mkdir -p /home/daytona/workspace/ecg-emergency-ppt && ls /home/daytona/workspace…

~/ecg-emergency-ppt/create_ecg_ppt.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "ECG Emergency Cases";
pres.author = "Emergency Medicine";

// ── Color Palette ──────────────────────────────────────────────
const C = {
  darkBg: "0D1B2A",       // deep navy – dominant dark
  midBg:  "1B2D45",       // medium navy
  cardBg: "162236",       // card panel background
  accent: "E63946",       // vivid red – ECG / alert color
  accent2:"FF6B35",       // orange accent
  accentG:"2EC4B6",       // teal / green – normal/sinus
  white:  "FFFFFF",
  light:  "D8E4F0",       // soft blue-white text
  muted:  "7B9CBF",       // muted blue text
  yellow: "FFD166",       // highlight yellow
  purple: "9B5DE5",       // arrhythmia purple
};

// ── Shared helpers ─────────────────────────────────────────────
function darkSlide(slide) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBg }
  });
}

function addSectionBar(slide, color) {
  // left accent bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.12, h: "100%", fill: { color: color || C.accent }
  });
}

function headerStrip(slide, color) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: 1.1, fill: { color: color || C.midBg }
  });
}

function slideTitle(slide, text, color) {
  slide.addText(text, {
    x: 0.22, y: 0.18, w: 12.8, h: 0.72,
    fontSize: 26, bold: true, color: color || C.white,
    fontFace: "Calibri", margin: 0
  });
}

function badge(slide, label, x, y, bg, fg) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w: 2.0, h: 0.38, fill: { color: bg || C.accent },
    line: { color: bg || C.accent, width: 0 }, rectRadius: 0.06
  });
  slide.addText(label, {
    x, y, w: 2.0, h: 0.38,
    fontSize: 11, bold: true, color: fg || C.white,
    align: "center", valign: "middle", margin: 0, fontFace: "Calibri"
  });
}

// ECG waveform drawn with lines (stylised)
function drawECGLine(slide, x, y, color, scale) {
  const s = scale || 1;
  const c = color || C.accentG;
  const pts = [
    [0,0],[0.18,0],[0.22,-0.04],[0.26,0],[0.3,0],
    [0.32,-0.01],[0.34,0.28],[0.37,0],[0.4,-0.1],[0.44,0],[0.5,0],
    [0.52,0.06],[0.54,0],[0.56,0],
    [0.68,0],[0.72,-0.04],[0.76,0],[0.8,0],
    [0.82,-0.01],[0.84,0.28],[0.87,0],[0.9,-0.1],[0.94,0],[1.0,0],
  ];
  for (let i = 0; i < pts.length - 1; i++) {
    slide.addShape(pres.ShapeType.line, {
      x: x + pts[i][0]*s*3,   y: y + pts[i][1]*s*1.2,
      w: (pts[i+1][0]-pts[i][0])*s*3,
      h: Math.abs((pts[i+1][1]-pts[i][1]))*s*1.2 + 0.001,
      line: { color: c, width: 1.5 },
      flipV: (pts[i+1][1] - pts[i][1]) < 0 ? true : false
    });
  }
}

// ══════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  // Full dark bg
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBg }
  });
  // Red diagonal band
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 3.4, w: "100%", h: 0.08, fill: { color: C.accent }
  });
  // Big ECG flatline with QRS spike decoration
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 3.32, w: "100%", h: 0.08, fill: { color: C.accent }
  });

  // Title
  slide.addText("ECG EMERGENCY CASES", {
    x: 0.8, y: 0.7, w: 11.7, h: 1.2,
    fontSize: 48, bold: true, color: C.white,
    fontFace: "Calibri", charSpacing: 4, align: "center"
  });
  slide.addText("A Clinical Guide for Medical Students", {
    x: 0.8, y: 1.95, w: 11.7, h: 0.55,
    fontSize: 20, color: C.light, fontFace: "Calibri",
    align: "center", italic: true
  });

  // 6 topic badges in a row
  const topics = ["STEMI", "Heart Blocks", "VF/VT", "SVT/AF", "Bradyarrhythmias", "Life-Threatening"];
  topics.forEach((t, i) => {
    const cols = [C.accent, C.purple, C.accent, C.accentG, C.accent2, C.yellow];
    const fgs  = [C.white,  C.white,  C.white,  C.white,   C.white,   C.darkBg];
    slide.addShape(pres.ShapeType.roundRect, {
      x: 0.6 + i*2.08, y: 2.8, w: 1.9, h: 0.42,
      fill: { color: cols[i] }, line: { color: cols[i] }, rectRadius: 0.06
    });
    slide.addText(t, {
      x: 0.6 + i*2.08, y: 2.8, w: 1.9, h: 0.42,
      fontSize: 11, bold: true, color: fgs[i],
      align: "center", valign: "middle", margin: 0, fontFace: "Calibri"
    });
  });

  slide.addText("Emergency Medicine  |  2026", {
    x: 0.8, y: 6.8, w: 11.7, h: 0.4,
    fontSize: 13, color: C.muted, align: "center", fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 2 – HOW TO READ AN ECG (Quick Review)
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accentG);
  slideTitle(slide, "How to Read an ECG  –  The Systematic Approach");

  // 6 boxes in 2 rows × 3 cols
  const steps = [
    { n:"1", title:"Rate", val:"Normal: 60-100 bpm\nBradycardia: <60\nTachycardia: >100" },
    { n:"2", title:"Rhythm", val:"Regular vs Irregular\nP waves present?\nP:QRS ratio" },
    { n:"3", title:"Axis", val:"Normal: −30° to +90°\nLAD / RAD / Extreme" },
    { n:"4", title:"P Wave", val:"Present, upright in II\nDuration <0.12s\nLooks before every QRS?" },
    { n:"5", title:"PR Interval", val:"Normal: 0.12–0.20s\nShort = WPW / junctional\nLong = Heart Block" },
    { n:"6", title:"QRS / ST / T", val:"Width <0.12s\nST elevation/depression\nT-wave inversion" },
  ];

  steps.forEach((s, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const bx = 0.22 + col * 4.35;
    const by = 1.25 + row * 2.55;
    const colors = [C.accentG, C.accent2, C.yellow, C.accent, C.purple, C.accentG];

    slide.addShape(pres.ShapeType.roundRect, {
      x: bx, y: by, w: 4.1, h: 2.35,
      fill: { color: C.cardBg }, line: { color: colors[i], width: 1.5 }, rectRadius: 0.1
    });
    // Number circle
    slide.addShape(pres.ShapeType.ellipse, {
      x: bx + 0.1, y: by + 0.1, w: 0.52, h: 0.52,
      fill: { color: colors[i] }, line: { color: colors[i] }
    });
    slide.addText(s.n, {
      x: bx + 0.1, y: by + 0.1, w: 0.52, h: 0.52,
      fontSize: 16, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0, fontFace: "Calibri"
    });
    slide.addText(s.title, {
      x: bx + 0.72, y: by + 0.12, w: 3.3, h: 0.45,
      fontSize: 15, bold: true, color: colors[i], fontFace: "Calibri", margin: 0
    });
    slide.addText(s.val, {
      x: bx + 0.15, y: by + 0.65, w: 3.8, h: 1.55,
      fontSize: 12, color: C.light, fontFace: "Calibri", margin: 4
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 3 – STEMI
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accent);
  slideTitle(slide, "STEMI  –  ST-Elevation Myocardial Infarction");
  badge(slide, "⚠  LIFE-THREATENING", 10.3, 0.18, C.accent, C.white);

  // Left panel – ECG features
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 5.9, h: 5.5,
    fill: { color: C.cardBg }, line: { color: C.accent, width: 1 }, rectRadius: 0.1
  });
  slide.addText("ECG Features", {
    x: 0.4, y: 1.3, w: 5.5, h: 0.45,
    fontSize: 15, bold: true, color: C.accent, fontFace: "Calibri", margin: 0
  });
  const feats = [
    "ST elevation ≥1 mm in ≥2 contiguous leads",
    "New LBBB (Sgarbossa criteria)",
    "Reciprocal ST depression in opposite leads",
    "Hyperacute T waves (earliest sign)",
    "Q waves (late – irreversible necrosis)",
    "De Winter T waves (LAD occlusion equivalent)",
    "Wellens syndrome – critical LAD stenosis",
  ];
  feats.forEach((f, i) => {
    slide.addShape(pres.ShapeType.rect, {
      x: 0.38, y: 1.88 + i*0.58, w: 0.06, h: 0.28, fill: { color: C.accent }
    });
    slide.addText(f, {
      x: 0.55, y: 1.85 + i*0.58, w: 5.35, h: 0.35,
      fontSize: 12.5, color: C.light, fontFace: "Calibri", margin: 0
    });
  });

  // Right panel – territories
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.42, y: 1.2, w: 6.88, h: 5.5,
    fill: { color: C.cardBg }, line: { color: C.accent2, width: 1 }, rectRadius: 0.1
  });
  slide.addText("Territory Localisation", {
    x: 6.6, y: 1.3, w: 6.5, h: 0.45,
    fontSize: 15, bold: true, color: C.accent2, fontFace: "Calibri", margin: 0
  });

  const terr = [
    { loc:"Anterior",         leads:"V1–V4",          art:"LAD",  c: C.accent  },
    { loc:"Lateral",          leads:"I, aVL, V5–V6",  art:"LCx",  c: C.accent2 },
    { loc:"Inferior",         leads:"II, III, aVF",   art:"RCA",  c: C.yellow  },
    { loc:"Septal",           leads:"V1–V2",           art:"LAD",  c: C.accentG },
    { loc:"Posterior (STEMI)",leads:"V1–V2 depression",art:"RCA/LCx",c: C.purple},
    { loc:"Right Ventricular",leads:"V3R–V4R",         art:"RCA",  c: C.accent  },
  ];
  terr.forEach((t, i) => {
    const by = 1.88 + i*0.72;
    slide.addShape(pres.ShapeType.roundRect, {
      x: 6.58, y: by, w: 6.55, h: 0.62,
      fill: { color: C.midBg }, line: { color: t.c, width: 1 }, rectRadius: 0.06
    });
    slide.addText(t.loc, {
      x: 6.68, y: by+0.06, w: 2.5, h: 0.5,
      fontSize: 12, bold: true, color: t.c, fontFace: "Calibri", margin: 0
    });
    slide.addText(`Leads: ${t.leads}`, {
      x: 9.0, y: by+0.06, w: 2.3, h: 0.25,
      fontSize: 10.5, color: C.light, fontFace: "Calibri", margin: 0
    });
    slide.addText(`Artery: ${t.art}`, {
      x: 9.0, y: by+0.3, w: 2.3, h: 0.25,
      fontSize: 10.5, color: C.muted, fontFace: "Calibri", margin: 0
    });
  });

  // Management footer
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 6.82, w: 13.08, h: 0.52,
    fill: { color: C.accent }, line: { color: C.accent }, rectRadius: 0.06
  });
  slide.addText("Management: Activate Cath Lab (PCI within 90 min) | Aspirin 300 mg + Ticagrelor 180 mg | Heparin | O₂ if SpO₂ <94%", {
    x: 0.22, y: 6.82, w: 13.08, h: 0.52,
    fontSize: 12, bold: true, color: C.white,
    align: "center", valign: "middle", margin: 0, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 4 – NSTEMI / UA
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accent2);
  slideTitle(slide, "NSTEMI & Unstable Angina  –  Non-ST Elevation ACS");
  badge(slide, "⚠  URGENT", 11.4, 0.18, C.accent2, C.white);

  const panels = [
    {
      title: "ECG Findings (NSTEMI/UA)",
      color: C.accent2,
      items: [
        "ST depression ≥0.5 mm in ≥2 contiguous leads",
        "Transient ST elevation (Prinzmetal's angina)",
        "Deep T-wave inversions (diffuse)",
        "Normal ECG (does NOT exclude NSTEMI)",
        "Tall R waves in V1–V2 (posterior MI)",
        "New ST changes compared to old ECG",
      ]
    },
    {
      title: "Distinguish from STEMI",
      color: C.yellow,
      items: [
        "No persistent ST elevation",
        "No new LBBB",
        "Troponin rise confirms myocyte damage",
        "Unstable Angina = troponin NEGATIVE",
        "NSTEMI = troponin POSITIVE",
        "Both need urgent risk stratification (GRACE/TIMI)",
      ]
    },
    {
      title: "Management",
      color: C.accentG,
      items: [
        "Aspirin 300 mg + P2Y12 inhibitor (ticagrelor)",
        "Anticoagulation (LMWH / fondaparinux)",
        "High-dose statin (atorvastatin 80 mg)",
        "Beta-blocker if no contraindication",
        "GTN for ongoing chest pain",
        "Invasive strategy within 24–72 hrs (angiography)",
      ]
    }
  ];

  panels.forEach((p, i) => {
    const bx = 0.22 + i * 4.42;
    slide.addShape(pres.ShapeType.roundRect, {
      x: bx, y: 1.2, w: 4.2, h: 5.8,
      fill: { color: C.cardBg }, line: { color: p.color, width: 1.5 }, rectRadius: 0.1
    });
    slide.addShape(pres.ShapeType.rect, {
      x: bx, y: 1.2, w: 4.2, h: 0.55,
      fill: { color: p.color }, line: { color: p.color }
    });
    slide.addText(p.title, {
      x: bx + 0.12, y: 1.22, w: 3.96, h: 0.5,
      fontSize: 13, bold: true, color: C.white,
      fontFace: "Calibri", margin: 0, valign: "middle"
    });
    p.items.forEach((item, j) => {
      slide.addShape(pres.ShapeType.ellipse, {
        x: bx + 0.18, y: 1.9 + j*0.77, w: 0.15, h: 0.15,
        fill: { color: p.color }, line: { color: p.color }
      });
      slide.addText(item, {
        x: bx + 0.42, y: 1.85 + j*0.77, w: 3.68, h: 0.65,
        fontSize: 12, color: C.light, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 5 – VENTRICULAR FIBRILLATION & PULSELESS VT
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accent);
  slideTitle(slide, "Ventricular Fibrillation (VF) & Pulseless VT");

  // DANGER banner
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.1, w: 13.08, h: 0.62,
    fill: { color: C.accent }, line: { color: C.accent }, rectRadius: 0.06
  });
  slide.addText("⚡  SHOCKABLE RHYTHM  –  Immediate Defibrillation Required  –  Begin CPR NOW", {
    x: 0.22, y: 1.1, w: 13.08, h: 0.62,
    fontSize: 16, bold: true, color: C.white,
    align: "center", valign: "middle", margin: 0, fontFace: "Calibri"
  });

  // Two columns
  const leftItems = [
    { heading: "Ventricular Fibrillation (VF)", color: C.accent, desc: [
      "Chaotic, irregular waveforms – no discernible QRS",
      "No organised cardiac activity → no output",
      "Causes: IHD, electrolyte abnormalities, drugs, hypothermia",
      "Fine VF (low amplitude) vs Coarse VF (high amplitude)",
    ]},
    { heading: "Pulseless VT", color: C.accent2, desc: [
      "Wide QRS (>0.12s), monomorphic or polymorphic",
      "Rate >100 bpm (usually 150–250 bpm)",
      "No pulse despite organised rhythm on ECG",
      "Torsades de Pointes: polymorphic VT, long QT syndrome",
    ]},
  ];

  leftItems.forEach((item, i) => {
    const by = 1.9 + i * 2.6;
    slide.addShape(pres.ShapeType.roundRect, {
      x: 0.22, y: by, w: 6.7, h: 2.35,
      fill: { color: C.cardBg }, line: { color: item.color, width: 1.5 }, rectRadius: 0.1
    });
    slide.addText(item.heading, {
      x: 0.4, y: by + 0.1, w: 6.3, h: 0.45,
      fontSize: 14, bold: true, color: item.color, fontFace: "Calibri", margin: 0
    });
    item.desc.forEach((d, j) => {
      slide.addText("▸  " + d, {
        x: 0.4, y: by + 0.6 + j * 0.41, w: 6.3, h: 0.4,
        fontSize: 12, color: C.light, fontFace: "Calibri", margin: 0
      });
    });
  });

  // Right: ALS algorithm steps
  slide.addShape(pres.ShapeType.roundRect, {
    x: 7.15, y: 1.9, w: 6.15, h: 5.5,
    fill: { color: C.cardBg }, line: { color: C.yellow, width: 1.5 }, rectRadius: 0.1
  });
  slide.addText("ALS Algorithm (Shockable)", {
    x: 7.32, y: 2.0, w: 5.8, h: 0.45,
    fontSize: 14, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0
  });
  const alg = [
    { s:"1", t:"Call for help / Confirm cardiac arrest", c: C.accent },
    { s:"2", t:"CPR 30:2 immediately – do not delay", c: C.accent },
    { s:"3", t:"Attach defibrillator, confirm VF/VT", c: C.accent2 },
    { s:"4", t:"Shock 200 J (biphasic) → resume CPR 2 min", c: C.yellow },
    { s:"5", t:"Adrenaline 1 mg IV after 3rd shock, then every 3–5 min", c: C.accentG },
    { s:"6", t:"Amiodarone 300 mg IV after 3rd shock", c: C.purple },
    { s:"7", t:"Identify reversible causes (4 Hs & 4 Ts)", c: C.accentG },
  ];
  alg.forEach((a, i) => {
    slide.addShape(pres.ShapeType.ellipse, {
      x: 7.3, y: 2.58 + i*0.46, w: 0.36, h: 0.36,
      fill: { color: a.c }, line: { color: a.c }
    });
    slide.addText(a.s, {
      x: 7.3, y: 2.58 + i*0.46, w: 0.36, h: 0.36,
      fontSize: 11, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
    slide.addText(a.t, {
      x: 7.75, y: 2.58 + i*0.46, w: 5.45, h: 0.38,
      fontSize: 11.5, color: C.light, fontFace: "Calibri", margin: 0
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 6 – SUPRAVENTRICULAR TACHYCARDIA (SVT)
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.purple);
  slideTitle(slide, "Supraventricular Tachycardia (SVT)");

  // Three column cards
  const cards = [
    {
      title: "ECG Features of SVT",
      color: C.purple,
      content: [
        "Heart rate: 150–250 bpm",
        "Regular, narrow QRS (<0.12s)",
        "P waves absent or retrograde (negative in II)",
        "No delta wave (unless AVRT in WPW)",
        "Sudden onset and termination",
        "May cause ST depression (rate-related ischaemia)",
      ]
    },
    {
      title: "SVT Subtypes",
      color: C.accent2,
      content: [
        "AVNRT (commonest) – P buried in or after QRS",
        "AVRT (WPW) – delta wave in sinus rhythm",
        "Atrial Tachycardia – P wave visible, different morphology",
        "PSVT – paroxysmal, sudden onset/offset",
        "Atrial Flutter – sawtooth P waves, rate ~300/min",
        "Junctional Tachycardia – short PR / retrograde P",
      ]
    },
    {
      title: "Management",
      color: C.accentG,
      content: [
        "Vagal manoeuvres FIRST (Valsalva, carotid sinus massage)",
        "Adenosine 6 mg IV rapid push (12 mg if no response)",
        "Warn: transient chest tightness, flushing, asystole",
        "If haemodynamically unstable → DC cardioversion",
        "If WPW + AF: avoid AV nodal blockers (use procainamide)",
        "Long-term: beta-blockers, CCBs, or ablation",
      ]
    }
  ];

  cards.forEach((c, i) => {
    const bx = 0.22 + i * 4.42;
    slide.addShape(pres.ShapeType.roundRect, {
      x: bx, y: 1.2, w: 4.2, h: 5.8,
      fill: { color: C.cardBg }, line: { color: c.color, width: 1.5 }, rectRadius: 0.1
    });
    slide.addShape(pres.ShapeType.rect, {
      x: bx, y: 1.2, w: 4.2, h: 0.55,
      fill: { color: c.color }, line: { color: c.color }
    });
    slide.addText(c.title, {
      x: bx + 0.12, y: 1.22, w: 3.96, h: 0.5,
      fontSize: 13, bold: true, color: C.white,
      fontFace: "Calibri", margin: 0, valign: "middle"
    });
    c.content.forEach((item, j) => {
      slide.addShape(pres.ShapeType.ellipse, {
        x: bx + 0.18, y: 1.9 + j*0.77, w: 0.15, h: 0.15,
        fill: { color: c.color }, line: { color: c.color }
      });
      slide.addText(item, {
        x: bx + 0.42, y: 1.85 + j*0.77, w: 3.68, h: 0.68,
        fontSize: 11.5, color: C.light, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 7 – ATRIAL FIBRILLATION & FLUTTER
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accent2);
  slideTitle(slide, "Atrial Fibrillation & Atrial Flutter");

  // AF card
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 6.3, h: 5.7,
    fill: { color: C.cardBg }, line: { color: C.accent2, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.22, y: 1.2, w: 6.3, h: 0.55,
    fill: { color: C.accent2 }, line: { color: C.accent2 }
  });
  slide.addText("Atrial Fibrillation (AF)", {
    x: 0.34, y: 1.22, w: 6.06, h: 0.5,
    fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const afItems = [
    { h: "ECG Features", items: ["Absent P waves (fibrillatory baseline)", "Irregularly irregular QRS", "Rate 100–180 bpm (uncontrolled)", "Narrow QRS (unless aberrant conduction)"] },
    { h: "Management", items: ["Rate control: metoprolol, diltiazem, digoxin", "Rhythm control: flecainide, amiodarone, DC cardioversion", "Anticoagulation: CHA₂DS₂-VASc score", "New AF <48 hrs: cardiovert safely; >48 hrs: anticoagulate 3 weeks first"] }
  ];
  afItems.forEach((group, gi) => {
    slide.addText(group.h, {
      x: 0.38, y: 1.9 + gi*2.4, w: 5.9, h: 0.38,
      fontSize: 13, bold: true, color: C.accent2, fontFace: "Calibri", margin: 0
    });
    group.items.forEach((item, j) => {
      slide.addText("▸  " + item, {
        x: 0.42, y: 2.3 + gi*2.4 + j*0.46, w: 5.9, h: 0.42,
        fontSize: 11.5, color: C.light, fontFace: "Calibri", margin: 0
      });
    });
  });

  // Flutter card
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.82, y: 1.2, w: 6.48, h: 5.7,
    fill: { color: C.cardBg }, line: { color: C.purple, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 6.82, y: 1.2, w: 6.48, h: 0.55,
    fill: { color: C.purple }, line: { color: C.purple }
  });
  slide.addText("Atrial Flutter", {
    x: 6.95, y: 1.22, w: 6.22, h: 0.5,
    fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const flItems = [
    { h: "ECG Features", items: [
      "Sawtooth flutter waves (F waves) at ~300/min",
      "Most common: 2:1 block → ventricular rate ~150",
      "Regular or regularly irregular QRS",
      "No isoelectric baseline between flutter waves",
      "Flutter most visible in inferior leads (II, III, aVF)"
    ]},
    { h: "Management", items: [
      "Rate control: beta-blockers or CCBs",
      "Anticoagulation same as AF",
      "DC cardioversion effective (lower energy needed)",
      "Atrial flutter ablation: high cure rate (>95%)"
    ]}
  ];
  let fy = 1.9;
  flItems.forEach((group) => {
    slide.addText(group.h, {
      x: 7.0, y: fy, w: 6.1, h: 0.38,
      fontSize: 13, bold: true, color: C.purple, fontFace: "Calibri", margin: 0
    });
    fy += 0.42;
    group.items.forEach((item) => {
      slide.addText("▸  " + item, {
        x: 7.04, y: fy, w: 6.1, h: 0.42,
        fontSize: 11.5, color: C.light, fontFace: "Calibri", margin: 0
      });
      fy += 0.46;
    });
    fy += 0.2;
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 8 – HEART BLOCKS
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.yellow);
  slideTitle(slide, "Atrioventricular (AV) Heart Blocks");

  const blocks = [
    {
      degree: "1st Degree", color: C.accentG,
      ecg: "PR interval >200 ms (>5 small squares)\nAll P waves conduct\nRegular rhythm",
      tx: "Usually benign\nNo treatment required\nMonitor (may progress)",
      badge: "BENIGN"
    },
    {
      degree: "2nd Degree – Mobitz I (Wenckebach)", color: C.yellow,
      ecg: "Progressive PR lengthening\nUntil a P wave is dropped (non-conducted)\nCycles repeat\nGrouped beating",
      tx: "Usually benign\nAtropine if symptomatic\nTemporary pacing rarely needed\nMonitor",
      badge: "MOSTLY BENIGN"
    },
    {
      degree: "2nd Degree – Mobitz II", color: C.accent2,
      ecg: "Fixed PR interval\nSudden non-conducted P waves\n2:1, 3:1 block pattern\nWide QRS (often LBBB/RBBB)",
      tx: "High risk of progression to 3rd degree\nPermanent pacemaker indicated\nAtropine / transcutaneous pacing acutely",
      badge: "⚠ URGENT"
    },
    {
      degree: "3rd Degree (Complete Heart Block)", color: C.accent,
      ecg: "Complete AV dissociation\nP waves & QRS independent\nEscape rhythm (junctional 40–60 or ventricular 20–40)\nBroad QRS if ventricular escape",
      tx: "Emergency pacing (transcutaneous then transvenous)\nAtropine 0.5–1 mg IV\nDopamine infusion if unstable\nPermanent pacemaker",
      badge: "⚠ EMERGENCY"
    },
  ];

  blocks.forEach((b, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const bx = 0.22 + col * 6.72;
    const by = 1.2 + row * 3.1;

    slide.addShape(pres.ShapeType.roundRect, {
      x: bx, y: by, w: 6.4, h: 2.9,
      fill: { color: C.cardBg }, line: { color: b.color, width: 1.5 }, rectRadius: 0.1
    });
    // Degree title
    slide.addText(b.degree, {
      x: bx + 0.18, y: by + 0.1, w: 4.8, h: 0.45,
      fontSize: 13.5, bold: true, color: b.color, fontFace: "Calibri", margin: 0
    });
    // Badge
    slide.addShape(pres.ShapeType.roundRect, {
      x: bx + 4.7, y: by + 0.12, w: 1.5, h: 0.34,
      fill: { color: b.color }, line: { color: b.color }, rectRadius: 0.05
    });
    slide.addText(b.badge, {
      x: bx + 4.7, y: by + 0.12, w: 1.5, h: 0.34,
      fontSize: 9, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });

    slide.addText("ECG:  " + b.ecg, {
      x: bx + 0.15, y: by + 0.6, w: 3.0, h: 2.12,
      fontSize: 10.5, color: C.light, fontFace: "Calibri", margin: 4
    });
    slide.addText("Mx:  " + b.tx, {
      x: bx + 3.25, y: by + 0.6, w: 2.98, h: 2.12,
      fontSize: 10.5, color: C.accentG, fontFace: "Calibri", margin: 4
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 9 – BRADYARRHYTHMIAS & BROAD COMPLEX TACHYCARDIA
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accentG);
  slideTitle(slide, "Bradyarrhythmias & Broad Complex Tachycardias");

  // Left: Bradyarrhythmias
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 6.3, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.accentG, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.22, y: 1.2, w: 6.3, h: 0.55,
    fill: { color: C.accentG }, line: { color: C.accentG }
  });
  slide.addText("Bradyarrhythmias  (HR <60)", {
    x: 0.35, y: 1.22, w: 6.04, h: 0.5,
    fontSize: 14, bold: true, color: C.darkBg, fontFace: "Calibri", margin: 0, valign: "middle"
  });

  const bradyData = [
    { t: "Sinus Bradycardia", c: C.accentG, d: "Rate <60, regular P waves, normal PR. Causes: athletes, vagal, hypothyroidism, beta-blockers. Treat if symptomatic: atropine 0.5 mg IV." },
    { t: "Sick Sinus Syndrome", c: C.yellow, d: "Alternating brady-tachycardia (brady-tachy syndrome). Often requires PPM + anticoagulation." },
    { t: "Junctional Rhythm", c: C.accent2, d: "Rate 40–60. Retrograde P waves, narrow QRS. No atrial activity. Pacing if symptomatic." },
    { t: "Idioventricular Rhythm", c: C.accent, d: "Rate 20–40. Wide QRS, no P waves. Ventricular escape. Emergency pacing required." },
  ];

  bradyData.forEach((d, i) => {
    slide.addShape(pres.ShapeType.roundRect, {
      x: 0.35, y: 1.9 + i*1.2, w: 6.0, h: 1.1,
      fill: { color: C.midBg }, line: { color: d.c, width: 1 }, rectRadius: 0.06
    });
    slide.addText(d.t, {
      x: 0.5, y: 1.95 + i*1.2, w: 5.7, h: 0.32,
      fontSize: 12, bold: true, color: d.c, fontFace: "Calibri", margin: 0
    });
    slide.addText(d.d, {
      x: 0.5, y: 2.28 + i*1.2, w: 5.7, h: 0.6,
      fontSize: 10.5, color: C.light, fontFace: "Calibri", margin: 0
    });
  });

  // Atropine algorithm box
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.35, y: 6.7, w: 6.0, h: 0.35,
    fill: { color: C.accentG }, line: { color: C.accentG }, rectRadius: 0.05
  });
  slide.addText("Symptomatic bradycardia: Atropine 0.5 mg IV → Transcutaneous Pacing", {
    x: 0.35, y: 6.7, w: 6.0, h: 0.35,
    fontSize: 10, bold: true, color: C.darkBg,
    align: "center", valign: "middle", margin: 0
  });

  // Right: Broad complex tachycardia
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.82, y: 1.2, w: 6.48, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.purple, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 6.82, y: 1.2, w: 6.48, h: 0.55,
    fill: { color: C.purple }, line: { color: C.purple }
  });
  slide.addText("Broad Complex Tachycardia  (QRS >0.12s, rate >100)", {
    x: 6.95, y: 1.22, w: 6.22, h: 0.5,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });

  const broadItems = [
    { t:"Always assume VT until proven otherwise", c: C.accent },
    { t:"Monomorphic VT: regular, uniform wide-complex QRS", c: C.light },
    { t:"Polymorphic VT: varying QRS morphology", c: C.light },
    { t:"Torsades de Pointes: twisting around baseline, long QT", c: C.yellow },
    { t:"SVT with aberrancy: looks wide but actually SVT", c: C.accent2 },
  ];
  broadItems.forEach((bi, i) => {
    slide.addText("▸  " + bi.t, {
      x: 7.0, y: 1.95 + i*0.52, w: 6.1, h: 0.48,
      fontSize: 12, color: bi.c, fontFace: "Calibri", margin: 0,
      bold: i === 0 ? true : false
    });
  });

  // Brugada criteria box
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.97, y: 4.7, w: 6.15, h: 2.2,
    fill: { color: C.midBg }, line: { color: C.yellow, width: 1 }, rectRadius: 0.08
  });
  slide.addText("Differentiating VT from SVT with Aberrancy", {
    x: 7.1, y: 4.78, w: 5.9, h: 0.38,
    fontSize: 12.5, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0
  });
  const brugItems = [
    "AV dissociation → confirms VT",
    "Capture / fusion beats → confirms VT",
    "QRS >0.16s favours VT",
    "Extreme axis deviation (NW axis) → VT",
    "Brugada / Vereckei criteria for confirmation",
  ];
  brugItems.forEach((bi, i) => {
    slide.addText("• " + bi, {
      x: 7.1, y: 5.2 + i*0.32, w: 5.9, h: 0.3,
      fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 10 – WOLFF-PARKINSON-WHITE & LONG QT
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.purple);
  slideTitle(slide, "WPW Syndrome & Long QT Syndrome");

  // WPW
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 6.3, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.purple, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.22, y: 1.2, w: 6.3, h: 0.55,
    fill: { color: C.purple }, line: { color: C.purple }
  });
  slide.addText("Wolff-Parkinson-White (WPW)", {
    x: 0.35, y: 1.22, w: 6.04, h: 0.5,
    fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const wpwContent = [
    { h: "ECG Findings", c: C.purple, items: [
      "Short PR interval (<0.12s)",
      "Delta wave (slurred QRS upstroke)",
      "Wide QRS complex",
      "Secondary ST-T wave changes",
      "Pseudo-infarction patterns possible",
    ]},
    { h: "Key Danger: AF in WPW", c: C.accent, items: [
      "Rapid conduction via accessory pathway",
      "Can cause ventricular rates >250 bpm",
      "Risk of VF and sudden cardiac death",
      "NEVER give adenosine, digoxin, or verapamil",
      "Treatment: DC cardioversion or procainamide",
    ]},
  ];
  let wy = 1.9;
  wpwContent.forEach((grp) => {
    slide.addText(grp.h, {
      x: 0.4, y: wy, w: 5.9, h: 0.38,
      fontSize: 13, bold: true, color: grp.c, fontFace: "Calibri", margin: 0
    });
    wy += 0.42;
    grp.items.forEach((item) => {
      slide.addText("▸  " + item, {
        x: 0.42, y: wy, w: 5.9, h: 0.42,
        fontSize: 12, color: C.light, fontFace: "Calibri", margin: 0
      });
      wy += 0.46;
    });
    wy += 0.22;
  });

  // Long QT
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.82, y: 1.2, w: 6.48, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.yellow, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 6.82, y: 1.2, w: 6.48, h: 0.55,
    fill: { color: C.yellow }, line: { color: C.yellow }
  });
  slide.addText("Long QT Syndrome", {
    x: 6.95, y: 1.22, w: 6.22, h: 0.5,
    fontSize: 15, bold: true, color: C.darkBg, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const lqtContent = [
    { h: "ECG Findings", c: C.yellow, items: [
      "QTc >440 ms (men) / >460 ms (women)",
      "Prolonged T-wave duration",
      "May show T-wave alternans",
      "Predisposes to Torsades de Pointes",
    ]},
    { h: "Causes (LQTS)", c: C.accent2, items: [
      "Congenital: LQT1–3 (gene mutations)",
      "Drugs: antiarrhythmics, antibiotics (clarithromycin), antipsychotics",
      "Electrolytes: hypokalaemia, hypomagnesaemia, hypocalcaemia",
      "Hypothyroidism, hypothermia, intracranial events",
    ]},
    { h: "Management", c: C.accentG, items: [
      "Stop offending drugs",
      "Correct electrolytes (IV MgSO₄ for Torsades)",
      "IV MgSO₄ 2g is first-line for Torsades de Pointes",
      "Overdrive pacing / isoproterenol to shorten QT",
      "ICD for congenital LQTS",
    ]},
  ];
  let ly = 1.9;
  lqtContent.forEach((grp) => {
    slide.addText(grp.h, {
      x: 7.0, y: ly, w: 6.1, h: 0.38,
      fontSize: 13, bold: true, color: grp.c, fontFace: "Calibri", margin: 0
    });
    ly += 0.42;
    grp.items.forEach((item) => {
      slide.addText("▸  " + item, {
        x: 7.04, y: ly, w: 6.1, h: 0.42,
        fontSize: 11.5, color: C.light, fontFace: "Calibri", margin: 0
      });
      ly += 0.46;
    });
    ly += 0.16;
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 11 – PERICARDITIS & HYPERKALEMIA
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accent2);
  slideTitle(slide, "Pericarditis & Hyperkalaemia  –  ECG Patterns");

  // Pericarditis
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 6.3, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.accent2, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.22, y: 1.2, w: 6.3, h: 0.55,
    fill: { color: C.accent2 }, line: { color: C.accent2 }
  });
  slide.addText("Pericarditis", {
    x: 0.35, y: 1.22, w: 6.04, h: 0.5,
    fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const pericItems = [
    { h: "ECG Stages", c: C.accent2, items: [
      "Stage 1: Saddle-shaped (concave up) ST elevation in most leads; PR depression",
      "Stage 2: ST returns to baseline, T waves flatten",
      "Stage 3: T-wave inversion (diffuse)",
      "Stage 4: ECG normalises (weeks to months)",
    ]},
    { h: "Key Features (vs STEMI)", c: C.yellow, items: [
      "ST elevation is diffuse (not territorial)",
      "PR segment depression (highly specific)",
      "No reciprocal ST depression",
      "No Q waves",
      "Spitzweg sign: PR depression in V5/V6",
    ]},
    { h: "Management", c: C.accentG, items: [
      "NSAIDs (ibuprofen 600 mg TDS) + colchicine 0.5 mg BD",
      "Avoid strenuous activity for 3 months",
      "Steroids only if NSAIDs fail (increased recurrence risk)",
    ]},
  ];
  let py = 1.9;
  pericItems.forEach((grp) => {
    slide.addText(grp.h, {
      x: 0.4, y: py, w: 5.9, h: 0.38,
      fontSize: 12.5, bold: true, color: grp.c, fontFace: "Calibri", margin: 0
    });
    py += 0.42;
    grp.items.forEach((item) => {
      slide.addText("▸  " + item, {
        x: 0.42, y: py, w: 5.9, h: 0.42,
        fontSize: 11.5, color: C.light, fontFace: "Calibri", margin: 0
      });
      py += 0.46;
    });
    py += 0.16;
  });

  // Hyperkalaemia
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.82, y: 1.2, w: 6.48, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.accent, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 6.82, y: 1.2, w: 6.48, h: 0.55,
    fill: { color: C.accent }, line: { color: C.accent }
  });
  slide.addText("Hyperkalaemia  (K⁺ >5.5 mmol/L)", {
    x: 6.95, y: 1.22, w: 6.22, h: 0.5,
    fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const hyperKStages = [
    { k: "K⁺ 5.5–6.5", changes: "Peaked/tented T waves (earliest sign)", c: C.yellow },
    { k: "K⁺ 6.5–7.0", changes: "Prolonged PR, wide QRS, flattened P waves", c: C.accent2 },
    { k: "K⁺ >7.0",   changes: "Sine wave pattern (P merges into QRS)", c: C.accent },
    { k: "K⁺ >8.0",   changes: "VF / asystole – cardiac arrest risk", c: C.accent },
  ];
  slide.addText("ECG Changes by Severity", {
    x: 6.95, y: 1.88, w: 6.22, h: 0.38,
    fontSize: 13, bold: true, color: C.yellow, fontFace: "Calibri", margin: 0
  });
  hyperKStages.forEach((s, i) => {
    slide.addShape(pres.ShapeType.roundRect, {
      x: 7.0, y: 2.38 + i*0.74, w: 6.15, h: 0.62,
      fill: { color: C.midBg }, line: { color: s.c, width: 1 }, rectRadius: 0.06
    });
    slide.addText(s.k, {
      x: 7.1, y: 2.44 + i*0.74, w: 1.7, h: 0.5,
      fontSize: 11, bold: true, color: s.c, fontFace: "Calibri", margin: 0
    });
    slide.addText(s.changes, {
      x: 8.88, y: 2.44 + i*0.74, w: 4.2, h: 0.5,
      fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0
    });
  });

  slide.addText("Management", {
    x: 6.95, y: 5.42, w: 6.22, h: 0.38,
    fontSize: 13, bold: true, color: C.accentG, fontFace: "Calibri", margin: 0
  });
  const hkMx = [
    "Cardiac membrane stabilisation: IV Calcium Gluconate 10% 10 mL",
    "Shift K⁺ into cells: insulin+dextrose, salbutamol nebuliser, NaHCO₃",
    "Remove K⁺: kayexalate, furosemide, dialysis",
    "Monitor on continuous cardiac monitoring throughout",
  ];
  hkMx.forEach((item, i) => {
    slide.addText("▸  " + item, {
      x: 7.0, y: 5.85 + i*0.32, w: 6.1, h: 0.3,
      fontSize: 10.5, color: C.light, fontFace: "Calibri", margin: 0
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 12 – PULMONARY EMBOLISM ECG & BUNDLE BRANCH BLOCKS
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accentG);
  slideTitle(slide, "Pulmonary Embolism ECG & Bundle Branch Blocks");

  // PE ECG
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 6.3, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.accentG, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.22, y: 1.2, w: 6.3, h: 0.55,
    fill: { color: C.accentG }, line: { color: C.accentG }
  });
  slide.addText("Pulmonary Embolism – ECG Signs", {
    x: 0.35, y: 1.22, w: 6.04, h: 0.5,
    fontSize: 14, bold: true, color: C.darkBg, fontFace: "Calibri", margin: 0, valign: "middle"
  });
  const peItems = [
    { t: "Tachycardia", d: "Most common finding (sinus tachycardia)", c: C.accentG },
    { t: "S1Q3T3 Pattern", d: "S wave in I, Q wave + T inversion in III – only 20% sensitive", c: C.yellow },
    { t: "Right Heart Strain", d: "New RBBB, RAD, T inversion in V1–V4", c: C.accent2 },
    { t: "P Pulmonale", d: "Peaked P waves in II (>2.5mm) – right atrial enlargement", c: C.accentG },
    { t: "AF / Atrial Flutter", d: "New onset arrhythmia can be presenting feature", c: C.purple },
    { t: "Non-specific ST-T changes", d: "Often present but not diagnostic", c: C.muted },
  ];
  peItems.forEach((pi, i) => {
    slide.addShape(pres.ShapeType.roundRect, {
      x: 0.35, y: 1.9 + i*0.77, w: 6.0, h: 0.68,
      fill: { color: C.midBg }, line: { color: pi.c, width: 1 }, rectRadius: 0.06
    });
    slide.addText(pi.t, {
      x: 0.5, y: 1.96 + i*0.77, w: 2.1, h: 0.55,
      fontSize: 11.5, bold: true, color: pi.c, fontFace: "Calibri", margin: 0, valign: "middle"
    });
    slide.addText(pi.d, {
      x: 2.68, y: 1.96 + i*0.77, w: 3.55, h: 0.55,
      fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0, valign: "middle"
    });
  });
  slide.addText("⚠ ECG cannot rule out PE – use clinical probability (Wells) + CT-PA", {
    x: 0.35, y: 6.7, w: 6.0, h: 0.35,
    fontSize: 10, bold: true, color: C.yellow,
    align: "center", valign: "middle", margin: 0
  });

  // Bundle branch blocks
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.82, y: 1.2, w: 6.48, h: 5.9,
    fill: { color: C.cardBg }, line: { color: C.accent2, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 6.82, y: 1.2, w: 6.48, h: 0.55,
    fill: { color: C.accent2 }, line: { color: C.accent2 }
  });
  slide.addText("Bundle Branch Blocks", {
    x: 6.95, y: 1.22, w: 6.22, h: 0.5,
    fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
  });

  // RBBB
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.97, y: 1.9, w: 6.15, h: 2.15,
    fill: { color: C.midBg }, line: { color: C.accent2, width: 1 }, rectRadius: 0.08
  });
  slide.addText("RBBB  (Right Bundle Branch Block)", {
    x: 7.1, y: 1.98, w: 5.9, h: 0.38,
    fontSize: 13, bold: true, color: C.accent2, fontFace: "Calibri", margin: 0
  });
  const rbbbItems = [
    "QRS >0.12s (wide)",
    "RSR' pattern (M-shaped) in V1–V2  ('rabbit ears')",
    "Deep slurred S wave in V5–V6, I, aVL",
    "ST depression + T inversion in V1–V2",
  ];
  rbbbItems.forEach((r, i) => {
    slide.addText("• " + r, {
      x: 7.1, y: 2.4 + i*0.36, w: 5.9, h: 0.34,
      fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0
    });
  });

  // LBBB
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.97, y: 4.18, w: 6.15, h: 2.15,
    fill: { color: C.midBg }, line: { color: C.purple, width: 1 }, rectRadius: 0.08
  });
  slide.addText("LBBB  (Left Bundle Branch Block)", {
    x: 7.1, y: 4.26, w: 5.9, h: 0.38,
    fontSize: 13, bold: true, color: C.purple, fontFace: "Calibri", margin: 0
  });
  const lbbbItems = [
    "QRS >0.12s (wide), broad notched R in I, aVL, V5–V6",
    "Deep S in V1, no septal Q waves",
    "Concordant ST changes (discordant in ischaemia – Sgarbossa)",
    "New LBBB in chest pain context = treat as STEMI equivalent",
  ];
  lbbbItems.forEach((l, i) => {
    slide.addText("• " + l, {
      x: 7.1, y: 4.68 + i*0.38, w: 5.9, h: 0.36,
      fontSize: 11, color: C.light, fontFace: "Calibri", margin: 0
    });
  });
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.97, y: 6.46, w: 6.15, h: 0.38,
    fill: { color: C.purple }, line: { color: C.purple }, rectRadius: 0.05
  });
  slide.addText("New LBBB + chest pain → Activate Cath Lab immediately", {
    x: 6.97, y: 6.46, w: 6.15, h: 0.38,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 13 – 4H 4T REVERSIBLE CAUSES & QUICK REFERENCE SUMMARY
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.yellow);
  slideTitle(slide, "Reversible Causes of Cardiac Arrest  –  4H & 4T");

  const Hs = [
    { t: "Hypoxia",                hint: "Ensure airway, high-flow O₂, ventilation" },
    { t: "Hypovolaemia",           hint: "IV fluid challenge, control haemorrhage" },
    { t: "Hypo/Hyperkalaemia",     hint: "Electrolytes, Ca gluconate, IV MgSO₄" },
    { t: "Hypothermia",            hint: "Warm IV fluids, active rewarming, ECMO" },
  ];
  const Ts = [
    { t: "Tension Pneumothorax",   hint: "Needle decompression 2nd ICS MCL, then chest drain" },
    { t: "Tamponade (cardiac)",    hint: "Pericardiocentesis or emergency thoracotomy" },
    { t: "Toxins / Overdose",      hint: "Naloxone, flumazenil, specific antidotes" },
    { t: "Thrombosis (PE/MI)",     hint: "Thrombolysis, PPCI, surgical embolectomy" },
  ];

  // 4H box
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.22, y: 1.2, w: 6.3, h: 5.7,
    fill: { color: C.cardBg }, line: { color: C.accentG, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.22, y: 1.2, w: 6.3, h: 0.55,
    fill: { color: C.accentG }, line: { color: C.accentG }
  });
  slide.addText("4  H's", {
    x: 0.35, y: 1.22, w: 6.04, h: 0.5,
    fontSize: 22, bold: true, color: C.darkBg, fontFace: "Calibri",
    align: "center", margin: 0, valign: "middle"
  });
  Hs.forEach((h, i) => {
    slide.addShape(pres.ShapeType.roundRect, {
      x: 0.35, y: 1.9 + i*1.18, w: 6.0, h: 1.05,
      fill: { color: C.midBg }, line: { color: C.accentG, width: 0.8 }, rectRadius: 0.07
    });
    slide.addShape(pres.ShapeType.ellipse, {
      x: 0.42, y: 1.97 + i*1.18, w: 0.55, h: 0.55,
      fill: { color: C.accentG }, line: { color: C.accentG }
    });
    slide.addText("H", {
      x: 0.42, y: 1.97 + i*1.18, w: 0.55, h: 0.55,
      fontSize: 18, bold: true, color: C.darkBg,
      align: "center", valign: "middle", margin: 0
    });
    slide.addText(h.t, {
      x: 1.06, y: 1.97 + i*1.18, w: 4.9, h: 0.36,
      fontSize: 13, bold: true, color: C.light, fontFace: "Calibri", margin: 0
    });
    slide.addText(h.hint, {
      x: 1.06, y: 2.36 + i*1.18, w: 4.9, h: 0.36,
      fontSize: 11, color: C.accentG, fontFace: "Calibri", margin: 0
    });
  });

  // 4T box
  slide.addShape(pres.ShapeType.roundRect, {
    x: 6.82, y: 1.2, w: 6.48, h: 5.7,
    fill: { color: C.cardBg }, line: { color: C.yellow, width: 1.5 }, rectRadius: 0.1
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 6.82, y: 1.2, w: 6.48, h: 0.55,
    fill: { color: C.yellow }, line: { color: C.yellow }
  });
  slide.addText("4  T's", {
    x: 6.95, y: 1.22, w: 6.22, h: 0.5,
    fontSize: 22, bold: true, color: C.darkBg, fontFace: "Calibri",
    align: "center", margin: 0, valign: "middle"
  });
  Ts.forEach((t, i) => {
    slide.addShape(pres.ShapeType.roundRect, {
      x: 6.95, y: 1.9 + i*1.18, w: 6.18, h: 1.05,
      fill: { color: C.midBg }, line: { color: C.yellow, width: 0.8 }, rectRadius: 0.07
    });
    slide.addShape(pres.ShapeType.ellipse, {
      x: 7.0, y: 1.97 + i*1.18, w: 0.55, h: 0.55,
      fill: { color: C.yellow }, line: { color: C.yellow }
    });
    slide.addText("T", {
      x: 7.0, y: 1.97 + i*1.18, w: 0.55, h: 0.55,
      fontSize: 18, bold: true, color: C.darkBg,
      align: "center", valign: "middle", margin: 0
    });
    slide.addText(t.t, {
      x: 7.65, y: 1.97 + i*1.18, w: 5.1, h: 0.36,
      fontSize: 13, bold: true, color: C.light, fontFace: "Calibri", margin: 0
    });
    slide.addText(t.hint, {
      x: 7.65, y: 2.36 + i*1.18, w: 5.1, h: 0.36,
      fontSize: 11, color: C.yellow, fontFace: "Calibri", margin: 0
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 14 – SUMMARY TABLE
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  darkSlide(slide);
  headerStrip(slide, C.midBg);
  addSectionBar(slide, C.accentG);
  slideTitle(slide, "Quick Reference Summary");

  const rows = [
    { cond: "STEMI",           ecg: "ST elevation ≥1mm in 2+ leads, new LBBB",          action: "PCI within 90 min, aspirin+ticagrelor",         urgency: "EMERGENCY", uc: C.accent },
    { cond: "NSTEMI/UA",       ecg: "ST depression, T inversion, or normal ECG",         action: "GRACE score, anticoagulate, angiography <72h",  urgency: "URGENT",    uc: C.accent2 },
    { cond: "VF/Pulseless VT", ecg: "Chaotic/wide QRS, no organised rhythm",             action: "Defibrillate + CPR, adrenaline + amiodarone",   urgency: "EMERGENCY", uc: C.accent },
    { cond: "SVT",             ecg: "Narrow QRS tachycardia 150–250 bpm",                action: "Vagal manoeuvre → adenosine → cardioversion",   urgency: "URGENT",    uc: C.purple },
    { cond: "AF",              ecg: "Irregularly irregular, absent P waves",              action: "Rate/rhythm control, anticoagulate",             urgency: "MONITOR",   uc: C.accent2 },
    { cond: "3rd Degree HB",   ecg: "AV dissociation, slow escape rhythm",               action: "Atropine, transcutaneous then transvenous pacing",urgency: "EMERGENCY",uc: C.accent },
    { cond: "WPW + AF",        ecg: "Fast, irregular, wide QRS – delta waves in sinus",  action: "DC cardioversion; avoid adenosine/digoxin",      urgency: "EMERGENCY", uc: C.accent },
    { cond: "Long QT/TdP",     ecg: "QTc >440ms, twisting polymorphic VT",               action: "IV MgSO₄ 2g, stop offending drugs, overdrive pacing", urgency: "EMERGENCY", uc: C.accent },
    { cond: "Hyperkalaemia",   ecg: "Peaked T, wide QRS, sine wave",                     action: "Ca gluconate, insulin+dextrose, dialysis",       urgency: "URGENT",    uc: C.yellow },
    { cond: "PE",              ecg: "Sinus tach, S1Q3T3, new RBBB",                      action: "CTPA, anticoagulate, thrombolysis if massive",   urgency: "URGENT",    uc: C.accentG },
  ];

  // Header row
  slide.addShape(pres.ShapeType.rect, {
    x: 0.18, y: 1.1, w: 13.14, h: 0.45,
    fill: { color: C.accentG }, line: { color: C.accentG }
  });
  ["Condition", "ECG Features", "Immediate Action", "Priority"].forEach((hdr, i) => {
    const widths = [2.1, 4.4, 5.2, 1.35];
    const xs     = [0.2, 2.34, 6.78, 12.02];
    slide.addText(hdr, {
      x: xs[i], y: 1.1, w: widths[i], h: 0.45,
      fontSize: 12, bold: true, color: C.darkBg,
      fontFace: "Calibri", margin: 4, valign: "middle"
    });
  });

  rows.forEach((r, i) => {
    const by = 1.58 + i * 0.49;
    const rowBg = i % 2 === 0 ? C.cardBg : C.midBg;
    slide.addShape(pres.ShapeType.rect, {
      x: 0.18, y: by, w: 13.14, h: 0.47,
      fill: { color: rowBg }, line: { color: C.midBg }
    });
    slide.addText(r.cond, {
      x: 0.22, y: by + 0.03, w: 2.08, h: 0.41,
      fontSize: 10.5, bold: true, color: r.uc, fontFace: "Calibri", margin: 3, valign: "middle"
    });
    slide.addText(r.ecg, {
      x: 2.34, y: by + 0.03, w: 4.38, h: 0.41,
      fontSize: 10, color: C.light, fontFace: "Calibri", margin: 3, valign: "middle"
    });
    slide.addText(r.action, {
      x: 6.78, y: by + 0.03, w: 5.2, h: 0.41,
      fontSize: 10, color: C.light, fontFace: "Calibri", margin: 3, valign: "middle"
    });
    // Priority badge
    slide.addShape(pres.ShapeType.roundRect, {
      x: 12.06, y: by + 0.06, w: 1.18, h: 0.34,
      fill: { color: r.uc }, line: { color: r.uc }, rectRadius: 0.05
    });
    slide.addText(r.urgency, {
      x: 12.06, y: by + 0.06, w: 1.18, h: 0.34,
      fontSize: 8, bold: true, color: r.urgency === "MONITOR" ? C.darkBg : C.white,
      align: "center", valign: "middle", margin: 0
    });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 15 – CLOSING SLIDE
// ══════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkBg }
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 2.8, w: "100%", h: 0.08, fill: { color: C.accent }
  });
  slide.addText("KEY TAKEAWAYS", {
    x: 0.8, y: 0.5, w: 11.7, h: 0.65,
    fontSize: 28, bold: true, color: C.accent, fontFace: "Calibri",
    align: "center", charSpacing: 4
  });

  const takeaways = [
    { icon: "1", msg: "Systematic approach to every ECG: Rate → Rhythm → Axis → Intervals → ST-T", c: C.accentG },
    { icon: "2", msg: "Time = Myocardium: New STEMI or LBBB → activate cath lab immediately", c: C.accent },
    { icon: "3", msg: "VF/pulseless VT = shockable: CPR + defibrillate + adrenaline + amiodarone", c: C.accent },
    { icon: "4", msg: "SVT: vagal manoeuvres first → adenosine. WPW + AF: never give AV nodal blockers", c: C.purple },
    { icon: "5", msg: "Always look for reversible causes (4H & 4T) in any cardiac arrest", c: C.yellow },
    { icon: "6", msg: "ECG is a snapshot: compare with old ECGs and correlate with clinical picture", c: C.accentG },
  ];

  takeaways.forEach((t, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const bx = 0.4 + col * 6.65;
    const by = 3.1 + row * 1.3;

    slide.addShape(pres.ShapeType.roundRect, {
      x: bx, y: by, w: 6.3, h: 1.1,
      fill: { color: C.cardBg }, line: { color: t.c, width: 1 }, rectRadius: 0.08
    });
    slide.addShape(pres.ShapeType.ellipse, {
      x: bx + 0.12, y: by + 0.27, w: 0.55, h: 0.55,
      fill: { color: t.c }, line: { color: t.c }
    });
    slide.addText(t.icon, {
      x: bx + 0.12, y: by + 0.27, w: 0.55, h: 0.55,
      fontSize: 16, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
    slide.addText(t.msg, {
      x: bx + 0.78, y: by + 0.12, w: 5.42, h: 0.86,
      fontSize: 12, color: C.light, fontFace: "Calibri", margin: 4
    });
  });

  slide.addText("Emergency Medicine  |  ECG Emergency Cases  |  2026", {
    x: 0.8, y: 7.0, w: 11.7, h: 0.35,
    fontSize: 12, color: C.muted, align: "center", fontFace: "Calibri"
  });
}

// ── Write file ────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/ecg-emergency-ppt/ECG_Emergency_Cases.pptx" })
  .then(() => console.log("Done: ECG_Emergency_Cases.pptx"))
  .catch(err => { console.error(err); process.exit(1); });

cd /home/daytona/workspace/ecg-emergency-ppt && node create_ecg_ppt.js

ls -lh /home/daytona/workspace/ecg-emergency-ppt/ECG_Emergency_Cases.pptx