injuries; Lightning injuryLow-voltage (<1,000V): consultation + follow-up in burn center to screen for delayed onset and vision problems
The three possible outcomes of consultation are now: immediate transfer, telemedicine consultation, or outpatient follow-up β€” allowing more nuanced triage.

2. The 2018 ABA eDelphi Consensus Update (Published 2020, PMID: 32123911)

A landmark expert consensus revision by Bettencourt et al. (n=61 burn specialists, 4 Delphi rounds) updated criteria that had been unchanged for >20 years. Key changes from the old criteria:
  • Full-thickness burns β‰₯5% TBSA (previously any full-thickness) β†’ immediate transfer
  • Deep partial-thickness β‰₯10% TBSA β†’ strongly recommended referral
  • Older adults and children with specific dressing/medical needs β†’ added as explicit criteria
  • Frostbite, Stevens-Johnson syndrome/TEN, and necrotizing fasciitis β†’ added as conditions benefiting from burn center care
  • Telemedicine formally recognized as an acceptable consultation pathway
  • Individual patient factors (geography, referring hospital capability, injury severity) should guide decisions rather than rigid rules

3. Classic ABA Burn Center Referral Criteria (10 Points β€” from Mulholland & Greenfield Surgery, 7e)

Still widely cited and used in residency training:
  1. 10% TBSA partial- or full-thickness burns
  2. Burns involving face, hands, feet, genitalia, perineum, or major joints
  3. Full-thickness burns in any age group
  4. Electrical burns, including lightning
  5. Chemical burns
  6. Inhalation injury
  7. Pre-existing medical conditions that could complicate management
  8. Concomitant traumatic injuries (trauma guidelines supersede burn criteria when both present)
  9. Children in hospitals without qualified pediatric burn personnel or equipment
  10. Patients needing special social, emotional, or rehabilitative intervention

4. ABA Clinical Practice Guideline β€” Burn Shock Resuscitation (2024)

Cartotto et al., J Burn Care Res 2024 [PMID: 38051821], published the first formal ABA CPG on fluid resuscitation. Key points relevant to transfer decisions:
  • Start resuscitation at 2 mL/kg/%TBSA (Modified Brooke) to reduce fluid creep β€” a shift from 4 mL/kg (Parkland)
  • Consider human albumin in large burns to lower total resuscitation volumes
  • Monitor intra-abdominal pressure in large resuscitations
  • Computer decision-support software recommended (weak recommendation) to guide fluid titration

5. Real-World Adherence Gaps β€” Recent Evidence (2026)

Two very recent studies highlight ongoing implementation challenges:
Gus et al., JAMA Network Open 2026 [PMID: 41678190] β€” Ontario cohort of 79,782 pediatric burn patients (2003–2023):
  • 43.6% met at least one referral criterion
  • Only 21.6% of those who met criteria were actually treated at a burn center
  • More criteria = higher likelihood of referral (β‰₯3 criteria: aRR 4.71)
  • Inhalation and chemical injuries had the strongest association with burn center care
  • Geographic and socioeconomic barriers are major drivers of under-triage
Usman et al., J Burn Care Res 2026 [PMID: 41239977] β€” 588 burn center consultations (2024):
  • Larger hospitals (β‰₯300 beds) adhered to ABA guidelines 72% of the time
  • Smaller hospitals (<100 beds) adhered only 25% of the time (p=0.02)
  • Only 35% of all referrals led to actual admission β€” suggesting both over- and under-triage
  • Telehealth programs + outreach education for smaller hospitals recommended to improve efficiency

6. Telehealth as an Emerging Tool (Systematic Reviews, 2023)

Two systematic reviews (GarcΓ­a-DΓ­az et al., PMID: 36833860; Hayavi-Haghighi et al., PMID: 37537108) confirm telehealth platforms are effective for burn triage, reducing unnecessary transfers and supporting rural providers in following referral criteria.

Key Clinical Takeaways for R2 Level

Old ThinkingCurrent Evidence
"Transfer all full-thickness burns"Full-thickness β‰₯5% TBSA β†’ transfer; <5% β†’ consult/outpatient
Binary: transfer or don'tThree-tier: transfer / telehealth consult / outpatient follow-up
Children same as adultsAll pediatric burns may benefit from referral regardless of size
Low-voltage electric burns = minorLow-voltage needs follow-up at burn center (delayed symptoms, eye problems)
Only ABA 10-point listAdd: frostbite, SJS/TEN, necrotizing fasciitis
Parkland 4 mL/kgABA CPG 2024 recommends starting at 2 mL/kg (Modified Brooke)
Bottom line: The 2025 ABA guidelines now support a nuanced, three-outcome referral framework rather than a rigid transfer checklist, with telehealth consultation filling the gap for uncertain cases and smaller hospitals.
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