kindly make a ppt for mbbs students under NMC "Emergency procedures during pandemics 1.indications for invasive procedures during pandemics 2.points to be verified before emergnecy procedures 3.steps to be taken to reduce transmission pf infections 4.attitude and communications issues related to complucated procedures"
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Running Command
mkdir -p /home/daytona/workspace/pandemic-emergency-ppt && ls /home/daytona/work…
Writing File
~/pandemic-emergency-ppt/build.js
const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "NMC MBBS Medical Education";
pres.title = "Emergency Procedures During Pandemics";
// ─── PALETTE ────────────────────────────────────────────────
const CLR = {
navy: "0D1B3E",
teal: "0A7E8C",
tealMid: "0D9EAF",
amber: "F5A623",
white: "FFFFFF",
lightBg: "EAF6F8",
darkText:"1A1A2E",
slate: "4A5568",
red: "C0392B",
green: "1A6B3C",
lightTeal:"E0F5F8",
};
// ─── HELPER: add decorative left bar ────────────────────────
function addLeftBar(slide, color) {
slide.addShape(pres.ShapeType.rect, {
x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: color || CLR.teal }
});
}
// ─── HELPER: section title band ─────────────────────────────
function addTitleBand(slide, title, subtitle, icon) {
// full-width gradient top band
slide.addShape(pres.ShapeType.rect, {
x: 0, y: 0, w: 10, h: 1.6, fill: { color: CLR.navy }
});
// accent bar below band
slide.addShape(pres.ShapeType.rect, {
x: 0, y: 1.6, w: 10, h: 0.07, fill: { color: CLR.amber }
});
// icon circle
if (icon) {
slide.addShape(pres.ShapeType.ellipse, {
x: 0.3, y: 0.2, w: 1.2, h: 1.2,
fill: { color: CLR.tealMid }, line: { color: CLR.white, width: 2 }
});
slide.addText(icon, {
x: 0.3, y: 0.28, w: 1.2, h: 1.0,
fontSize: 28, align: "center", valign: "middle", color: CLR.white, bold: true
});
}
slide.addText(title, {
x: icon ? 1.7 : 0.3, y: 0.1, w: icon ? 7.9 : 9.4, h: 0.85,
fontSize: 26, bold: true, color: CLR.white, fontFace: "Calibri", valign: "middle"
});
if (subtitle) {
slide.addText(subtitle, {
x: icon ? 1.7 : 0.3, y: 0.95, w: 8.5, h: 0.55,
fontSize: 13, color: CLR.tealMid, italic: true, fontFace: "Calibri", valign: "middle"
});
}
}
// ─── HELPER: bullet card ────────────────────────────────────
function addBulletCard(slide, x, y, w, h, heading, bullets, headingColor, bulletColor) {
slide.addShape(pres.ShapeType.roundRect, {
x, y, w, h,
rectRadius: 0.08,
fill: { color: CLR.lightBg }, line: { color: CLR.tealMid, width: 1.5 }
});
if (heading) {
slide.addShape(pres.ShapeType.rect, {
x, y, w, h: 0.38,
fill: { color: headingColor || CLR.teal }
});
slide.addText(heading, {
x: x + 0.12, y: y + 0.03, w: w - 0.24, h: 0.34,
fontSize: 12, bold: true, color: CLR.white, fontFace: "Calibri", valign: "middle"
});
}
const bulletItems = bullets.map((b, i) => ({
text: b,
options: { bullet: { type: "bullet", code: "2022" }, breakLine: i < bullets.length - 1 }
}));
slide.addText(bulletItems, {
x: x + 0.12, y: y + (heading ? 0.44 : 0.1), w: w - 0.24,
h: h - (heading ? 0.5 : 0.15),
fontSize: 11, color: bulletColor || CLR.darkText,
fontFace: "Calibri", valign: "top"
});
}
// ─── HELPER: numbered step box ──────────────────────────────
function addStepBox(slide, x, y, num, text, color) {
slide.addShape(pres.ShapeType.ellipse, {
x, y, w: 0.42, h: 0.42,
fill: { color: color || CLR.teal }
});
slide.addText(String(num), {
x, y, w: 0.42, h: 0.42,
fontSize: 14, bold: true, color: CLR.white, align: "center", valign: "middle"
});
slide.addText(text, {
x: x + 0.5, y: y + 0.02, w: 4.0, h: 0.38,
fontSize: 10.5, color: CLR.darkText, fontFace: "Calibri", valign: "middle"
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
// full background
s.addShape(pres.ShapeType.rect, {
x: 0, y: 0, w: 10, h: 5.625, fill: { color: CLR.navy }
});
// teal bottom stripe
s.addShape(pres.ShapeType.rect, {
x: 0, y: 4.5, w: 10, h: 1.125, fill: { color: CLR.teal }
});
// amber accent
s.addShape(pres.ShapeType.rect, {
x: 0, y: 4.48, w: 10, h: 0.07, fill: { color: CLR.amber }
});
// diagonal decorative shape
s.addShape(pres.ShapeType.rect, {
x: 7.5, y: 0, w: 2.5, h: 5.625,
fill: { color: CLR.teal, transparency: 80 }
});
// biohazard/cross icon area
s.addShape(pres.ShapeType.ellipse, {
x: 7.8, y: 0.4, w: 1.8, h: 1.8,
fill: { color: CLR.tealMid, transparency: 30 }, line: { color: CLR.amber, width: 2 }
});
s.addText("⚕", {
x: 7.8, y: 0.5, w: 1.8, h: 1.6,
fontSize: 52, align: "center", valign: "middle", color: CLR.white
});
s.addText("EMERGENCY PROCEDURES", {
x: 0.4, y: 0.6, w: 7.2, h: 0.9,
fontSize: 30, bold: true, color: CLR.white, fontFace: "Calibri",
charSpacing: 2
});
s.addText("DURING PANDEMICS", {
x: 0.4, y: 1.45, w: 7.2, h: 0.75,
fontSize: 38, bold: true, color: CLR.amber, fontFace: "Calibri"
});
s.addText("A Comprehensive Guide for MBBS Students", {
x: 0.4, y: 2.2, w: 7.2, h: 0.5,
fontSize: 15, italic: true, color: CLR.tealMid, fontFace: "Calibri"
});
// divider
s.addShape(pres.ShapeType.rect, {
x: 0.4, y: 2.75, w: 4.5, h: 0.05, fill: { color: CLR.amber }
});
s.addText([
{ text: "National Medical Commission (NMC) — India", options: { bold: true, breakLine: true } },
{ text: "MBBS Curriculum | Undergraduate Medical Education", options: { italic: true } }
], {
x: 0.4, y: 2.85, w: 7.0, h: 0.7,
fontSize: 12, color: "AACFD4", fontFace: "Calibri"
});
s.addText("Topics: Indications • Pre-procedure Verification • Infection Control • Communication Ethics", {
x: 0.2, y: 4.6, w: 9.5, h: 0.4,
fontSize: 11, color: CLR.white, align: "center", fontFace: "Calibri"
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.lightBg } });
addLeftBar(s, CLR.navy);
s.addText("OVERVIEW", {
x: 0.4, y: 0.2, w: 9, h: 0.5,
fontSize: 22, bold: true, color: CLR.navy, fontFace: "Calibri", charSpacing: 3
});
s.addText("Emergency Procedures During Pandemics", {
x: 0.4, y: 0.65, w: 9, h: 0.4,
fontSize: 14, italic: true, color: CLR.teal, fontFace: "Calibri"
});
s.addShape(pres.ShapeType.rect, { x:0.4, y:1.1, w:9.2, h:0.04, fill:{ color: CLR.amber } });
const topics = [
{ num:"01", title:"INDICATIONS FOR INVASIVE PROCEDURES", sub:"When to proceed despite pandemic risks — life-threatening emergencies", color: CLR.red },
{ num:"02", title:"PRE-PROCEDURE VERIFICATION CHECKLIST", sub:"Essential checks before any emergency procedure in pandemic settings", color: CLR.teal },
{ num:"03", title:"INFECTION TRANSMISSION REDUCTION", sub:"PPE, airborne precautions, environmental controls, and protocols", color: CLR.tealMid },
{ num:"04", title:"ATTITUDE & COMMUNICATION IN COMPLEX PROCEDURES", sub:"Consent, team dynamics, ethics, and patient/family communication", color: "#6B4C9A" },
];
topics.forEach((t, i) => {
const y = 1.25 + i * 1.0;
s.addShape(pres.ShapeType.roundRect, {
x: 0.4, y, w: 9.2, h: 0.85, rectRadius: 0.07,
fill: { color: CLR.white }, line: { color: t.color, width: 2 }
});
s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 0.7, h: 0.85, fill: { color: t.color } });
s.addText(t.num, {
x: 0.4, y: y+0.03, w: 0.7, h: 0.8,
fontSize: 20, bold: true, color: CLR.white, align: "center", valign: "middle"
});
s.addText(t.title, {
x: 1.2, y: y+0.07, w: 8.2, h: 0.38,
fontSize: 13, bold: true, color: CLR.navy, fontFace: "Calibri"
});
s.addText(t.sub, {
x: 1.2, y: y+0.46, w: 8.2, h: 0.3,
fontSize: 10, italic: true, color: CLR.slate, fontFace: "Calibri"
});
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 3 — INTRODUCTION: PANDEMIC CONTEXT
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "PANDEMIC CONTEXT & BACKGROUND", "Why emergency procedures require special protocols during pandemics", "🌐");
// two-column layout
addBulletCard(s, 0.25, 1.82, 4.6, 3.55, "KEY PANDEMICS IN MODERN HISTORY", [
"1918 — Spanish Flu (H1N1): 50–100 million deaths",
"2003 — SARS-CoV: Killed 15%, >50% in elderly; 33 anesthesiologists among HCWs in Toronto",
"2014 — West Africa Ebola: Extreme mortality; required biocontainment units",
"2009 — H1N1 Influenza Pandemic: Global spread within weeks",
"2020–23 — COVID-19: 758M+ confirmed cases, 6.8M deaths; redefined emergency surgical protocols"
], CLR.navy);
addBulletCard(s, 5.1, 1.82, 4.65, 3.55, "IMPACT ON SURGICAL & EMERGENCY CARE", [
"Routine and elective procedures suspended during surges",
"ICU capacity overwhelmed — tiered staffing models adopted",
"Aerosol-generating procedures (AGPs) posed highest HCW infection risk",
"PPE shortages forced protocol innovation",
"Anesthesiologists & surgeons at frontline risk (SARS: 3 anesthesiologists died in Toronto)",
"NMC mandates pandemic preparedness as core MBBS competency"
], CLR.red);
}
// ═══════════════════════════════════════════════════════════
// SLIDE 4 — MODULE 1: INDICATIONS (overview)
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
// red module header
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:1.6, fill:{ color: CLR.red } });
s.addShape(pres.ShapeType.rect, { x:0, y:1.6, w:10, h:0.07, fill:{ color: CLR.amber } });
s.addShape(pres.ShapeType.ellipse, { x:0.3, y:0.2, w:1.2, h:1.2, fill:{ color:"#8B0000" }, line:{ color:CLR.white, width:2 } });
s.addText("01", { x:0.3, y:0.28, w:1.2, h:1.0, fontSize:28, bold:true, color:CLR.white, align:"center", valign:"middle" });
s.addText("INDICATIONS FOR INVASIVE PROCEDURES DURING PANDEMICS", {
x:1.7, y:0.1, w:8.0, h:0.85,
fontSize:20, bold:true, color:CLR.white, fontFace:"Calibri", valign:"middle"
});
s.addText("The fundamental principle: Life-threatening emergencies override pandemic caution", {
x:1.7, y:0.95, w:8.0, h:0.55,
fontSize:12, italic:true, color:"FFCCCC", fontFace:"Calibri"
});
s.addText("ABSOLUTE INDICATIONS — Proceed immediately regardless of pandemic status:", {
x:0.3, y:1.82, w:9.4, h:0.4,
fontSize:13, bold:true, color:CLR.red, fontFace:"Calibri"
});
const abs = [
{ title:"Airway Emergency", detail:"Tension pneumothorax, airway obstruction, impending respiratory failure" },
{ title:"Cardiac Arrest / Tamponade", detail:"Emergency pericardiocentesis, open chest cardiac massage, thoracotomy" },
{ title:"Uncontrolled Hemorrhage", detail:"Damage-control surgery for hemorrhagic shock (class III/IV), ruptured aortic aneurysm" },
{ title:"Intracranial Emergency", detail:"Burr hole decompression for herniation, cerebral abscess with impending coning" },
{ title:"Intestinal Perforation/Obstruction", detail:"Peritonitis with septic shock, complete bowel obstruction" },
];
abs.forEach((item, i) => {
const col = i < 3 ? 0 : 1;
const row = i < 3 ? i : i - 3;
const x = 0.25 + col * 4.85;
const y = 2.32 + row * 1.02;
s.addShape(pres.ShapeType.roundRect, {
x, y, w:4.6, h:0.9, rectRadius:0.06,
fill:{ color:"FFF5F5" }, line:{ color:CLR.red, width:1.5 }
});
s.addShape(pres.ShapeType.rect, { x, y, w:0.12, h:0.9, fill:{ color:CLR.red } });
s.addText(item.title, {
x:x+0.2, y:y+0.06, w:4.2, h:0.32,
fontSize:11.5, bold:true, color:CLR.red, fontFace:"Calibri"
});
s.addText(item.detail, {
x:x+0.2, y:y+0.38, w:4.2, h:0.45,
fontSize:9.5, color:CLR.darkText, fontFace:"Calibri"
});
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 5 — MODULE 1 (cont): RELATIVE INDICATIONS + TRIAGE
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "INDICATIONS — RELATIVE & TRIAGE FRAMEWORK", "Balancing urgency vs. pandemic transmission risk", "⚖");
// Relative indications left
addBulletCard(s, 0.25, 1.82, 4.5, 2.2, "RELATIVE INDICATIONS (Assess Risk-Benefit)", [
"Organ-threatening conditions (e.g., compartment syndrome)",
"Infection requiring surgical drainage (abscess, empyema)",
"Obstetric emergencies — emergency LSCS, cord prolapse",
"Acute limb ischaemia (6-hour window)",
"Fractures with neurovascular compromise",
"Acute urinary retention with renal failure"
], CLR.amber);
// Contraindicated (defer) right
addBulletCard(s, 5.0, 1.82, 4.75, 2.2, "DEFER / POSTPONE (Non-Emergency)", [
"Elective cosmetic / aesthetic procedures",
"Routine hernia repair, elective cholecystectomy",
"Non-urgent endoscopies (screening colonoscopy)",
"Stable cancer resections (< 4 weeks delay acceptable)",
"Dental procedures not causing systemic sepsis",
"Routine joint replacement surgeries"
], CLR.slate);
// Triage decision rule
s.addShape(pres.ShapeType.roundRect, {
x:0.25, y:4.1, w:9.5, h:1.35, rectRadius:0.1,
fill:{ color:"FFFDE7" }, line:{ color:CLR.amber, width:2 }
});
s.addText("TRIAGE DECISION RULE (WHO / NMC Guidance)", {
x:0.45, y:4.17, w:9.0, h:0.35,
fontSize:12, bold:true, color:"7B4F00", fontFace:"Calibri"
});
s.addText(
"Ask: (1) Will delay of >6 hours cause death or permanent disability? → YES = Proceed with full PPE " +
"(2) Can equivalent outcome be achieved with non-invasive approach? → Prefer non-invasive " +
"(3) Is the patient COVID-positive/suspected? → Maximize precautions & use negative-pressure OR",
{
x:0.45, y:4.5, w:9.0, h:0.85,
fontSize:9.5, color:CLR.darkText, fontFace:"Calibri"
}
);
}
// ═══════════════════════════════════════════════════════════
// SLIDE 6 — MODULE 2: PRE-PROCEDURE VERIFICATION
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
// teal module header
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:1.6, fill:{ color: CLR.teal } });
s.addShape(pres.ShapeType.rect, { x:0, y:1.6, w:10, h:0.07, fill:{ color: CLR.amber } });
s.addShape(pres.ShapeType.ellipse, { x:0.3, y:0.2, w:1.2, h:1.2, fill:{ color:"#065f69" }, line:{ color:CLR.white, width:2 } });
s.addText("02", { x:0.3, y:0.28, w:1.2, h:1.0, fontSize:28, bold:true, color:CLR.white, align:"center", valign:"middle" });
s.addText("POINTS TO VERIFY BEFORE EMERGENCY PROCEDURES", {
x:1.7, y:0.1, w:8.0, h:0.85,
fontSize:20, bold:true, color:CLR.white, fontFace:"Calibri", valign:"middle"
});
s.addText("Systematic pre-procedural checklist — inspired by WHO Surgical Safety Checklist adapted for pandemic settings", {
x:1.7, y:0.95, w:8.0, h:0.55,
fontSize:11, italic:true, color:"AADFE5", fontFace:"Calibri"
});
// Three columns
const cols = [
{
title:"PATIENT ASSESSMENT",
color: CLR.teal,
items:[
"COVID-19 / infectious status confirmed (PCR / RDT)",
"Vital signs: BP, HR, SpO2, RR, GCS",
"Airway assessment (Mallampati, mouth opening, neck mobility)",
"Known allergies & current medications",
"Comorbidities — immunosuppression, DM, CKD",
"Pregnancy status (for females of reproductive age)",
"Blood group & cross-match done",
"Coagulation profile (especially for anticoagulated patients)"
]
},
{
title:"EQUIPMENT & TEAM READINESS",
color: CLR.tealMid,
items:[
"Negative-pressure OR / isolation room available",
"Video laryngoscope (preferred over direct in COVID+)",
"Difficult airway cart at bedside",
"Full PPE donned by entire team before entry",
"Emergency drugs drawn and labeled (adrenaline, atropine, etc.)",
"Defibrillator checked & functional",
"Suction working; HME filter on circuit",
"Minimum staff in OR (only essential personnel)"
]
},
{
title:"DOCUMENTATION & CONSENT",
color: CLR.navy,
items:[
"Emergency informed consent obtained (patient/guardian)",
"Risk of procedure vs. risk of delay documented",
"COVID status noted in surgical record",
"Pre-operative note & indication clearly written",
"Blood products ordered and available",
"Anesthesia pre-assessment completed",
"ICU/HDU bed confirmed if post-op intensive care needed",
"Next-of-kin notified and contact documented"
]
}
];
cols.forEach((col, i) => {
const x = 0.22 + i * 3.25;
addBulletCard(s, x, 1.82, 3.1, 3.6, col.title, col.items, col.color);
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 7 — PRE-PROCEDURE VERIFICATION (The 5 RIGHTS adapted)
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "PRE-PROCEDURE VERIFICATION — 5-STEP SIGN-IN PROTOCOL", "Adapted WHO Surgical Safety Checklist for Pandemic Settings", "✅");
const steps = [
{
step:"SIGN IN\n(Before Induction)",
points:[
"Patient identity confirmed (name, DOB, ID band)",
"Procedure & site marked and confirmed by surgeon",
"COVID/infectious status communicated to all team",
"Anaesthesia machine & medications checked",
"Pulse oximeter attached & functional",
"Known allergy confirmed"
],
color: CLR.red
},
{
step:"TIME OUT\n(Before Incision)",
points:[
"All team members introduced by name & role",
"Surgeon confirms procedure, site, patient",
"Antibiotic prophylaxis given within 60 min",
"Critical events anticipated (major blood loss?)",
"Are imaging results displayed? (if applicable)",
"PPE integrity of all team members confirmed"
],
color: CLR.teal
},
{
step:"SIGN OUT\n(Before Patient Leaves OR)",
points:[
"Procedure performed documented",
"Specimen labeled & sent",
"Any instrument/sponge/needle count completed",
"Equipment problems to address",
"Post-op recovery location confirmed (ICU/HDU/ward)",
"Decontamination protocol initiated for OR"
],
color: CLR.navy
}
];
steps.forEach((step, i) => {
const x = 0.22 + i * 3.25;
s.addShape(pres.ShapeType.roundRect, {
x, y:1.82, w:3.1, h:3.6, rectRadius:0.08,
fill:{ color: CLR.lightBg }, line:{ color: step.color, width:2 }
});
s.addShape(pres.ShapeType.rect, { x, y:1.82, w:3.1, h:0.6, fill:{ color: step.color } });
s.addText(step.step, {
x:x+0.1, y:1.84, w:2.9, h:0.56,
fontSize:11, bold:true, color:CLR.white, align:"center", valign:"middle", fontFace:"Calibri"
});
const bItems = step.points.map((p,j) => ({
text:p, options:{ bullet:{ type:"bullet", code:"2022" }, breakLine: j < step.points.length-1 }
}));
s.addText(bItems, {
x:x+0.12, y:2.48, w:2.88, h:2.88,
fontSize:9.5, color:CLR.darkText, fontFace:"Calibri", valign:"top"
});
});
// bottom note
s.addShape(pres.ShapeType.rect, { x:0, y:5.3, w:10, h:0.32, fill:{ color:"FFF8E1" } });
s.addText("⚠ During pandemics: Add COVID screening results, PPE status, and isolation room confirmation to each step", {
x:0.3, y:5.33, w:9.4, h:0.25,
fontSize:9, bold:true, color:"7B4F00", fontFace:"Calibri"
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 8 — MODULE 3: INFECTION CONTROL OVERVIEW
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:1.6, fill:{ color: CLR.green } });
s.addShape(pres.ShapeType.rect, { x:0, y:1.6, w:10, h:0.07, fill:{ color: CLR.amber } });
s.addShape(pres.ShapeType.ellipse, { x:0.3, y:0.2, w:1.2, h:1.2, fill:{ color:"#0D5C2E" }, line:{ color:CLR.white, width:2 } });
s.addText("03", { x:0.3, y:0.28, w:1.2, h:1.0, fontSize:28, bold:true, color:CLR.white, align:"center", valign:"middle" });
s.addText("STEPS TO REDUCE TRANSMISSION OF INFECTIONS", {
x:1.7, y:0.1, w:8.0, h:0.85,
fontSize:20, bold:true, color:CLR.white, fontFace:"Calibri", valign:"middle"
});
s.addText("Hierarchy of controls: Elimination → Substitution → Engineering → Administrative → PPE", {
x:1.7, y:0.95, w:8.0, h:0.55,
fontSize:11, italic:true, color:"AADDBB", fontFace:"Calibri"
});
// Hierarchy of controls visual
const levels = [
{ label:"ELIMINATION", sub:"Defer non-urgent procedures; restrict access", color:"C0392B", w:9.0 },
{ label:"SUBSTITUTION", sub:"Non-invasive alternatives where possible; telemedicine", color:"E67E22", w:7.6 },
{ label:"ENGINEERING CONTROLS", sub:"Negative-pressure ORs; HEPA filtration; airborne isolation rooms", color:"F1C40F", w:6.2 },
{ label:"ADMINISTRATIVE CONTROLS", sub:"Protocols, training, COVID screening, minimise staff in OR", color:"27AE60", w:4.8 },
{ label:"PPE", sub:"Last line: N95, gown, gloves, face shield, goggles", color:"2980B9", w:3.4 },
];
levels.forEach((lv, i) => {
const x = (9.5 - lv.w) / 2 + 0.25;
const y = 1.85 + i * 0.69;
s.addShape(pres.ShapeType.rect, {
x, y, w:lv.w, h:0.6,
fill:{ color: lv.color }
});
s.addText(`${lv.label} — ${lv.sub}`, {
x:x+0.1, y:y+0.08, w:lv.w-0.2, h:0.44,
fontSize:10, bold: i<2, color:CLR.white, fontFace:"Calibri", align:"center", valign:"middle"
});
});
s.addText("MOST EFFECTIVE ↑ ↓ LEAST EFFECTIVE", {
x:0.3, y:5.32, w:9.4, h:0.28,
fontSize:9, italic:true, color:CLR.slate, align:"center", fontFace:"Calibri"
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 9 — PPE & AGP PROTOCOLS
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "PPE PROTOCOLS & AEROSOL-GENERATING PROCEDURES (AGPs)", "High-risk procedures demanding maximal precautions", "🛡");
// AGP list
addBulletCard(s, 0.25, 1.82, 4.5, 1.7, "AEROSOL-GENERATING PROCEDURES (AGPs)", [
"Endotracheal intubation & extubation ★ Highest Risk",
"Cardiopulmonary resuscitation (CPR)",
"Non-invasive ventilation (NIV/CPAP/BiPAP)",
"High-flow nasal oxygen (HFNO)",
"Bronchoscopy, upper GI endoscopy",
"Tracheostomy creation/suctioning",
"Open airway suctioning"
], CLR.red);
// PPE levels
addBulletCard(s, 5.0, 1.82, 4.75, 1.7, "PPE SELECTION BY RISK LEVEL", [
"Standard: Gloves + surgical mask + apron",
"Droplet: Surgical mask + gown + gloves + eye protection",
"Airborne/AGP: N95/FFP2 respirator + full gown + double gloves + face shield + goggles",
"Biocontainment (Ebola/MERS): PAPR + full coverall + hood + impermeable boots",
"N95 must be fit-tested; seal check before each use"
], CLR.teal);
// Donning & doffing
const steps_don = [
"1. Perform hand hygiene (WHO 6-step technique)",
"2. Don isolation gown (ties at back)",
"3. Don N95 respirator — seal check",
"4. Don goggles / face shield",
"5. Don inner gloves → outer gloves (seal over gown cuff)",
"6. Enter patient area — minimum team members only"
];
const steps_doff = [
"1. Remove outer gloves (peel inside-out) → hand hygiene",
"2. Remove gown (roll away from body) → hand hygiene",
"3. Remove face shield (grab back straps) → hand hygiene",
"4. Remove respirator (lift from behind, DO NOT touch front) → hand hygiene",
"5. Remove inner gloves → final hand hygiene",
"★ DOFFING must be supervised by a dedicated doffing partner"
];
addBulletCard(s, 0.25, 3.6, 4.5, 1.85, "DONNING SEQUENCE (Put On)", steps_don, CLR.green);
addBulletCard(s, 5.0, 3.6, 4.75, 1.85, "DOFFING SEQUENCE (Remove) ★ Higher Risk", steps_doff, CLR.red);
}
// ═══════════════════════════════════════════════════════════
// SLIDE 10 — ENVIRONMENTAL & ADMINISTRATIVE CONTROLS
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "ENVIRONMENTAL CONTROLS & ADMINISTRATIVE MEASURES", "Engineering the environment to minimise airborne & contact spread", "🏥");
const cards = [
{
x:0.25, y:1.82, w:3.0, h:3.6, title:"OPERATING ROOM SETUP",
color: CLR.teal,
items:[
"Negative-pressure room (≥12 ACH preferred)",
"HEPA filter on anaesthesia circuit",
"Plastic sheeting / aerosol box for intubation",
"Minimize equipment; use disposables",
"Only essential personnel in OR",
"Shared surfaces disinfected every 30 min during case",
"Post-procedure: HEPA air scrubber run for ≥30 min before next patient"
]
},
{
x:3.42, y:1.82, w:3.0, h:3.6, title:"PATIENT FLOW PROTOCOLS",
color: CLR.navy,
items:[
"Dedicated COVID/infectious patient pathways",
"Separate entrance to OR; skip recovery bay",
"Pre-operative testing all emergency admissions",
"Cohort suspected/confirmed cases in dedicated zones",
"Transfer in surgical mask (if patient can tolerate)",
"Portable HEPA filter in transfer corridors",
"Dedicated COVID ICU post-operatively"
]
},
{
x:6.6, y:1.82, w:3.15, h:3.6, title:"DECONTAMINATION & WASTE",
color: CLR.green,
items:[
"Terminal clean with hospital-grade disinfectant (chlorine/H₂O₂ based)",
"All linens treated as infectious waste",
"Instrument decontamination — heat sterilization preferred",
"Sharps disposal in sealed puncture-proof containers",
"Biomedical waste (Category I/II) segregation per BMWM Rules 2016",
"OR closure time ≥1 hour after COVID+ case (for air exchange)",
"Surfaces: horizontal then vertical wipe technique"
]
}
];
cards.forEach(c => addBulletCard(s, c.x, c.y, c.w, c.h, c.title, c.items, c.color));
}
// ═══════════════════════════════════════════════════════════
// SLIDE 11 — MODULE 4: COMMUNICATION & ATTITUDE
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:1.6, fill:{ color:"#6B4C9A" } });
s.addShape(pres.ShapeType.rect, { x:0, y:1.6, w:10, h:0.07, fill:{ color: CLR.amber } });
s.addShape(pres.ShapeType.ellipse, { x:0.3, y:0.2, w:1.2, h:1.2, fill:{ color:"#4A2C6A" }, line:{ color:CLR.white, width:2 } });
s.addText("04", { x:0.3, y:0.28, w:1.2, h:1.0, fontSize:28, bold:true, color:CLR.white, align:"center", valign:"middle" });
s.addText("ATTITUDE & COMMUNICATION IN COMPLICATED PROCEDURES", {
x:1.7, y:0.1, w:8.0, h:0.85,
fontSize:19, bold:true, color:CLR.white, fontFace:"Calibri", valign:"middle"
});
s.addText("Professionalism, ethics, and human factors in high-stakes pandemic surgery", {
x:1.7, y:0.95, w:8.0, h:0.55,
fontSize:11, italic:true, color:"CCB8E8", fontFace:"Calibri"
});
// Four quadrant cards
const quads = [
{
x:0.25, y:1.82, w:4.6, h:1.75, title:"INFORMED CONSENT IN EMERGENCIES",
color:"#6B4C9A",
items:[
"Explain risk of procedure AND risk of non-intervention clearly",
"Use plain language — avoid medical jargon",
"If patient incapacitated: next-of-kin consent (surrogate decision-making)",
"In imminent life-threat with no NOK: implied/presumed consent applies",
"Document the consent process meticulously in notes",
"MCI (NMC) Code: Duty of care overrides in life-threatening situations"
]
},
{
x:5.1, y:1.82, w:4.65, h:1.75, title:"COMMUNICATION WITH FAMILY",
color: CLR.teal,
items:[
"Regular updates to family — designated communication lead",
"Use telemedicine/phone updates to avoid hospital crowding",
"Empathy first: acknowledge fear and uncertainty",
"Explain pandemic-specific restrictions (no visitor policy)",
"Provide written information where possible",
"Bereavement communication — compassionate disclosure of death"
]
},
{
x:0.25, y:3.65, w:4.6, h:1.8, title:"TEAM DYNAMICS & CREW RESOURCE MANAGEMENT",
color: CLR.navy,
items:[
"Closed-loop communication: repeat-back critical orders",
"Speak-up culture: any team member can call a safety stop",
"Pre-briefing: roles, contingencies, code word for distress",
"PPE impairs communication — use clear verbal signals",
"Leader remains calm; models composed, deliberate behaviour",
"Post-procedure debriefing: emotional & clinical review"
]
},
{
x:5.1, y:3.65, w:4.65, h:1.8, title:"PROFESSIONAL ATTITUDES & ETHICS",
color: CLR.red,
items:[
"Duty to treat during pandemics — NMC Code of Professional Conduct",
"Non-abandonment principle: cannot refuse care due to personal fear",
"Balance personal safety (adequate PPE) with professional duty",
"Resource allocation: triage ethics (utilitarian vs. equity principles)",
"Moral distress: acknowledge and seek institutional support",
"Honesty about prognosis — 'truth-telling' even in difficult situations"
]
}
];
quads.forEach(q => addBulletCard(s, q.x, q.y, q.w, q.h, q.title, q.items, q.color));
}
// ═══════════════════════════════════════════════════════════
// SLIDE 12 — COMMUNICATION: DIFFICULT CONVERSATIONS
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "DIFFICULT CONVERSATIONS — SPIKES & GRIEV ING PROTOCOLS", "Structured communication frameworks for breaking bad news", "💬");
// SPIKES protocol
s.addShape(pres.ShapeType.roundRect, {
x:0.25, y:1.82, w:4.6, h:3.6, rectRadius:0.08,
fill:{ color: CLR.lightBg }, line:{ color:"#6B4C9A", width:2 }
});
s.addShape(pres.ShapeType.rect, { x:0.25, y:1.82, w:4.6, h:0.4, fill:{ color:"#6B4C9A" } });
s.addText("SPIKES PROTOCOL — Breaking Bad News", {
x:0.37, y:1.85, w:4.36, h:0.34,
fontSize:11, bold:true, color:CLR.white, fontFace:"Calibri", valign:"middle"
});
const spikes = [
{ l:"S", t:"Setting", d:"Private, seated, uninterrupted — even if via phone/video in pandemic" },
{ l:"P", t:"Perception", d:"Ask what patient/family already knows: 'What have you been told?'" },
{ l:"I", t:"Invitation", d:"'Would it be ok if I share the findings with you?'" },
{ l:"K", t:"Knowledge", d:"Warning shot → deliver news clearly, no euphemisms" },
{ l:"E", t:"Emotions", d:"Acknowledge and respond to emotional reaction (NURSE: Name, Understand, Respect, Support, Explore)" },
{ l:"S", t:"Strategy", d:"Discuss next steps; ensure follow-up plan communicated" },
];
spikes.forEach((sp, i) => {
const y = 2.3 + i * 0.52;
s.addShape(pres.ShapeType.ellipse, { x:0.38, y:y+0.04, w:0.38, h:0.38, fill:{ color:"#6B4C9A" } });
s.addText(sp.l, { x:0.38, y:y+0.04, w:0.38, h:0.38, fontSize:13, bold:true, color:CLR.white, align:"center", valign:"middle" });
s.addText(`${sp.t}: `, { x:0.85, y:y+0.06, w:1.0, h:0.3, fontSize:9.5, bold:true, color:CLR.navy, fontFace:"Calibri" });
s.addText(sp.d, { x:1.7, y:y+0.06, w:2.95, h:0.38, fontSize:9, color:CLR.darkText, fontFace:"Calibri" });
});
// Pandemic-specific challenges
addBulletCard(s, 5.1, 1.82, 4.65, 3.6, "PANDEMIC-SPECIFIC COMMUNICATION CHALLENGES", [
"No physical presence of family at bedside — digital grief",
"Time pressure: rapid deterioration leaves little time for discussion",
"Uncertainty about prognosis in novel pathogens (COVID, Ebola)",
"Language barriers amplified when PPE muffles speech",
"HCW emotional exhaustion affects communication quality",
"Resource scarcity discussions — cannot promise best-case care",
"Cultural & religious considerations for dying patients",
"Consent for innovative/experimental treatments (EUA drugs)",
"Second opinion delayed due to pandemic restrictions"
], "#6B4C9A");
}
// ═══════════════════════════════════════════════════════════
// SLIDE 13 — SPECIAL TOPICS: COVID-19 INTUBATION PROTOCOL
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "SPECIAL FOCUS: COVID-19 INTUBATION PROTOCOL", "The highest-risk AGP — step-by-step approach for MBBS students", "🫁");
const intubSteps = [
{ n:"1", t:"Pre-oxygenation", d:"High-flow O₂ via tight-fitting mask 3–5 min; avoid NIV/HFNO if possible" },
{ n:"2", t:"Team Briefing", d:"Assign: Airway Doctor, Assistant, Runner, Recorder; minimize to 3–4 people in room" },
{ n:"3", t:"Full PPE Donning", d:"N95 + face shield + gown + double gloves; seal check before entry" },
{ n:"4", t:"Rapid Sequence Induction (RSI)", d:"Propofol + succinylcholine/rocuronium; avoid bag-mask ventilation (reduces aerosolization)" },
{ n:"5", t:"Video Laryngoscope", d:"First-line preferred over direct laryngoscopy; keep operator distance" },
{ n:"6", t:"Confirm & Secure ETT", d:"EtCO₂ waveform + CXR; clamp ETT before circuit disconnection" },
{ n:"7", t:"Post-intubation", d:"Close-circuit suctioning only; HME filter on circuit; sedate adequately" },
{ n:"8", t:"Decontaminate OR", d:"All personnel: doffing under supervision; terminal clean of room" },
];
intubSteps.forEach((step, i) => {
const col = i < 4 ? 0 : 1;
const row = i < 4 ? i : i - 4;
const x = 0.25 + col * 4.88;
const y = 1.82 + row * 0.9;
s.addShape(pres.ShapeType.roundRect, {
x, y, w:4.6, h:0.82, rectRadius:0.06,
fill:{ color: CLR.lightBg }, line:{ color: CLR.teal, width:1.5 }
});
s.addShape(pres.ShapeType.ellipse, { x:x+0.08, y:y+0.17, w:0.48, h:0.48, fill:{ color: CLR.teal } });
s.addText(step.n, { x:x+0.08, y:y+0.17, w:0.48, h:0.48, fontSize:13, bold:true, color:CLR.white, align:"center", valign:"middle" });
s.addText(step.t, { x:x+0.65, y:y+0.07, w:3.8, h:0.3, fontSize:11, bold:true, color:CLR.teal, fontFace:"Calibri" });
s.addText(step.d, { x:x+0.65, y:y+0.38, w:3.8, h:0.38, fontSize:9.5, color:CLR.darkText, fontFace:"Calibri" });
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 14 — CASE-BASED LEARNING
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.white } });
addTitleBand(s, "CASE-BASED LEARNING — VIGNETTE FOR DISCUSSION", "Apply the four modules to a real-world pandemic scenario", "📋");
// case box
s.addShape(pres.ShapeType.roundRect, {
x:0.25, y:1.82, w:9.5, h:1.5, rectRadius:0.08,
fill:{ color:"FFF8DC" }, line:{ color: CLR.amber, width:2 }
});
s.addText("CLINICAL VIGNETTE", { x:0.45, y:1.88, w:9.1, h:0.35, fontSize:12, bold:true, color:"7B4F00", fontFace:"Calibri" });
s.addText(
"A 45-year-old male, known COVID-19 positive (Day 5 of symptoms), presents with acute abdomen — guarding, rigidity, and haemodynamic instability (BP 80/50, HR 120). SpO₂ 88% on room air. " +
"Attending surgeon suspects intestinal perforation with peritonitis. The patient is distressed, his family is waiting outside, unable to enter due to pandemic visitor restrictions.",
{
x:0.45, y:2.22, w:9.1, h:1.0,
fontSize:11, color:CLR.darkText, fontFace:"Calibri"
}
);
const qs = [
{ q:"Q1: INDICATION", a:"Absolute — peritonitis with septic shock + haemodynamic instability. Delay = death. Proceed to emergency laparotomy.", c: CLR.red },
{ q:"Q2: PRE-PROCEDURE CHECKS", a:"COVID+ status documented; negative-pressure OR; full AGP PPE; RSI planned; emergency consent from patient if conscious; NOK notified by phone.", c: CLR.teal },
{ q:"Q3: INFECTION CONTROL", a:"Minimum team (3–4); N95+PAPR if available; video laryngoscope for intubation; HEPA filter on anaesthesia circuit; terminal clean post-procedure.", c: CLR.green },
{ q:"Q4: COMMUNICATION", a:"Surgeon speaks to family via phone before incision (SPIKES); explains gravity; gets verbal consent. Post-op: regular phone updates. Empathy and clear language.", c:"#6B4C9A" },
];
qs.forEach((q, i) => {
const col = i % 2;
const row = Math.floor(i / 2);
const x = 0.25 + col * 4.88;
const y = 3.42 + row * 1.0;
s.addShape(pres.ShapeType.roundRect, {
x, y, w:4.6, h:0.9, rectRadius:0.06,
fill:{ color: CLR.lightBg }, line:{ color: q.c, width:2 }
});
s.addShape(pres.ShapeType.rect, { x, y, w:1.2, h:0.9, fill:{ color: q.c } });
s.addText(q.q, { x:x+0.05, y:y+0.05, w:1.1, h:0.8, fontSize:8.5, bold:true, color:CLR.white, align:"center", valign:"middle", fontFace:"Calibri" });
s.addText(q.a, { x:x+1.3, y:y+0.08, w:3.2, h:0.74, fontSize:9, color:CLR.darkText, fontFace:"Calibri", valign:"top" });
});
}
// ═══════════════════════════════════════════════════════════
// SLIDE 15 — SUMMARY & KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: CLR.navy } });
// geometric accents
s.addShape(pres.ShapeType.rect, { x:0, y:4.8, w:10, h:0.825, fill:{ color: CLR.teal } });
s.addShape(pres.ShapeType.rect, { x:0, y:4.78, w:10, h:0.07, fill:{ color: CLR.amber } });
s.addShape(pres.ShapeType.rect, { x:7.0, y:0, w:3.0, h:5.625, fill:{ color: CLR.teal, transparency:85 } });
s.addText("KEY TAKEAWAYS", {
x:0.4, y:0.15, w:6.5, h:0.55,
fontSize:22, bold:true, color:CLR.amber, fontFace:"Calibri", charSpacing:3
});
s.addText("Emergency Procedures During Pandemics — MBBS NMC", {
x:0.4, y:0.65, w:6.5, h:0.4,
fontSize:13, italic:true, color:CLR.tealMid, fontFace:"Calibri"
});
const takeaways = [
{ icon:"01", text:"Life-threatening emergencies ALWAYS take priority — proceed with optimal PPE and infection control measures." },
{ icon:"02", text:"Pre-procedure verification is systematic: COVID status, team PPE, equipment check, consent, and OR setup BEFORE every emergency." },
{ icon:"03", text:"Hierarchy of controls: Engineering > Administrative > PPE. PPE alone is the LAST resort — not the first line." },
{ icon:"04", text:"AGPs (intubation, bronchoscopy, CPR) require maximal airborne precautions: N95, face shield, gown, double gloves, negative-pressure room." },
{ icon:"05", text:"Communication is a clinical skill: Use SPIKES for bad news. Use closed-loop communication in OR. Duty to treat cannot be abandoned." },
{ icon:"06", text:"NMC/MCI Code: Pandemic does not diminish professional duty; adequate PPE is the institution's responsibility to provide." },
];
takeaways.forEach((t, i) => {
const y = 1.15 + i * 0.71;
s.addShape(pres.ShapeType.ellipse, { x:0.3, y:y+0.04, w:0.42, h:0.42, fill:{ color: CLR.amber } });
s.addText(t.icon, { x:0.3, y:y+0.04, w:0.42, h:0.42, fontSize:11, bold:true, color:CLR.navy, align:"center", valign:"middle" });
s.addText(t.text, {
x:0.85, y:y, w:8.8, h:0.62,
fontSize:11, color:CLR.white, fontFace:"Calibri", valign:"middle"
});
});
s.addText("Sources: Miller's Anesthesia 10e | Morgan & Mikhail's Clinical Anesthesiology 7e | Barash Clinical Anesthesia 9e | WHO IPC Guidelines | NMC Competency Framework", {
x:0.3, y:4.87, w:9.4, h:0.35,
fontSize:7.5, italic:true, color:"AADFE5", fontFace:"Calibri", align:"center"
});
}
// ─── WRITE FILE ─────────────────────────────────────────────
const outPath = "/home/daytona/workspace/pandemic-emergency-ppt/Emergency_Procedures_Pandemics_NMC_MBBS.pptx";
pres.writeFile({ fileName: outPath })
.then(() => console.log("SUCCESS: " + outPath))
.catch(e => { console.error("ERROR:", e); process.exit(1); });
Running Command
cd /home/daytona/workspace/pandemic-emergency-ppt && node build.js 2>&1
Running Command
ls -lh /home/daytona/workspace/pandemic-emergency-ppt/Emergency_Procedures_Pande…
Your presentation is ready!
Emergency Procedures Pandemics NMC MBBS
Presentation · PPTX
What's inside — 15 slides
| Slide | Content |
|---|---|
| 1 | Title slide — bold Navy/Teal/Amber palette, NMC branding |
| 2 | Table of Contents — all 4 modules overview |
| 3 | Pandemic Context — history from Spanish Flu → COVID-19; impact on emergency surgery |
| 4 | Module 1 — Absolute Indications — airway emergencies, cardiac tamponade, hemorrhagic shock, ICP, perforation |
| 5 | Module 1 cont. — Relative Indications + Triage Decision Rule — WHO/NMC framework with defer vs. proceed logic |
| 6 | Module 2 — Pre-procedure Verification — 3-column checklist: Patient Assessment / Equipment & Team / Documentation & Consent |
| 7 | 5-Step Sign-in Protocol — WHO Surgical Safety Checklist adapted for pandemic (Sign-In → Time-Out → Sign-Out) |
| 8 | Module 3 — Hierarchy of Controls — visual pyramid: Elimination → Substitution → Engineering → Administrative → PPE |
| 9 | PPE & AGP Protocols — list of AGPs, PPE levels, donning & doffing sequences |
| 10 | Environmental Controls — negative-pressure OR, patient flow, decontamination & BMWM Rules |
| 11 | Module 4 — Communication & Attitude — consent, family communication, CRM/team dynamics, professional ethics |
| 12 | SPIKES Protocol — breaking bad news + pandemic-specific communication challenges |
| 13 | Special Focus: COVID-19 Intubation Protocol — 8-step clinical protocol including RSI, video laryngoscope, HME filter |
| 14 | Case-Based Learning Vignette — COVID+ peritonitis patient integrating all 4 modules |
| 15 | Key Takeaways — 6 concise NMC-aligned learning points with sources |
Sources referenced: Miller's Anesthesia 10e, Morgan & Mikhail's Clinical Anesthesiology 7e, Barash Clinical Anesthesia 9e, WHO IPC Guidelines, and NMC Competency Framework.
Ppt?
The file was already generated in our previous session. Here is your download link:
Emergency Procedures Pandemics NMC MBBS
Presentation · PPTX
Click the link above to download the 15-slide presentation. If the file isn't downloading, let me know and I'll regenerate it immediately.
Can you make it longer and elaborate on airway management and emergency prorcedures by anesthesist as it is going to be presented in an anaesthesia class
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Reading File
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Ppt?
Running Command
ls /home/daytona/workspace/pandemic-emergency-ppt/
Writing File
~/pandemic-emergency-ppt/build2.js
const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "NMC MBBS Anaesthesia Department";
pres.title = "Emergency Procedures During Pandemics – Anaesthesia Focus";
// ── PALETTE ─────────────────────────────────────────────────
const C = {
navy: "0D1B3E",
teal: "0A7E8C",
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amber: "F5A623",
white: "FFFFFF",
red: "B03030",
redLt: "FFF0F0",
green: "1A6B3C",
greenLt: "EAF7EF",
purple: "5C3D8F",
purpleLt:"F3EEFF",
slate: "4A5568",
dark: "1A1A2E",
bg: "F4F8FB",
amber2: "7B4F00",
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// ── HELPERS ──────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════
// S1 — TITLE
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.navy);
rect(s,0,4.52,10,1.1,C.teal);
rect(s,0,4.5,10,0.07,C.amber);
rect(s,7.2,0,2.8,5.625,C.tealMid,80);
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txt(s,"⚕",7.5,0.45,2.0,1.8,{fontSize:58,align:"center",valign:"middle",color:C.white});
txt(s,"EMERGENCY PROCEDURES",0.4,0.55,6.8,0.85,{fontSize:26,bold:true,color:C.white,fontFace:"Calibri",charSpacing:2});
txt(s,"DURING PANDEMICS",0.4,1.35,6.8,0.82,{fontSize:38,bold:true,color:C.amber,fontFace:"Calibri"});
txt(s,"With Special Emphasis on Airway Management\n& Anaesthetic Emergency Procedures",0.4,2.15,6.8,0.75,{fontSize:14,italic:true,color:C.tealMid,fontFace:"Calibri"});
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txt(s,[
{text:"National Medical Commission (NMC) — India ",options:{bold:true,breakLine:true}},
{text:"MBBS Curriculum | Department of Anaesthesiology",options:{italic:true}}
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txt(s,"Modules: Indications • Pre-procedure Verification • Infection Control • Airway Management • Communication",0.25,4.62,9.5,0.38,{fontSize:10.5,color:C.white,align:"center",fontFace:"Calibri"});
}
// ═══════════════════════════════════════════════════════════
// S2 — TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
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rect(s,0,0,0.18,5.625,C.navy);
txt(s,"COURSE OUTLINE",0.4,0.18,9,0.5,{fontSize:22,bold:true,color:C.navy,fontFace:"Calibri",charSpacing:3});
txt(s,"Emergency Procedures During Pandemics — Anaesthesia Perspective",0.4,0.65,9,0.38,{fontSize:13,italic:true,color:C.teal,fontFace:"Calibri"});
rect(s,0.4,1.08,9.2,0.05,C.amber);
const topics=[
{num:"01",title:"INDICATIONS FOR EMERGENCY PROCEDURES",sub:"Life-threatening emergencies, triage framework",color:C.red},
{num:"02",title:"PRE-PROCEDURE VERIFICATION CHECKLIST",sub:"Systematic checks before any pandemic-setting procedure",color:C.teal},
{num:"03",title:"INFECTION TRANSMISSION CONTROL",sub:"Hierarchy of controls, PPE, environmental measures",color:C.green},
{num:"04",title:"AIRWAY MANAGEMENT — DETAILED",sub:"RSI, difficult airway algorithm, CICO, devices, COVID protocols",color:C.navy},
{num:"05",title:"ANAESTHETIC EMERGENCY PROCEDURES",sub:"Regional vs GA, ventilation, extubation, post-op ICU care",color:C.tealMid},
{num:"06",title:"COMMUNICATION & PROFESSIONAL ATTITUDES",sub:"Consent, team dynamics, ethics, crew resource management",color:C.purple},
];
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const y=1.25+i*0.71;
roundRect(s,0.4,y,9.2,0.62,C.white,t.color,2);
rect(s,0.4,y,0.7,0.62,t.color);
txt(s,t.num,0.4,y+0.03,0.7,0.56,{fontSize:16,bold:true,color:C.white,align:"center",valign:"middle"});
txt(s,t.title,1.2,y+0.07,8.2,0.3,{fontSize:12,bold:true,color:C.navy,fontFace:"Calibri"});
txt(s,t.sub,1.2,y+0.36,8.2,0.22,{fontSize:9.5,italic:true,color:C.slate,fontFace:"Calibri"});
});
}
// ═══════════════════════════════════════════════════════════
// S3 — PANDEMIC CONTEXT
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🌐","PANDEMIC CONTEXT — WHY SPECIAL PROTOCOLS?","Pandemics redefine every aspect of surgical and anaesthetic practice");
twoCol(s,[
"1918 Spanish Flu — 50–100 million deaths; overwhelmed hospitals globally",
"2003 SARS-CoV — 15% mortality; >50% in elderly; 3 anaesthesiologists died in Toronto",
"2014 West Africa Ebola — extreme HCW mortality; required biocontainment units",
"2009 H1N1 Influenza — global spread within weeks of index case",
"2012 MERS-CoV — 34% case fatality rate; Middle East & Korea outbreaks",
"2020–23 COVID-19 — 758M+ cases, 6.8M deaths; redefined every surgical protocol"
],"KEY PANDEMICS (Modern History)",[
"Routine & elective surgery suspended during surge phases",
"ICUs overwhelmed → tiered staffing & crisis standards of care",
"Aerosol-generating procedures (AGPs) = highest HCW risk",
"PPE shortages forced real-time protocol innovation",
"Anaesthesiologists at frontline: airway = AGP #1",
"NMC mandates pandemic preparedness as core MBBS competency (2022 curriculum)",
"Anesthesia machines repurposed as ICU ventilators during COVID"
],"IMPACT ON ANAESTHESIA & SURGERY",C.navy,C.red);
}
// ═══════════════════════════════════════════════════════════
// S4 — MODULE 1: ABSOLUTE INDICATIONS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
moduleHeader(s,"01","INDICATIONS FOR EMERGENCY PROCEDURES — ABSOLUTE","Life-threatening emergencies override ALL pandemic precautions",C.red,"#8B0000");
txt(s,"ABSOLUTE INDICATIONS — Proceed immediately, with full PPE:",0.3,1.82,9.4,0.35,{fontSize:12.5,bold:true,color:C.red,fontFace:"Calibri"});
const abs=[
{t:"Airway Emergency",d:"Tension pneumothorax, complete airway obstruction, stridor, epiglottitis, anaphylaxis with laryngeal oedema"},
{t:"Cardiac Arrest / Tamponade",d:"Emergency pericardiocentesis, thoracotomy, open cardiac massage, defibrillation"},
{t:"Uncontrolled Haemorrhage",d:"Damage-control surgery for haemorrhagic shock class III/IV, ruptured aortic aneurysm, post-partum haemorrhage"},
{t:"Intracranial Emergency",d:"Burr hole for transtentorial herniation, cerebral abscess draining with coning, acute extradural haematoma"},
{t:"Acute Abdomen / Perforation",d:"Peritonitis with septic shock, strangulated obstruction, Hartmann's procedure"},
{t:"Obstetric Emergency",d:"Category-1 LSCS (cord prolapse, abruption, fetal bradycardia), eclampsia with impending HELLP"},
];
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}
// ═══════════════════════════════════════════════════════════
// S5 — RELATIVE INDICATIONS + TRIAGE
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"⚖","RELATIVE INDICATIONS & TRIAGE FRAMEWORK","Balancing urgency vs. pandemic transmission risk",C.red);
twoCol(s,[
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"Surgical abscess / empyema requiring drainage",
"Acute limb ischaemia — threatened limb",
"Fractures with neurovascular compromise",
"Acute urinary retention with renal impairment",
"Testicular / ovarian torsion",
"Penetrating eye injury with globe integrity risk",
"Burns >30% TBSA requiring early debridement"
],"RELATIVE — Assess Risk-Benefit First",[
"Elective cosmetic / aesthetic procedures",
"Routine laparoscopic cholecystectomy",
"Non-urgent screening endoscopy",
"Stable malignancy (< 4 weeks acceptable)",
"Dental extractions (no systemic sepsis)",
"Elective joint replacement, hernia repair",
"Outpatient minor procedures"
],"DEFER — Non-Emergency (Postpone)",C.amber,C.slate);
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txt(s,
"Q1: Will delay >6 hours cause death or permanent disability? YES → Proceed with full PPE\n"+
"Q2: Can equivalent outcome be achieved non-invasively? YES → Prefer non-invasive route first\n"+
"Q3: Is patient COVID-positive/suspected? YES → Maximize precautions, negative-pressure OR mandatory",
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}
// ═══════════════════════════════════════════════════════════
// S6 — MODULE 2: PRE-PROCEDURE CHECKLIST
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
moduleHeader(s,"02","PRE-PROCEDURE VERIFICATION CHECKLIST","Systematic checks before every emergency procedure in pandemic settings",C.teal,"#065f69");
const cols=[
{t:"PATIENT ASSESSMENT",c:C.teal,b:[
"COVID-19 / infectious status (PCR / RDT result)",
"Airway assessment: Mallampati, mouth opening, neck mobility, thyromental distance",
"Vital signs: BP, HR, SpO₂, RR, Temperature, GCS",
"Known allergies and current medications (anticoagulants!)",
"Comorbidities: immunosuppression, DM, CKD, lung disease",
"Pregnancy status (reproductive-age females)",
"Blood group, cross-match, coagulation profile",
"Nil-by-mouth (NPO) status — impacts RSI decision"
]},
{t:"EQUIPMENT & TEAM READINESS",c:C.navy,b:[
"Negative-pressure OR / isolation room confirmed",
"Video laryngoscope (VL) ready — first choice in COVID+",
"Difficult airway cart at bedside: VL, FONA kit, LMA sizes",
"Full PPE donned by entire team before patient entry",
"Emergency drugs drawn: adrenaline, atropine, sux, roc",
"Defibrillator checked and pads attached",
"HME filter on anaesthetic circuit; suction working",
"Only essential personnel in OR (≤4 for airway procedures)"
]},
{t:"DOCUMENTATION & CONSENT",c:C.purple,b:[
"Emergency informed consent obtained (patient/guardian)",
"Risk of procedure vs. risk of delay documented in notes",
"COVID status noted in surgical and anaesthetic record",
"Pre-operative anaesthetic assessment completed",
"Blood products ordered; cell saver available if needed",
"ICU/HDU bed confirmed if post-op intensive care needed",
"Next-of-kin notified; contact details documented",
"Team briefing completed (roles, contingencies)"
]},
];
cols.forEach((col,i)=>{
const x=0.22+i*3.25;
card(s,x,1.82,3.1,3.62,col.t,col.b,col.c);
});
}
// ═══════════════════════════════════════════════════════════
// S7 — WHO SIGN-IN / TIME-OUT / SIGN-OUT
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"✅","WHO SURGICAL SAFETY CHECKLIST — ADAPTED FOR PANDEMICS","Sign-In → Time-Out → Sign-Out with COVID-specific additions",C.teal);
const steps=[
{step:"SIGN IN\n(Before Induction)",points:[
"Patient identity: name, DOB, ID band confirmed",
"Procedure & site marked and agreed by surgeon",
"COVID/infectious status communicated to ALL team",
"Anaesthesia machine & drugs checked",
"Pulse oximeter attached & functional",
"Known allergy verified",
"PPE of all entering staff confirmed"
],color:C.red},
{step:"TIME OUT\n(Before Skin Incision)",points:[
"All team members: name & role stated aloud",
"Surgeon confirms procedure, site, patient",
"Antibiotic prophylaxis given within 60 minutes",
"Critical events anticipated: major blood loss? difficult airway?",
"Imaging displayed if applicable",
"PPE integrity re-confirmed for all team",
"Negative-pressure room verified"
],color:C.teal},
{step:"SIGN OUT\n(Before Patient Leaves OR)",points:[
"Procedure name recorded in notes",
"Specimen labelled and dispatched",
"Instrument / sponge / needle count complete",
"Equipment problems to be addressed post-op",
"Post-op recovery location: ICU / HDU / ward",
"OR decontamination protocol initiated",
"Doffing supervised: dedicated doffing partner"
],color:C.navy},
];
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const x=0.22+i*3.25;
roundRect(s,x,1.82,3.1,3.62,C.bg,st.color,2);
rect(s,x,1.82,3.1,0.62,st.color);
txt(s,st.step,x+0.1,1.84,2.9,0.58,{fontSize:10.5,bold:true,color:C.white,align:"center",valign:"middle",fontFace:"Calibri"});
const bItems=st.points.map((p,j)=>({text:p,options:{bullet:{type:"bullet",code:"2022"},breakLine:j<st.points.length-1}}));
s.addText(bItems,{x:x+0.12,y:2.5,w:2.88,h:2.88,fontSize:9.5,color:C.dark,fontFace:"Calibri",valign:"top"});
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rect(s,0,5.3,10,0.32,"FFF8E1");
txt(s,"⚠ Pandemic addition: document COVID result, PPE status, room pressure, and decontamination plan at each checkpoint",0.3,5.33,9.4,0.25,{fontSize:9,bold:true,color:C.amber2,fontFace:"Calibri"});
}
// ═══════════════════════════════════════════════════════════
// S8 — MODULE 3: HIERARCHY OF CONTROLS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
moduleHeader(s,"03","STEPS TO REDUCE INFECTION TRANSMISSION","Hierarchy of Controls — most to least effective",C.green,"#0D5C2E");
const levels=[
{l:"ELIMINATION",sub:"Defer all non-urgent invasive procedures; tele-consultations replace in-person visits",color:"C0392B",w:9.2},
{l:"SUBSTITUTION",sub:"Replace AGPs with non-invasive equivalents where outcome is not compromised",color:"D35400",w:7.8},
{l:"ENGINEERING CONTROLS",sub:"Negative-pressure ORs (≥12 ACH); HEPA filtration; aerosol-reduction boxes; UV-C sterilisers",color:"D4AC0D",w:6.4},
{l:"ADMINISTRATIVE CONTROLS",sub:"COVID screening all admissions; dedicated surgical pathways; minimum staff in OR; training & simulation",color:"1E8449",w:5.0},
{l:"PPE (Last Resort)",sub:"N95/FFP2 + face shield + gown + double gloves — mandatory for all AGPs",color:"1A5276",w:3.6},
];
levels.forEach((lv,i)=>{
const x=(9.7-lv.w)/2+0.15;
const y=1.88+i*0.7;
rect(s,x,y,lv.w,0.6,lv.color);
txt(s,`${lv.l} ✦ ${lv.sub}`,x+0.15,y+0.08,lv.w-0.3,0.44,{fontSize:9.5,bold:i<2,color:C.white,fontFace:"Calibri",align:"center",valign:"middle"});
});
txt(s,"▲ MOST EFFECTIVE LEAST EFFECTIVE ▼",0.3,5.34,9.4,0.26,{fontSize:8.5,italic:true,color:C.slate,align:"center",fontFace:"Calibri"});
}
// ═══════════════════════════════════════════════════════════
// S9 — PPE PROTOCOLS & AGPs
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🛡","PPE PROTOCOLS & AEROSOL-GENERATING PROCEDURES","High-risk procedures demand maximal airborne precautions",C.green);
card(s,0.22,1.82,4.65,1.75,"AEROSOL-GENERATING PROCEDURES (AGPs)",[
"Endotracheal intubation & extubation ★ HIGHEST RISK",
"Cardiopulmonary resuscitation (CPR)",
"Non-invasive ventilation — NIV, BiPAP, CPAP",
"High-flow nasal oxygen (HFNO >6 L/min)",
"Bronchoscopy; upper GI endoscopy",
"Tracheostomy insertion / suctioning / care",
"Open airway suctioning; bag-mask ventilation"
],C.red);
card(s,5.13,1.82,4.65,1.75,"PPE SELECTION BY RISK LEVEL",[
"Standard: gloves + surgical mask + apron",
"Droplet: surgical mask + gown + gloves + eye protection",
"Airborne/AGP: N95/FFP2 + gown + double gloves + face shield + goggles",
"Biocontainment (Ebola/MERS): PAPR + full coverall + hood + impermeable boots",
"N95 must be fit-tested; seal-check before EVERY use",
"PAPR preferred when multiple intubation attempts anticipated"
],C.teal);
card(s,0.22,3.65,4.65,1.82,"DONNING SEQUENCE (Put On)",[
"1. Hand hygiene — WHO 6-step technique",
"2. Isolation gown (ties secured at back)",
"3. N95 respirator — upper then lower strap, seal-check",
"4. Goggles then face shield (both for intubation)",
"5. Inner gloves → outer gloves sealed over gown cuffs",
"6. Enter patient area with minimum team (3–4 persons)"
],C.green);
card(s,5.13,3.65,4.65,1.82,"DOFFING SEQUENCE ★ HIGHEST RISK MOMENT",[
"1. Remove outer gloves (peel inside-out) → hand hygiene",
"2. Remove gown (roll away from body) → hand hygiene",
"3. Remove face shield (grab rear straps) → hand hygiene",
"4. Remove respirator (lift straps from behind, never touch front) → hand hygiene",
"5. Remove inner gloves → final hand hygiene",
"★ Entire doffing MUST be supervised by a dedicated doffing partner"
],C.red);
}
// ═══════════════════════════════════════════════════════════
// S10 — MODULE 4 INTRO: AIRWAY IN PANDEMICS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
moduleHeader(s,"04","AIRWAY MANAGEMENT IN PANDEMICS — OVERVIEW","The single greatest AGP risk; the core skill of every anaesthesiologist",C.navy,"#0D2B6E");
const principles=[
{icon:"①",t:"Treat ALL Patients as Infectious",d:"During an outbreak, assume COVID/unknown pathogen until proven otherwise. Full AGP PPE for every intubation."},
{icon:"②",t:"Video Laryngoscope = First Line",d:"Keeps operator farther from airway. Greater first-pass success. Reduces aerosolization time. Preferred over DL in pandemic."},
{icon:"③",t:"Rapid Sequence Induction (RSI)",d:"Minimise bag-mask ventilation → minimise aerosolization. Short apnoeic window; optimise preoxygenation before RSI."},
{icon:"④",t:"Minimum Team, Maximum Preparation",d:"Only 3–4 essential staff in OR. Most experienced airway provider performs intubation. Pre-brief every step before entering."},
{icon:"⑤",t:"CICO Plan Always Ready",d:"Cannot-Intubate-Cannot-Oxygenate (CICO) kit at bedside. FONA (front-of-neck access) must be planned before induction."},
{icon:"⑥",t:"Extubation = Equal AGP Risk",d:"Plan extubation as carefully as intubation. Full PPE, cough suppression strategies, anti-emetics pre-extubation."},
];
principles.forEach((p,i)=>{
const col=i<3?0:1;
const row=i<3?i:i-3;
const x=0.22+col*4.88;
const y=1.82+row*1.2;
roundRect(s,x,y,4.65,1.1,C.bg,C.navy,1.5);
ellipse(s,x+0.1,y+0.33,0.44,0.44,C.navy);
txt(s,p.icon,x+0.1,y+0.33,0.44,0.44,{fontSize:13,bold:true,color:C.white,align:"center",valign:"middle"});
txt(s,p.t,x+0.65,y+0.1,3.88,0.32,{fontSize:11,bold:true,color:C.navy,fontFace:"Calibri"});
txt(s,p.d,x+0.65,y+0.44,3.88,0.58,{fontSize:9.5,color:C.dark,fontFace:"Calibri"});
});
}
// ═══════════════════════════════════════════════════════════
// S11 — AIRWAY ASSESSMENT IN PANDEMIC SETTING
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🔍","AIRWAY ASSESSMENT — MNEMONICS FOR ANAESTHESIOLOGISTS","Predict difficulty BEFORE induction — your most important step",C.navy);
card(s,0.22,1.82,3.0,3.62,"LEMON Assessment",[
"L — Look externally: obesity, beard, small mouth, receding chin",
"E — Evaluate 3-3-2 rule: 3 fingers mouth opening, 3 fingers thyromental distance, 2 fingers thyroid-to-floor of mouth",
"M — Mallampati score (Class III/IV = difficult)",
"O — Obstruction: abscess, tumour, haematoma, foreign body",
"N — Neck mobility: C-spine rigidity, ankylosing spondylitis, halo traction"
],C.navy);
card(s,3.38,1.82,3.0,3.62,"Mallampati Classification",[
"Class I: Soft palate, uvula, faucial pillars visible → Easy",
"Class II: Soft palate, uvula visible → Likely easy",
"Class III: Soft palate, base of uvula visible → Potentially difficult",
"Class IV: Only hard palate visible → Anticipated difficult",
"★ In COVID+: Do NOT ask patient to open mouth without mask in place",
"Use phone camera or video consultation for remote assessment"
],C.teal);
card(s,6.54,1.82,3.24,3.62,"Predictors of Difficult Mask Ventilation (MOANS)",[
"M — Mask seal poor (beard, facial trauma, edentulous)",
"O — Obese / Obstetric (BMI >30, pregnancy >20 weeks)",
"A — Age >55 years",
"N — No teeth (edentulous)",
"S — Stiff lungs (asthma, COPD, COVID pneumonitis)",
"★ If MOANS present: have LMA rescue immediately available",
"★ COVID pneumonitis = stiff lungs; expect high airway pressures"
],C.red);
}
// ═══════════════════════════════════════════════════════════
// S12 — RSI DRUGS & TECHNIQUE
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"💉","RAPID SEQUENCE INDUCTION (RSI) — DRUGS & TECHNIQUE","The standard induction for emergency surgery in pandemic settings",C.navy);
// 6Ps table
roundRect(s,0.22,1.82,9.56,2.1,C.bg,C.navy,1.5);
rect(s,0.22,1.82,9.56,0.38,C.navy);
txt(s,'THE "6 Ps" OF RSI (Current Surgical Therapy / Miller\'s Anesthesia)',0.4,1.85,9.2,0.32,{fontSize:11,bold:true,color:C.white,fontFace:"Calibri"});
const ps=[
["Preoxygenation","0–3 min","100% O₂ tight-fitting mask; HFNC nasal cannula 10–15 L/min for apnoeic oxygenation backup"],
["Premedication","3 min","Fentanyl 1–3 mcg/kg (blunt pressor response); Lidocaine 1.5 mg/kg (↓ ICP/bronchospasm); Atropine in children"],
["Paralysis (+ Induction)","3.5–5.5 min","Induction agent first, THEN paralytic — see drug table below"],
["Placement","6–6.5 min","Intubate — no BVM ventilation; cricoid pressure (Sellick, 30N after LOC)"],
["Performance check","7–7.5 min","EtCO₂ waveform confirmation + bilateral auscultation; CXR if time allows"],
["Post-intubation Mgmt","7.5+ min","Sedation + analgesia; close-circuit suction only; vent settings; HME filter on circuit"],
];
ps.forEach((row,i)=>{
const y=2.26+i*0.27;
const bg=i%2===0?C.white:"EAF6F8";
rect(s,0.22,y,9.56,0.27,bg);
txt(s,row[0],0.35,y+0.04,1.8,0.22,{fontSize:9.5,bold:true,color:C.navy,fontFace:"Calibri"});
txt(s,row[1],2.18,y+0.04,0.9,0.22,{fontSize:9,color:C.slate,fontFace:"Calibri",align:"center"});
txt(s,row[2],3.2,y+0.04,6.45,0.22,{fontSize:9,color:C.dark,fontFace:"Calibri"});
});
// Drug table
roundRect(s,0.22,4.0,9.56,1.5,C.bg,C.teal,1.5);
rect(s,0.22,4.0,9.56,0.38,C.teal);
txt(s,"INDUCTION AGENTS & PARALYTICS — SELECTION GUIDE",0.4,4.03,9.2,0.32,{fontSize:11,bold:true,color:C.white,fontFace:"Calibri"});
const drugs=[
["Propofol","1.5–2.5 mg/kg IV","Haemodynamically stable, normotensive","↓ BP — AVOID in shock/hypovolaemia"],
["Ketamine","1–2 mg/kg IV","Haemodynamic instability, bronchospasm, asthma, septic shock","↑ ICP — use caution in head injury"],
["Etomidate","0.2–0.3 mg/kg IV","Cardiovascular instability, cardiac disease","Single dose OK; avoid repeated doses"],
["Succinylcholine","1–1.5 mg/kg IV","First choice paralytic for RSI (fastest onset 45–60s)","Contraindicated: hyperkalaemia, burns >48h, denervation"],
["Rocuronium","1.0–1.2 mg/kg IV","Succinylcholine contraindicated; CICO backup plan present","Reverse with Sugammadex 16 mg/kg if CICO"],
];
drugs.forEach((row,i)=>{
const y=4.44+i*0.2;
const bg=i%2===0?C.white:"EAF6F8";
rect(s,0.22,y,9.56,0.2,bg);
txt(s,row[0],0.3,y+0.03,1.1,0.16,{fontSize:8.5,bold:true,color:C.navy,fontFace:"Calibri"});
txt(s,row[1],1.45,y+0.03,1.2,0.16,{fontSize:8,color:C.slate,fontFace:"Calibri"});
txt(s,row[2],2.7,y+0.03,3.7,0.16,{fontSize:8,color:C.dark,fontFace:"Calibri"});
txt(s,row[3],6.5,y+0.03,3.15,0.16,{fontSize:8,color:C.red,fontFace:"Calibri"});
});
}
// ═══════════════════════════════════════════════════════════
// S13 — COVID-19 INTUBATION PROTOCOL STEP BY STEP
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🫁","COVID-19 INTUBATION PROTOCOL — STEP BY STEP","Derived from ASA, DAS, and Miller's Anesthesia 10e guidance",C.navy);
const steps=[
{n:"1",t:"Team Briefing (Outside Room)",d:"Assign roles: Airway Doctor, Assistant, Runner, Recorder. Pre-brief: plan A (VL), plan B (flexible scope), plan C (LMA), CICO/FONA. Limit to 3–4 personnel."},
{n:"2",t:"Full PPE Donning",d:"N95 (seal-check) + goggles + face shield + gown + double gloves. Supervised donning. No entry until all team fully protected."},
{n:"3",t:"Prepare Drugs & Equipment",d:"Video laryngoscope (primary), ETT + stylet, LMA (rescue), FONA kit (scalpel-finger-bougie). Draw: induction agent, sux/roc, vasopressor, emergency drugs."},
{n:"4",t:"Pre-oxygenation",d:"100% O₂ via tight-fitting mask ×3–5 min. Add nasal cannula 10–15 L/min for apnoeic oxygenation. Target SpO₂ >95% before induction. Avoid NIV/HFNC if possible."},
{n:"5",t:"RSI — Minimise BVM Ventilation",d:"Induction agent → paralytic → NO bag-mask unless SpO₂ <90%. If BVM needed: pressure <20 cmH₂O, 2-person technique, OPA in situ."},
{n:"6",t:"Video Laryngoscopy + Intubation",d:"VL first-pass preferred. Operator keeps maximum distance. Pre-loaded ETT on stylet. Insert tube, inflate cuff BEFORE connecting circuit."},
{n:"7",t:"Confirm ETT Position",d:"EtCO₂ waveform (gold standard) + bilateral auscultation. Attach HME filter between ETT and circuit. Secure tube. CXR confirmation."},
{n:"8",t:"Post-intubation Management",d:"Sedate adequately (prevent coughing → aerosolization). Closed-suction catheters only. Lung-protective ventilation: TV 6 mL/kg IBW, PEEP 5–8 cmH₂O. HME filter in-line."},
];
steps.forEach((step,i)=>{
const col=i<4?0:1;
const row=i<4?i:i-4;
const x=0.22+col*4.88;
const y=1.85+row*0.92;
roundRect(s,x,y,4.65,0.85,C.bg,C.teal,1.5);
ellipse(s,x+0.08,y+0.18,0.46,0.46,C.teal);
txt(s,step.n,x+0.08,y+0.18,0.46,0.46,{fontSize:13,bold:true,color:C.white,align:"center",valign:"middle"});
txt(s,step.t,x+0.62,y+0.06,3.9,0.3,{fontSize:10.5,bold:true,color:C.teal,fontFace:"Calibri"});
txt(s,step.d,x+0.62,y+0.38,3.9,0.4,{fontSize:9,color:C.dark,fontFace:"Calibri"});
});
}
// ═══════════════════════════════════════════════════════════
// S14 — DIFFICULT AIRWAY ALGORITHM (DAS/ASA)
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🔴","DIFFICULT AIRWAY ALGORITHM — PANDEMIC ADAPTATION","Based on DAS / ASA guidelines adapted for COVID-19 setting",C.red);
// Flowchart boxes
const fboxes=[
{x:3.5,y:1.82,w:3.0,h:0.52,txt:"AWAKE INTUBATION\n(if anticipated difficult airway)",color:C.purple},
{x:3.5,y:2.55,w:3.0,h:0.52,txt:"PLAN A: VIDEO LARYNGOSCOPY\n(first choice in pandemic)",color:C.teal},
{x:3.5,y:3.28,w:3.0,h:0.52,txt:"PLAN B: LMA / SUPRAGLOTTIC DEVICE\n(2nd generation preferred — seals better)",color:C.amber2},
{x:3.5,y:4.01,w:3.0,h:0.52,txt:"PLAN C: OPTIMISE & RETRY\n(BURP, head position, bougie-assisted)",color:C.navy},
{x:3.5,y:4.74,w:3.0,h:0.52,txt:"PLAN D: FONA — FRONT-OF-NECK ACCESS\n(scalpel-bougie-tube / needle crico)",color:C.red},
];
fboxes.forEach((b,i)=>{
roundRect(s,b.x,b.y,b.w,b.h,C.bg,b.color,2);
txt(s,b.txt,b.x+0.12,b.y+0.06,b.w-0.24,b.h-0.1,{fontSize:9.5,bold:true,color:b.color,fontFace:"Calibri",align:"center",valign:"middle"});
if(i<fboxes.length-1){
txt(s,"▼",4.85,b.y+b.h+0.02,0.3,0.22,{fontSize:12,bold:true,color:C.slate,align:"center"});
}
});
// Side notes left
card(s,0.22,1.82,3.05,3.62,"AWAKE INTUBATION INDICATIONS",[
"Known or suspected difficult airway",
"Predicted CICV (cannot intubate, cannot ventilate)",
"Unstable C-spine injury",
"Active haemoptysis / secretions obscuring airway",
"COVID+ with failed pre-oxygenation",
"★ Awake FOB = gold standard for difficult airway",
"★ Awake VL with topical anaesthesia also acceptable",
"★ Avoid heavy sedation — maintain spontaneous ventilation"
],C.purple);
// Side notes right
card(s,6.73,1.82,3.05,3.62,"CICO — CANNOT INTUBATE CANNOT OXYGENATE",[
"Declare CICO early — do NOT keep attempting DL",
"Call for help immediately",
"Insert LMA / iLMA — 2 attempts only",
"If LMA fails → FONA without delay",
"Scalpel-Finger-Bougie technique (DAS preferred)",
"Inflate cuff, ventilate, confirm EtCO₂",
"★ Sugammadex 16 mg/kg IV if rocuronium used — may restore spontaneous breathing",
"Practice FONA on mannequin regularly"
],C.red);
}
// ═══════════════════════════════════════════════════════════
// S15 — EXTUBATION IN PANDEMIC SETTING
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🌬","EXTUBATION IN PANDEMIC SETTINGS","Equally high AGP risk — requires as much planning as intubation",C.teal);
twoCol(s,[
"PRE-EXTUBATION CHECKLIST:",
"Patient awake, following commands",
"SpO₂ >95% on FiO₂ ≤0.4 for ≥30 min",
"Adequate neuromuscular reversal (train-of-four >0.9)",
"Anti-emetic administered (ondansetron) — prevent cough/retch",
"Lidocaine 1.5 mg/kg IV 90 sec before extubation — suppresses cough",
"Remifentanil infusion technique ('smooth extubation')",
"Suction all secretions via closed-circuit system before extubation",
"Have re-intubation kit ready at bedside"
],"EXTUBATION PROTOCOL",[
"DURING EXTUBATION:",
"Full PPE team: N95 + goggles + face shield",
"Exhale technique: remove ETT at end of expiration (↓ cough)",
"Immediately place surgical mask or aerosol box over face",
"Apply supplemental O₂ under surgical mask",
"AVOID nasopharyngeal airways — increased secretion risk",
"POST-EXTUBATION:",
"Monitor SpO₂ continuously for 30 min",
"Have HFNC / NIV / re-intubation pathway ready",
"OR terminal clean initiated immediately"
],C.teal,C.navy);
}
// ═══════════════════════════════════════════════════════════
// S16 — MODULE 5: ANAESTHETIC EMERGENCY PROCEDURES
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
moduleHeader(s,"05","ANAESTHETIC EMERGENCY PROCEDURES IN PANDEMICS","Key procedures performed or led by anaesthesiologists",C.tealMid,"#06707C");
const procs=[
{t:"Emergency LSCS (Caesarean Section)",d:"Prefer spinal/epidural (avoids intubation/AGP). If GA required: RSI with ketamine or propofol. Increased aspiration risk in pregnancy. Special NMC competency."},
{t:"Emergency Tracheostomy",d:"Percutaneous (PDT) preferred over surgical in COVID+ to reduce aerosolization time. Full airborne PPE. Delay tracheostomy ≥10 days in COVID+ if possible."},
{t:"Emergency CPR during Pandemic",d:"Full PPE before starting chest compressions. Intubate early (stops open-airway aerosolization). Use mechanical CPR device (LUCAS) to reduce HCW exposure if available."},
{t:"Fibreoptic / Awake Intubation",d:"Gold standard for anticipated difficult airway. Topical lignocaine spray to oropharynx. Sedation: dexmedetomidine or remifentanil (preserves breathing). PPE as for all AGPs."},
{t:"Regional Anaesthesia (Preferred in Pandemic)",d:"Spinal/epidural: avoids GA, avoids intubation, reduces AGP risk. Use for: lower limb surgery, obstetrics, urology, orthopaedics, vascular access. Ultrasound-guided blocks preferred."},
{t:"Central Venous Access / Invasive Monitoring",d:"Not classified as AGP. Standard PPE for procedures. However, arterial line placement in COVID+ patients should be done with full PPE as patients may cough during insertion."},
];
procs.forEach((p,i)=>{
const col=i<3?0:1;
const row=i<3?i:i-3;
const x=0.22+col*4.88;
const y=1.82+row*1.2;
roundRect(s,x,y,4.65,1.1,C.bg,C.tealMid,1.5);
rect(s,x,y,0.12,1.1,C.tealMid);
txt(s,p.t,x+0.22,y+0.07,4.3,0.3,{fontSize:11,bold:true,color:C.tealMid,fontFace:"Calibri"});
txt(s,p.d,x+0.22,y+0.4,4.3,0.62,{fontSize:9.5,color:C.dark,fontFace:"Calibri"});
});
}
// ═══════════════════════════════════════════════════════════
// S17 — VENTILATOR MANAGEMENT IN PANDEMIC ICU
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🌡","MECHANICAL VENTILATION & ICU MANAGEMENT IN PANDEMICS","Lung-protective strategy; anaesthesia machines as ICU ventilators",C.tealMid);
card(s,0.22,1.82,4.65,3.62,"LUNG-PROTECTIVE VENTILATION (COVID-19 ARDS)",[
"Tidal volume: 6 mL/kg ideal body weight (IBW)",
"PEEP: 5–8 cmH₂O initial; titrate to oxygenation (higher PEEP in ARDS)",
"Plateau pressure: ≤30 cmH₂O",
"Driving pressure: ≤15 cmH₂O (strong mortality predictor)",
"FiO₂: lowest to maintain SpO₂ 92–96%",
"Prone positioning ≥16 hours/day in moderate–severe ARDS (PaO₂/FiO₂ <150)",
"Permissive hypercapnia: PaCO₂ 45–60 mmHg acceptable if pH >7.2",
"Neuromuscular blockade: first 48h in severe ARDS (cisatracurium)",
"Daily SAT/SBT protocol when improving"
],C.tealMid);
card(s,5.13,1.82,4.65,3.62,"ANAESTHESIA MACHINE AS ICU VENTILATOR",[
"COVID-19 surge: anaesthesia machines repurposed when ICU vents exhausted (ASA/APSF guidance)",
"Use in volume-controlled mode; confirm CO₂ absorber functional",
"Fresh gas flow 2–3 L/min with circle system",
"HME filter on expiratory limb — prevents OR contamination",
"Scavenge system activated to prevent OR pollution",
"Sedation: propofol infusion (TIVA) preferred — no volatile pollution",
"One anaesthesia machine per patient — do NOT share",
"Daily machine check essential; log hours of use",
"Drugs: midazolam/propofol sedation; fentanyl/morphine analgesia"
],C.navy);
}
// ═══════════════════════════════════════════════════════════
// S18 — REGIONAL ANAESTHESIA IN PANDEMICS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"💡","REGIONAL ANAESTHESIA — PREFERRED STRATEGY IN PANDEMICS","Avoid intubation → reduce AGP risk → protect HCWs",C.teal);
card(s,0.22,1.82,3.0,3.62,"ADVANTAGES OF RA IN PANDEMICS",[
"Avoids general anaesthesia → avoids intubation (highest AGP)",
"Reduces HCW exposure to aerosols",
"Faster recovery; early discharge → free ICU beds",
"Preserves respiratory function post-op",
"Reduces systemic opioid use → less respiratory depression",
"Preferred by WHO for COVID+ patients requiring surgery",
"Ultrasound-guided RA: precise, lower drug volume"
],C.teal);
card(s,3.38,1.82,3.0,3.62,"SPINAL / EPIDURAL IN COVID PATIENT",[
"Spinal: suitable for lower limb, perineal, lower abdominal, obstetric surgery",
"Epidural: suitable for labour analgesia, thoracic / abdominal surgery",
"CSE (Combined Spinal-Epidural): for unpredictable surgical duration",
"Position patient with surgical mask in place before skin prep",
"Full PPE for operator",
"Monitor SpO₂ closely — COVID patients desaturate rapidly",
"Convert to GA if block fails — RSI protocol ready",
"Anticoagulation status must be checked (LMW heparin in COVID)"
],C.navy);
card(s,6.54,1.82,3.24,3.62,"PERIPHERAL NERVE BLOCKS (USG-guided)",[
"Brachial plexus blocks: upper limb fractures, vascular access",
"Femoral / Adductor canal block: knee surgery",
"Sciatic block: foot / ankle / lower limb",
"TAPS / Rectus sheath: abdominal wall analgesia",
"Paravertebral block: thoracic / rib fractures, VATS",
"Advantages: minimal systemic effect; patient conscious",
"Use ultrasound guidance — more accurate, less drug needed",
"★ AVOID awake blocks requiring patient to remove mask"
],C.tealMid);
}
// ═══════════════════════════════════════════════════════════
// S19 — PAEDIATRIC & OBSTETRIC AIRWAY CONSIDERATIONS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"👶","SPECIAL POPULATIONS — PAEDIATRIC & OBSTETRIC AIRWAY","Unique anatomical and physiological challenges in pandemic setting",C.purple);
twoCol(s,[
"ANATOMY: Larger occiput → sniffing position; smaller mandible; anterior larynx",
"Narrow subglottis — use uncuffed ETT <8 years; cuffed ≥8 years (low-pressure cuff)",
"RSI in children: atropine 0.02 mg/kg IV to prevent bradycardia",
"Ketamine 1–2 mg/kg preferred induction in emergency (maintains airway tone)",
"Succinylcholine: 2 mg/kg IV in children (higher dose needed)",
"Oxygen consumption 3× adult → desaturates faster → thorough preoxygenation essential",
"CICO in children: needle cricothyroidotomy preferred (narrow CTM)",
"LMA sizes: 1 (<5 kg), 1.5 (5–10 kg), 2 (10–20 kg), 2.5 (20–30 kg)"
],"PAEDIATRIC AIRWAY (Pandemic Setting)",[
"MATERNAL PHYSIOLOGY: Delayed gastric emptying → full stomach → always RSI",
"↑ Oxygen consumption; ↓ FRC → rapid desaturation (45–60 sec apnoea)",
"Mallampati increases in pregnancy — reassess at term",
"Laryngeal oedema in pre-eclampsia → small ETT (6.0–6.5 mm)",
"Category-1 LSCS: prefer spinal if fetal compromise allows; else RSI",
"RSI drugs: propofol 1.5 mg/kg or ketamine 1 mg/kg + suxamethonium 1.5 mg/kg",
"Perimortem CS: within 5 min of maternal cardiac arrest if resuscitation failing",
"COVID in pregnancy: high risk — early intubation threshold lower"
],"OBSTETRIC AIRWAY (Pandemic Setting)",C.purple,C.red);
}
// ═══════════════════════════════════════════════════════════
// S20 — MODULE 6: COMMUNICATION & ATTITUDE
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
moduleHeader(s,"06","COMMUNICATION & ATTITUDE IN COMPLEX PROCEDURES","Professionalism, ethics, and human factors in pandemic surgery",C.purple,"#4A2C6A");
const quads=[
{x:0.22,y:1.82,w:4.65,h:1.75,t:"INFORMED CONSENT IN EMERGENCIES",c:C.purple,b:[
"Explain risk of procedure AND risk of non-intervention",
"Use plain language; interpreter if needed",
"If incapacitated: next-of-kin surrogate consent",
"Imminent life-threat + no NOK: implied consent (documented)",
"Meticulous documentation of consent process",
"NMC Code: duty of care overrides in life-threatening emergencies"
]},
{x:5.13,y:1.82,w:4.65,h:1.75,t:"FAMILY COMMUNICATION IN PANDEMICS",c:C.teal,b:[
"Designated communication lead (one senior doctor per family)",
"Phone/video updates — avoid hospital crowding",
"Empathy first: acknowledge fear and uncertainty",
"Explain pandemic visitor restrictions clearly",
"Written update / printed summary when possible",
"Bereavement: compassionate disclosure by senior team member"
]},
{x:0.22,y:3.65,w:4.65,h:1.82,t:"CREW RESOURCE MANAGEMENT (CRM) IN OR",c:C.navy,b:[
"Closed-loop communication: repeat-back all critical orders",
"Speak-up culture: anyone can call a safety stop",
"Pre-briefing: roles, contingencies, code word for distress",
"PPE impairs speech — use clear, slow verbal signals",
"Leader models calm, deliberate behaviour under pressure",
"Post-procedure debriefing: emotional + clinical review",
"Human error is expected — system defences protect patients"
]},
{x:5.13,y:3.65,w:4.65,h:1.82,t:"PROFESSIONAL ETHICS & DUTY TO TREAT",c:C.red,b:[
"NMC/MCI Code: pandemic does not diminish professional duty",
"Non-abandonment principle: cannot refuse care due to fear alone",
"Balance personal safety (adequate PPE) with professional duty",
"Resource allocation ethics: utilitarian vs. equity-based triage",
"Moral distress: acknowledge → institutional support mechanisms",
"Honesty in prognosis: 'truth-telling' even in terminal cases",
"Self-care: rest, debrief, mental health support — mandatory for HCWs"
]},
];
quads.forEach(q=>card(s,q.x,q.y,q.w,q.h,q.t,q.b,q.c));
}
// ═══════════════════════════════════════════════════════════
// S21 — SPIKES + CRM FRAMEWORKS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"💬","SPIKES PROTOCOL & CRM — STRUCTURED FRAMEWORKS","Breaking bad news + Team communication under crisis conditions",C.purple);
// SPIKES
roundRect(s,0.22,1.82,4.65,3.62,C.bg,C.purple,1.5);
rect(s,0.22,1.82,4.65,0.38,C.purple);
txt(s,"SPIKES PROTOCOL — Breaking Bad News",0.36,1.85,4.38,0.32,{fontSize:10.5,bold:true,color:C.white,fontFace:"Calibri",valign:"middle"});
const spikes=[
{l:"S",t:"Setting",d:"Private, seated. Phone/video in pandemic — introduce yourself clearly"},
{l:"P",t:"Perception",d:"'What do you already know about the illness?' — assess baseline understanding"},
{l:"I",t:"Invitation",d:"'Would it be ok if I share the results with you now?'"},
{l:"K",t:"Knowledge",d:"Warning shot first: 'I have some difficult news to share...' then factual, simple language"},
{l:"E",t:"Emotions",d:"Respond empathetically using NURSE: Name, Understand, Respect, Support, Explore"},
{l:"S",t:"Strategy",d:"Discuss next steps clearly; ensure patient/family knows follow-up plan"},
];
spikes.forEach((sp,i)=>{
const y=2.27+i*0.52;
ellipse(s,0.34,y+0.05,0.38,0.38,C.purple);
txt(s,sp.l,0.34,y+0.05,0.38,0.38,{fontSize:12,bold:true,color:C.white,align:"center",valign:"middle"});
txt(s,sp.t+": ",0.82,y+0.06,0.88,0.26,{fontSize:9.5,bold:true,color:C.purple,fontFace:"Calibri"});
txt(s,sp.d,1.75,y+0.06,3.0,0.38,{fontSize:9,color:C.dark,fontFace:"Calibri"});
});
// CRM principles
roundRect(s,5.13,1.82,4.65,3.62,C.bg,C.navy,1.5);
rect(s,5.13,1.82,4.65,0.38,C.navy);
txt(s,"CRM PRINCIPLES FOR ANAESTHESIA TEAMS",5.27,1.85,4.38,0.32,{fontSize:10.5,bold:true,color:C.white,fontFace:"Calibri",valign:"middle"});
const crm=[
"1. Know the environment — pre-brief team on OR layout, exit, equipment",
"2. Anticipate and plan — think 2 steps ahead (plan B before plan A fails)",
"3. Call for help early — do not delay calling for senior/extra assistance",
"4. Exercise leadership and followership — clear role assignment, accept correction",
"5. Distribute workload — leader manages airway; delegate monitoring/drugs",
"6. Mobilise all available resources — difficult airway trolley, fibreoptic scope, FONA kit",
"7. Communicate effectively — closed-loop, read-back, avoid ambiguous orders",
"8. Use cognitive aids — checklists, algorithms posted in OR (DAS flowchart)",
"9. Re-evaluate repeatedly — reassess plan as situation evolves",
"10. Debrief after every critical event — psychological safety essential"
];
const crmItems=crm.map((c,i)=>({text:c,options:{bullet:{type:"bullet",code:"2022"},breakLine:i<crm.length-1}}));
s.addText(crmItems,{x:5.27,y:2.27,w:4.38,h:3.1,fontSize:9.5,color:C.dark,fontFace:"Calibri",valign:"top"});
}
// ═══════════════════════════════════════════════════════════
// S22 — POST-PROCEDURE CARE & OR DECONTAMINATION
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"🧹","POST-PROCEDURE CARE & OR DECONTAMINATION","Completing the safety cycle — from patient recovery to room clearance",C.green);
const c3=[
{t:"POST-OPERATIVE PATIENT CARE",c:C.teal,b:[
"Transfer to COVID-designated ICU/HDU with full PPE escort",
"Handover using SBAR: Situation, Background, Assessment, Recommendation",
"Mechanical ventilation: lung-protective strategy (6 mL/kg, PEEP 5–8)",
"Sedation: RASS target -1 to -2; SAT/SBT daily once stable",
"Thromboprophylaxis: LMWH (COVID = hypercoagulable state)",
"Prone positioning if P/F ratio <150 mmHg",
"Nutritional support: early enteral feeding within 24–48h",
"Daily fluid balance: target euvolaemia; avoid fluid overload"
]},
{t:"OR / ISOLATION ROOM DECONTAMINATION",c:C.green,b:[
"OR closure: ≥1 hour for air exchange (≥12 ACH) after COVID+ case",
"Terminal clean: hospital-grade disinfectant (0.5% sodium hypochlorite)",
"Wipe surfaces: horizontal surfaces first, then vertical",
"All linen treated as infectious (Category I BMWM waste)",
"Anaesthesia circuit: single-use or autoclaved",
"Suction canisters: decontaminated before disposal",
"Portable HEPA air scrubber running during terminal clean",
"Document decontamination time and sign-off by senior nurse"
]},
{t:"HCW POST-EXPOSURE MANAGEMENT",c:C.red,b:[
"Doffing under supervised doffing partner — highest-risk step",
"Hand hygiene after every layer removed",
"PPE breach: wash exposed area immediately, report to occupational health",
"Needlestick or splash: report within 2 hours for PEP assessment",
"COVID exposure: 10-day quarantine if unvaccinated/boosted",
"Respiratory symptoms in HCW: test and isolate immediately",
"Psychological support: debrief, mental health services available",
"Vaccination up-to-date: seasonal flu + COVID booster mandatory"
]},
];
c3.forEach((col,i)=>{
const x=0.22+i*3.25;
card(s,x,1.82,3.1,3.62,col.t,col.b,col.c);
});
}
// ═══════════════════════════════════════════════════════════
// S23 — CASE-BASED LEARNING
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"📋","CASE-BASED LEARNING — INTEGRATED VIGNETTE","Apply all 6 modules to a real-world anaesthesia scenario",C.navy);
roundRect(s,0.22,1.82,9.56,1.42,"FFFDE7",C.amber,2);
txt(s,"CLINICAL SCENARIO",0.42,1.89,9.1,0.3,{fontSize:11,bold:true,color:C.amber2,fontFace:"Calibri"});
txt(s,
"A 38-year-old male, COVID-19 positive (Day 7), BMI 34 kg/m², SpO₂ 84% on room air, presents with intestinal perforation and septic shock (BP 75/40, HR 128, GCS 12). "+
"He requires emergency laparotomy. Mallampati Class III, short neck, beard. His family is outside, unable to enter due to pandemic restrictions. "+
"No prior anaesthetic records available. Time to OR: 20 minutes.",
{x:0.42,y:2.17,w:9.12,h:0.98,fontSize:10.5,color:C.dark,fontFace:"Calibri"});
const qs=[
{q:"MODULE 1\nINDICATIONS",a:"ABSOLUTE — peritonitis + septic shock + haemodynamic instability. Delay = death. Proceed to emergency laparotomy immediately with full COVID PPE.",c:C.red},
{q:"MODULE 2\nVERIFICATION",a:"COVID+ documented; Mallampati III + BMI 34 → anticipate difficult airway; video laryngoscope + FONA kit ready; RSI planned; ICU bed confirmed; phone consent from patient (GCS 12).",c:C.teal},
{q:"MODULE 3\nINFECTION CONTROL",a:"Negative-pressure OR; minimum 4-person team; N95 + PAPR if available; HME filter; video laryngoscope first; HFNC for preoxygenation; terminal clean post-case.",c:C.green},
{q:"MODULE 4\nAIRWAY MGT",a:"RSI: ketamine 1.5 mg/kg (haemodynamic instability) + suxamethonium 1.5 mg/kg. Video laryngoscopy first. Plan B: iLMA. Plan C: FONA kit open. Pre-oxygenate ×5 min + nasal cannula 15 L/min.",c:C.navy},
{q:"MODULE 5\nANAESTHESIA",a:"GA with RSI (spinal not suitable — septic shock). TIVA: propofol + fentanyl infusion. Lung-protective ventilation intra-op. Post-op: COVID ICU, prone if P/F<150.",c:C.tealMid},
{q:"MODULE 6\nCOMMUNICATION",a:"Phone consent pre-op using SPIKES. Family briefed by designated senior doctor. Closed-loop CRM in OR. Post-op: regular phone updates to family. Debrief team after case.",c:C.purple},
];
qs.forEach((q,i)=>{
const col=i%3;
const row=Math.floor(i/3);
const x=0.22+col*3.25;
const y=3.32+row*1.12;
roundRect(s,x,y,3.1,1.05,C.bg,q.c,1.5);
rect(s,x,y,3.1,0.32,q.c);
txt(s,q.q,x+0.1,y+0.02,2.9,0.28,{fontSize:8.5,bold:true,color:C.white,align:"center",valign:"middle",fontFace:"Calibri"});
txt(s,q.a,x+0.1,y+0.37,2.9,0.62,{fontSize:8.5,color:C.dark,fontFace:"Calibri",valign:"top"});
});
}
// ═══════════════════════════════════════════════════════════
// S24 — NMC COMPETENCY MAPPING
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.white);
sectionHeader(s,"📚","NMC COMPETENCY MAPPING & LEARNING OBJECTIVES","Alignment with National Medical Commission MBBS Curriculum 2022",C.navy);
roundRect(s,0.22,1.82,9.56,3.62,C.bg,C.navy,1.5);
rect(s,0.22,1.82,9.56,0.38,C.navy);
txt(s,"At the end of this session, the MBBS student should be able to:",0.42,1.86,9.1,0.3,{fontSize:11,bold:true,color:C.white,fontFace:"Calibri"});
const objs=[
{num:"KU1",text:"Describe the indications for emergency invasive procedures during pandemic outbreaks (absolute vs. relative)",type:"Knowledge"},
{num:"KU2",text:"List the pre-procedural verification checklist adapted from the WHO Surgical Safety Checklist for pandemic settings",type:"Knowledge"},
{num:"KU3",text:"Explain the hierarchy of infection control measures and the appropriate level of PPE for aerosol-generating procedures",type:"Knowledge"},
{num:"SK1",text:"Demonstrate the correct donning and doffing sequence for airborne precaution PPE (in simulation lab)",type:"Skill"},
{num:"SK2",text:"Describe the steps of RSI and the selection of appropriate induction agents and paralytics in haemodynamically unstable patients",type:"Skill"},
{num:"SK3",text:"Outline the DAS/ASA difficult airway algorithm including CICO management and FONA indication",type:"Skill"},
{num:"AT1",text:"Apply the SPIKES protocol in breaking bad news to a family during a pandemic (role-play scenario)",type:"Attitude"},
{num:"AT2",text:"Recognise the ethical duty to treat during pandemics while asserting the right to adequate PPE protection",type:"Attitude"},
{num:"AT3",text:"Demonstrate crew resource management (CRM) principles during simulated emergency airway scenarios",type:"Attitude"},
];
const typeColors={Knowledge:C.navy,Skill:C.teal,Attitude:C.purple};
objs.forEach((o,i)=>{
const y=2.27+i*0.37;
const bg=i%2===0?C.white:"EAF6F8";
rect(s,0.22,y,9.56,0.37,bg);
roundRect(s,0.3,y+0.05,0.58,0.25,typeColors[o.type]||C.navy,typeColors[o.type],0);
txt(s,o.num,0.3,y+0.05,0.58,0.25,{fontSize:8,bold:true,color:C.white,align:"center",valign:"middle",fontFace:"Calibri"});
txt(s,`[${o.type}]`,0.96,y+0.07,1.0,0.22,{fontSize:7.5,italic:true,color:typeColors[o.type],fontFace:"Calibri"});
txt(s,o.text,2.05,y+0.07,7.6,0.26,{fontSize:9.5,color:C.dark,fontFace:"Calibri"});
});
}
// ═══════════════════════════════════════════════════════════
// S25 — SUMMARY / KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════
{
const s=pres.addSlide();
rect(s,0,0,10,5.625,C.navy);
rect(s,0,4.82,10,0.8,C.teal);
rect(s,0,4.8,10,0.07,C.amber);
rect(s,7.2,0,2.8,5.625,C.tealMid,85);
txt(s,"KEY TAKEAWAYS",0.4,0.18,6.5,0.52,{fontSize:22,bold:true,color:C.amber,fontFace:"Calibri",charSpacing:3});
txt(s,"Emergency Procedures During Pandemics — Anaesthesia Focus",0.4,0.67,6.5,0.38,{fontSize:13,italic:true,color:C.tealMid,fontFace:"Calibri"});
const takes=[
{n:"01",t:"Life-threatening emergencies ALWAYS proceed",d:"Pandemic does not stop emergency surgery. Proceed with full PPE, rapid team briefing, and optimised infection control."},
{n:"02",t:"Systematic pre-procedure verification",d:"COVID status, airway assessment, equipment check, consent, team briefing, and OR setup — EVERY time, no shortcuts."},
{n:"03",t:"Hierarchy of controls over PPE alone",d:"Engineering > Administrative > PPE. A negative-pressure OR protects more than an N95 alone."},
{n:"04",t:"RSI + Video Laryngoscopy = pandemic standard",d:"Minimise aerosolisation time. First-pass success with VL. Always have CICO/FONA plan ready before induction."},
{n:"05",t:"Regional anaesthesia: preferred where feasible",d:"Avoids intubation → reduces AGP risk. Spinal/epidural/USG-guided blocks are first-choice when clinically appropriate."},
{n:"06",t:"Communication is a clinical safety skill",d:"SPIKES for bad news. Closed-loop CRM in OR. PPE-adapted communication. Duty to treat + duty of self-care."},
];
takes.forEach((t,i)=>{
const y=1.18+i*0.69;
ellipse(s,0.3,y+0.07,0.42,0.42,C.amber);
txt(s,t.n,0.3,y+0.07,0.42,0.42,{fontSize:11,bold:true,color:C.navy,align:"center",valign:"middle"});
txt(s,t.t+" — ",0.85,y+0.06,2.8,0.3,{fontSize:10.5,bold:true,color:C.amber,fontFace:"Calibri"});
txt(s,t.d,0.85,y+0.36,8.7,0.28,{fontSize:9.5,color:C.white,fontFace:"Calibri"});
});
txt(s,"References: Miller's Anesthesia 10e | Morgan & Mikhail's Clinical Anesthesiology 7e | Barash Clinical Anesthesia 9e | DAS/ASA Difficult Airway Guidelines | WHO IPC Guidelines | NMC MBBS Curriculum 2022",
0.3,4.9,9.4,0.32,{fontSize:7.5,italic:true,color:"AADFE5",align:"center",fontFace:"Calibri"});
}
// ─── WRITE ───────────────────────────────────────────────────
const out="/home/daytona/workspace/pandemic-emergency-ppt/Emergency_Procedures_Pandemics_Anaesthesia_MBBS_NMC.pptx";
pres.writeFile({fileName:out})
.then(()=>console.log("SUCCESS: "+out))
.catch(e=>{console.error("ERROR:",e);process.exit(1);});
Running Command
cd /home/daytona/workspace/pandemic-emergency-ppt && node build2.js 2>&1
Editing File
~/pandemic-emergency-ppt/build2.js
Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pandemic-emergency-ppt/build2.js'
Reading File
Editing File
~/pandemic-emergency-ppt/build2.js
Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pandemic-emergency-ppt/build2.js'
Reading File
Editing File
~/pandemic-emergency-ppt/build2.js
Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pandemic-emergency-ppt/build2.js'
Running Command
cd /home/daytona/workspace/pandemic-emergency-ppt && node build2.js 2>&1
Running Command
ls -lh /home/daytona/workspace/pandemic-emergency-ppt/Emergency_Procedures_Pande…
Here's your expanded, anaesthesia-class-ready presentation:
Emergency Procedures Pandemics Anaesthesia MBBS NMC
Presentation · PPTX
25 Slides — Full Breakdown
| # | Slide | Content |
|---|---|---|
| 1 | Title | Anaesthesia-focused branding, NMC |
| 2 | Course Outline | 6 modules mapped |
| 3 | Pandemic Context | History + impact on anaesthesia & OR |
| 4 | Module 1 — Absolute Indications | 6 life-threatening emergencies with examples |
| 5 | Relative Indications + Triage Rule | Defer vs. proceed; 3-question decision framework |
| 6 | Module 2 — Pre-procedure Checklist | 3-column: Patient / Equipment / Documentation |
| 7 | WHO Safety Checklist (Pandemic-adapted) | Sign-In / Time-Out / Sign-Out |
| 8 | Module 3 — Hierarchy of Controls | 5-level pyramid visual |
| 9 | PPE & AGPs | Donning / Doffing sequences; PPE levels |
| 10 | Module 4 — Airway Overview | 6 core principles for anaesthesiologists |
| 11 | Airway Assessment | LEMON, Mallampati, MOANS mnemonics |
| 12 | RSI — Drugs & Technique | 6 Ps table + induction agent selection guide |
| 13 | COVID-19 Intubation Protocol | 8-step step-by-step (team briefing → decontamination) |
| 14 | Difficult Airway Algorithm | DAS Plan A→B→C→D flowchart; CICO management; Sugammadex |
| 15 | Extubation in Pandemic | Pre-extubation checklist + technique + post-extubation monitoring |
| 16 | Module 5 — Anaesthetic Emergency Procedures | LSCS, tracheostomy, CPR, awake FOB, regional, CVA |
| 17 | Ventilator Management | Lung-protective ventilation; anaesthesia machine as ICU vent |
| 18 | Regional Anaesthesia | Why preferred; spinal/epidural; USG peripheral nerve blocks |
| 19 | Paediatric & Obstetric Airway | Unique anatomy, drug doses, perimortem CS |
| 20 | Module 6 — Communication & Attitude | Consent, family comm, CRM, ethics |
| 21 | SPIKES + CRM Frameworks | Structured protocols side by side |
| 22 | Post-procedure & OR Decontamination | Patient care, terminal clean, HCW post-exposure |
| 23 | Case-Based Vignette | COVID+ peritonitis — all 6 modules applied |
| 24 | NMC Competency Mapping | KU / Skill / Attitude objectives from 2022 curriculum |
| 25 | Key Takeaways | 6 concise points with references |
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