mkdir -p /home/daytona/workspace/bite-ppt && ls /home/daytona/workspace/bite-ppt…

~/bite-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Types of Bites - Emergency Medicine";
pres.author = "Intern Presentation";

// Color palette
const DARK_RED    = "8B0000";
const MED_RED     = "C0392B";
const LIGHT_CREAM = "FDF6EC";
const DARK_GRAY   = "2C2C2C";
const WHITE       = "FFFFFF";
const ACCENT      = "E74C3C";
const LIGHT_GRAY  = "F5F5F5";
const MID_GRAY    = "7F8C8D";

// ─── Helper: section header bar ───────────────────────────────────────────────
function addHeaderBar(slide, title, subtitle) {
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      fontSize: 13, color: "FFCDD2",
      fontFace: "Calibri", margin: 0, valign: "middle", italic: true
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// ─── Helper: footer ───────────────────────────────────────────────────────────
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    fontSize: 8, color: MID_GRAY,
    fontFace: "Calibri", italic: true, margin: 0
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}

// ─── Helper: bullet block ─────────────────────────────────────────────────────
function addBulletBox(slide, items, x, y, w, h, opts) {
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}

// ─── Helper: info box ─────────────────────────────────────────────────────────
function addInfoBox(slide, label, content, x, y, w, h, bgColor) {
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    x, y, w, h,
    fill: { color: bgColor || "FFF3F3" },
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    { text: label + "\n", options: { bold: true, fontSize: 11, color: MED_RED, breakLine: true, fontFace: "Calibri" } },
    { text: content,       options: { fontSize: 10.5, color: DARK_GRAY, fontFace: "Calibri" } }
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}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 1 — Title
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: DARK_RED };

  sl.addShape(pres.ShapeType.rect, {
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    x: 0, y: 4.2, w: 10, h: 0.08, fill: { color: "FFCDD2" }, line: { color: "FFCDD2" }
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  sl.addText("TYPES OF BITES", {
    x: 0.5, y: 1.0, w: 9, h: 0.9,
    fontSize: 46, bold: true, color: WHITE,
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  sl.addText("A Comprehensive Emergency Medicine Approach", {
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    fontSize: 20, color: "FFCDD2",
    fontFace: "Calibri", align: "center", italic: true
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    { text: "Casualty Posting Presentation  |  ", options: { fontSize: 14, color: "FFCDD2" } },
    { text: "Emergency Medicine Department", options: { fontSize: 14, color: WHITE, bold: true } }
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  sl.addText([
    { text: "References:  ", options: { bold: true, color: "FFCDD2", fontSize: 11 } },
    { text: "Rosen's Emergency Medicine, 10e  |  Tintinalli's Emergency Medicine, 9e  |  Roberts & Hedges' Clinical Procedures in Emergency Medicine", options: { color: "FFCDD2", fontSize: 11 } }
  ], { x: 0.5, y: 4.55, w: 9, h: 0.5, align: "center" });
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 2 — Overview / Classification
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: LIGHT_CREAM };
  addHeaderBar(sl, "Classification of Bites", "Overview");

  sl.addText("Bites in Emergency Medicine are broadly classified as:", {
    x: 0.4, y: 1.3, w: 9.2, h: 0.35,
    fontSize: 14, color: DARK_GRAY, fontFace: "Calibri", italic: true
  });

  const cats = [
    ["🐶  MAMMALIAN BITES", "Dog • Cat • Human • Rodent • Monkey"],
    ["🐍  SNAKE BITES",     "Crotalinae (Pit Vipers) • Elapidae • Non-venomous"],
    ["🕷️  SPIDER BITES",    "Black Widow • Brown Recluse • Funnel-Web • Tarantula"],
    ["🦂  ARTHROPOD BITES", "Scorpion • Tick • Bee / Wasp / Hornet • Mosquito"],
    ["🐟  MARINE BITES",    "Blue-ringed Octopus • Jellyfish / Nematocyst • Sea Snake"],
    ["🦇  SPECIAL BITES",   "Bat (Rabies) • Heloderma (Gila Monster / Beaded Lizard)"],
  ];

  const cols = [[0, 1], [2, 3], [4, 5]];
  const xs = [0.35, 3.55, 6.75];
  const ys = [1.75, 3.1];

  cats.forEach((cat, i) => {
    const col = Math.floor(i / 2);
    const row = i % 2;
    const x = xs[col];
    const y = ys[row];
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  });

  addFooter(sl, "Rosen's Emergency Medicine 10e, Chapter 53 | Tintinalli's Emergency Medicine 9e");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 3 — Dog Bites
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Dog Bites", "Most Common Animal Bite — ~90% of all bite wounds");

  // Left column
  addInfoBox(sl, "Epidemiology", "~5 million animal bites/year in USA. Dog bites = 90%. Infection rate: 3–5%.", 0.3, 1.3, 3.1, 0.9);
  addInfoBox(sl, "Pathogens", "Pasteurella canis (most common), Staphylococcus aureus, Streptococcus viridans, Capnocytophaga canimorsus, Anaerobes (Bacteroides, Fusobacteria)", 0.3, 2.3, 3.1, 1.15);
  addInfoBox(sl, "Wound Type", "Crush injury & lacerations. Puncture wounds difficult to clean. Complications: cellulitis, osteomyelitis (rare).", 0.3, 3.55, 3.1, 0.95);

  // Right column
  addInfoBox(sl, "Management", "1. Wound irrigation (high-pressure)\n2. Débridement\n3. Primary closure (if <8h, face/scalp)\n4. Delayed closure (hands, feet)\n5. Tetanus prophylaxis\n6. Rabies assessment", 3.6, 1.3, 3.0, 1.9, "F0F4FF");
  addInfoBox(sl, "Prophylactic Antibiotics", "Amoxicillin-clavulanate 875/125 mg BD × 3–5 days\nAlternative: Clindamycin + TMP-SMX or Ciprofloxacin", 3.6, 3.3, 3.0, 0.95, "F0F4FF");

  // Right-right
  addInfoBox(sl, "Rabies Risk", "Observe dog for 10 days. If unavailable/unknown status → HRIG + rabies vaccine series.", 6.8, 1.3, 2.9, 1.15, "FFF8E1");
  addInfoBox(sl, "Capnocytophaga Warning", "Can cause fatal sepsis especially in:\n- Asplenic patients\n- Hepatic disease\n- Immunocompromised", 6.8, 2.55, 2.9, 1.1, "FFF8E1");
  addInfoBox(sl, "Key Concept", "Cultures at initial visit do NOT predict infecting organisms.", 6.8, 3.75, 2.9, 0.72, "E8F5E9");

  addFooter(sl, "Roberts & Hedges' Clinical Procedures in Emergency Medicine, 6e, p.766 | Red Book 2021, p.954");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 4 — Cat Bites
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Cat Bites", "Puncture wounds with high infection risk — up to 50%");

  const left = [
    "Infection rate up to 50% (much higher than dog bites)",
    "Sharp, pointed teeth create deep puncture wounds — hard to clean",
    "Infection often appears within 24 hours (Pasteurella hallmark)",
    "Risk of osteomyelitis, tenosynovitis, and septic arthritis",
    "Pasteurella multocida isolated in ~75% of cat bites",
    "Cat-scratch disease: Bartonella henselae via scratch or bite",
    "Rabies risk: observe animal 10 days if vaccinated",
  ];
  addBulletBox(sl, left, 0.3, 1.3, 5.5, 3.8, { fontSize: 13.5 });

  // Pathogen box
  addInfoBox(sl, "Key Pathogens", "• Pasteurella multocida (75%)\n• Staph aureus, Strep viridans\n• Anaerobes (Bacteroides, Fusobacterium)\n• Bartonella henselae (cat-scratch Dx)", 6.0, 1.3, 3.7, 1.5);
  addInfoBox(sl, "Treatment", "Amoxicillin-clavulanate 875/125 mg BD × 3–5 days\n\nPenicillin allergy:\nDoxycycline or Fluoroquinolone\n\nConsider IV antibiotics for established infection", 6.0, 2.92, 3.7, 1.75, "F0F4FF");
  addInfoBox(sl, "⚠ Warning", "Cat bites to hands — high risk for deep space infections. Low threshold for admission.", 6.0, 4.75, 3.7, 0.6, "FFF3F3");

  addFooter(sl, "Roberts & Hedges' Clinical Procedures in Emergency Medicine, 6e | Harrison's Internal Medicine 22e, Ch.158");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 5 — Human Bites
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Human Bites", "Higher bacterial load than animal bites — infection rate 10–50%");

  sl.addText("Two Types:", {
    x: 0.3, y: 1.28, w: 9.4, h: 0.32,
    fontSize: 15, bold: true, color: DARK_RED, fontFace: "Calibri", margin: 0
  });

  addInfoBox(sl, "1. Occlusal (True) Bite", "Direct biting — can involve any body part.\nMore common. Often associated with: domestic violence, child abuse, or fights.", 0.3, 1.65, 4.5, 1.15);
  addInfoBox(sl, "2. Clenched-Fist Injury (Fight Bite)", "Knuckle strikes opponent's tooth.\nMCP joint is the most common site.\nVery high infection risk — joint penetration, tendon injury.\nASSUME joint penetration until proven otherwise!", 0.3, 2.88, 4.5, 1.6, "FFF3F3");

  addInfoBox(sl, "Microbiology", "MORE bacterial isolates per wound than animal bites.\nAerobic: Strep viridans, Staph aureus, Haemophilus influenzae, Eikenella corrodens\nAnaerobic: Peptostreptococcus, Prevotella, Fusobacterium\n~4–5 isolates per wound (polymicrobial)", 5.0, 1.65, 4.7, 1.75);
  addInfoBox(sl, "Management", "• Irrigation and débridement\n• DO NOT primarily close clenched-fist injuries\n• Amoxicillin-clavulanate 875/125 mg BD × 5 days\n• Alt: Clindamycin + Ciprofloxacin or Moxifloxacin\n• Tetanus prophylaxis\n• Screen for Hepatitis B, C; HIV if risk\n• Hand surgery consult if joint involved", 5.0, 3.5, 4.7, 1.95, "F0F4FF");

  addFooter(sl, "Sabiston Textbook of Surgery 21e, Ch.29 | Tintinalli's Emergency Medicine 9e | Dermatology 5e, Table 85.9");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 6 — Snake Bites (Part 1: Pit Vipers)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Snake Bites — Crotalinae (Pit Vipers)", "Rattlesnakes, Copperheads, Water Moccasins — Most common in USA");

  // Left
  addInfoBox(sl, "Epidemiology", "~6,000 bites/year (USA); 7,000–8,000 by venomous snakes.\n~5 deaths/year (due to antivenom availability).\nMortality <0.5% (was 25% historically).\nUp to 25% are 'dry bites' — no venom injected.", 0.3, 1.3, 4.6, 1.45);
  addInfoBox(sl, "Pathophysiology", "Complex enzyme mixture causing:\n• Local tissue injury + necrosis\n• Systemic vascular damage + hemolysis\n• Fibrinolysis → coagulopathy (consumes fibrinogen + platelets)\n• Hypovolemia (venom alters vascular permeability)\n• Neuromuscular dysfunction (some species)", 0.3, 2.85, 4.6, 1.8);

  // Right
  addInfoBox(sl, "Clinical Features", "LOCAL:\n• Fang marks, pain, edema, ecchymosis, bullae\n• Soft tissue necrosis\n\nSYSTEMIC:\n• Coagulopathy (↓fibrinogen, ↓platelets)\n• Hypotension, tachycardia\n• Nausea, vomiting, metallic taste\n• Neuromuscular: ptosis, respiratory failure (some species)", 5.1, 1.3, 4.6, 2.05);
  addInfoBox(sl, "Management", "1. Immobilize limb, keep below heart level\n2. Labs: CBC, coagulation, fibrinogen, BMP, CK, UA\n3. Antivenom: CroFab (FabAV) or Anavip (Fab2AV)\n4. NO tourniquets, ice, incision/suction\n5. Pain control, IV fluids\n6. Tetanus prophylaxis\n7. ICU/admit all children + coral snake bites", 5.1, 3.44, 4.6, 2.0, "F0F4FF");

  addFooter(sl, "Tintinalli's Emergency Medicine 9e, Ch.212 | Rosen's Emergency Medicine 10e, Ch.53");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 7 — Snake Bites (Part 2: Elapids + Coral)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Snake Bites — Elapidae & Coral Snakes", "Neurotoxic Envenomation — Delayed but Severe");

  addInfoBox(sl, "Elapidae Family", "Includes: Coral snakes (USA), Cobras, Kraits, Mambas, Sea snakes, Australian elapids.\nCoral snakes: Eastern (Micrurus fulvius) + Western species in USA.", 0.3, 1.28, 4.65, 1.1);
  addInfoBox(sl, "Clinical Features — Coral Snake", "• Bite site appears MINOR (small fangs, fixed erect)\n• Neurotoxic venom: blocks acetylcholine at NMJ\n• Onset DELAYED by hours (can be 12–24h)\n• Ptosis, diplopia, dysphagia, dysarthria\n• Descending flaccid paralysis → respiratory failure\n• Severity CANNOT be estimated from bite site appearance!", 0.3, 2.45, 4.65, 2.05, "FFF3F3");
  addInfoBox(sl, "Sea Snakes", "Painless bite in marine setting.\nPresent: muscle aches (rhabdomyolysis), weakness, trismus.\nMyoglobinuria → renal failure.\nTreat as elapid envenomation.", 0.3, 4.57, 4.65, 0.9);

  addInfoBox(sl, "Management — Elapids", "1. ALL children + coral snake bites: ADMIT\n2. Coral snake antivenom (MICRURUS antivenom)\n   – Give EARLY before symptoms, don't wait!\n3. Supportive: intubation / ventilation for paralysis\n4. NO FabAV (CroFab) for coral snakes — different antivenom\n5. Monitor neuro status closely for 24–48h\n6. ICU admission for respiratory compromise", 5.1, 1.28, 4.6, 2.35, "F0F4FF");
  addInfoBox(sl, "Key Teaching Point", "Coral snake bites: Bite looks minor → patient feels well → deteriorates 12–24h later.\n\n'Dry bites' more common in coral snakes.\nNever discharge without 24h observation!", 5.1, 3.72, 4.6, 1.2, "FFF8E1");
  addInfoBox(sl, "Mnemonic", "Red on Yellow, Kill a Fellow\nRed on Black, Friend of Jack\n(Coral snake vs. King snake)", 5.1, 5.0, 4.6, 0.52, "E8F5E9");

  addFooter(sl, "Tintinalli's Emergency Medicine 9e, Ch.212 | Rosen's Emergency Medicine 10e, Ch.53, Q&A p.1023");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 8 — Spider Bites
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Spider Bites", "Black Widow & Brown Recluse — Most Medically Significant");

  // 2x2 grid
  addInfoBox(sl, "Black Widow (Latrodectus mactans)", "NEUROTOXIC\n• Venom: α-latrotoxin → massive neurotransmitter release (ACh, NE, DA, GABA)\n• Female: glossy black, red hourglass marking\n• Bite: pinprick, target lesion 1–2 cm\n• Latrodectism: severe muscle cramps, abdomen/back/chest pain\n• HTN, tachycardia, diaphoresis, nausea\n• TX: Opioids + benzodiazepines; Antivenom in severe cases (Merck Latrodectus antivenom)", 0.3, 1.28, 4.65, 2.4);
  addInfoBox(sl, "Brown Recluse (Loxosceles reclusa)", "NECROTIC (CYTOTOXIC)\n• Venom: sphingomyelinase D → necrosis via neutrophil activation + platelet aggregation\n• Violin-shaped mark on dorsal cephalothorax, 3 pairs of eyes\n• PAINLESS bite initially → firm erythematous lesion\n• Hemorrhagic blister at 24h → necrotic ulcer (loxoscelism)\n• Systemic: hemolysis, DIC, renal failure (esp. children)\n• TX: No validated antivenom; wound care, dapsone (controversial), colchicine", 0.3, 3.75, 4.65, 2.1, "FFF3F3");

  addInfoBox(sl, "Funnel-Web Spider (Australia)", "MOST DANGEROUS SPIDER\n• Severe pain, wheal + erythema at bite\n• Very rapid envenomation\n• Parasympathetic effects, muscle fasciculation\n• Myocardial damage, pulmonary edema, cerebral edema\n• Death within MINUTES\n• TX: Compressive elastic bandage + funnel-web antivenom ASAP", 5.1, 1.28, 4.6, 2.0);
  addInfoBox(sl, "Other Spiders", "Widow Spiders (worldwide Latrodectus species)\n→ Same management as black widow\n\nTarantula: painful bite, local erythema/edema\n→ Barbed hairs → corneal penetration (ophthalmology consult)\n\nArmed/Banana Spider (Brazil):\n→ Priapism, sympathetic/parasympathetic effects\n→ Antivenom available in Brazil", 5.1, 3.36, 4.6, 2.0, "F0F4FF");

  addFooter(sl, "Rosen's Emergency Medicine 10e, Ch.53, p.818 | Tintinalli's Emergency Medicine 9e, Table 211-1 (p.1393)");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 9 — Arthropod Bites (Scorpion + Tick)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Arthropod Bites & Stings", "Scorpions, Ticks, Insects");

  addInfoBox(sl, "Scorpion Stings", "Centruroides exilicauda (Arizona bark scorpion) — most dangerous in USA.\n• Neurotoxic: sodium channel activation → excessive nerve firing\n• Local: immediate pain + paresthesias (NO significant swelling)\n• Systemic (severe): hypersalivation, blurred vision, involuntary muscle movements, opisthotonos, respiratory failure\n• TX: Analgesia; Anascorp antivenom (FDA approved) for severe systemic toxicity\n• Children more severely affected than adults", 0.3, 1.28, 4.65, 2.5);
  addInfoBox(sl, "Tick Bites", "• Usually painless — embedded ticks often unnoticed\n• Proper removal: fine-tipped tweezers, grasp close to skin, pull steadily — no twisting/squeezing\n\nDisease Transmission:\n• Lyme disease (Borrelia burgdorferi) — requires >36–48h attachment\n• Rocky Mountain Spotted Fever (Rickettsia)\n• Ehrlichiosis, Anaplasmosis\n• Tick paralysis (ascending flaccid paralysis — resolves on tick removal)\n\nProphylaxis: Doxycycline 200 mg single dose if Ixodes tick attached >36h", 0.3, 3.87, 4.65, 1.72);

  addInfoBox(sl, "Hymenoptera (Bees/Wasps/Hornets)", "• Venom: phospholipase A2, melittin, histamine\n• Local: pain, erythema, edema\n• Anaphylaxis: urticaria, bronchospasm, hypotension → life-threatening\n• Multiple stings → systemic toxicity (hemolysis, rhabdomyolysis)\n\nManagement:\n1. Remove stinger (scrape, don't squeeze)\n2. Anaphylaxis: Epinephrine IM 0.3 mg (thigh)\n3. Antihistamines + corticosteroids for mild/moderate\n4. Observe 4–6h; prescribe EpiPen on discharge", 5.1, 1.28, 4.6, 2.6);
  addInfoBox(sl, "Ant Bites (Fire Ants)", "• Solenopsis invicta — fire ants — SE USA\n• Sting: immediate burning pain → sterile pustule (pathognomonic)\n• Multiple stings common (cluster pattern)\n• Anaphylaxis can occur\n• TX: Local care, topical steroids; anaphylaxis protocol if needed", 5.1, 3.97, 4.6, 1.38, "F0F4FF");

  addFooter(sl, "Rosen's Emergency Medicine 10e, Ch.53 | Tintinalli's Emergency Medicine 9e, Ch.211");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 10 — Marine Bites (Octopus + Jellyfish)
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "Marine Bites & Envenomation", "Blue-ringed Octopus, Jellyfish (Nematocyst), Sea Snakes");

  addInfoBox(sl, "Blue-ringed Octopus (Hapalochlaena maculosa)", "VENOM: Tetrodotoxin — potent sodium channel blocker\n• Found in Indo-Pacific shallow waters\n• Bite on upper extremity — painless or minor initially\n• Neurological symptoms within MINUTES:\n  – Paresthesias → paralysis → respiratory arrest\n• NO antivenom exists\n• TX: Supportive + RESPIRATORY SUPPORT (lifesaving)\n• Bite marks from parrot-like beak", 0.3, 1.28, 4.65, 2.3);
  addInfoBox(sl, "Jellyfish / Nematocyst", "NEMATOCYST: spring-loaded venom gland in Cnidaria\n• Includes: Portuguese man o' war, box jellyfish, Irukandji, sea nettle, fire coral\n• Can sting even when dead/beached — tentacles remain active for weeks!\n\nBox jellyfish (Chironex fleckeri):\n• Immediate severe pain, 'frosted ladder' linear welts\n• Skin necrosis 1–2 weeks later\n• Muscle spasm, pulmonary edema, cardiac arrest within minutes\n\nIrukandji (Carukia barnesi): tiny, potent — Irukandji syndrome", 0.3, 3.65, 4.65, 1.85);

  addInfoBox(sl, "Nematocyst Treatment", "1. Remove from water (drowning risk!)\n2. Rinse with seawater (NOT fresh water — triggers firing)\n3. Vinegar (box jellyfish) — deactivates nematocysts\n4. Remove tentacles with tweezers (gloves!)\n5. Box jellyfish antivenom if available\n6. Analgesia, antihistamines, corticosteroids\n7. ICU for cardiac/respiratory compromise", 5.1, 1.28, 4.6, 2.2, "F0F4FF");
  addInfoBox(sl, "Sea Snake Bites", "• Painless bite in marine setting\n• Puncture wound ± fang marks\n• Delayed onset: myalgia, weakness, trismus\n• Myoglobinuria → renal failure\n• Rhabdomyolysis\n\nTX: Sea snake antivenom; supportive care; dialysis if needed", 5.1, 3.56, 4.6, 1.7);
  addInfoBox(sl, "Heloderma Bites (Gila Monster / Beaded Lizard)", "• Chewing bite — delivers venom through grooved teeth\n• Venom: kallikrein-like enzyme → hypotension, tachycardia\n• TX: Wound care, analgesics, supportive — NO antivenom", 5.1, 5.3, 4.6, 0.85, "E8F5E9");

  addFooter(sl, "Rosen's Emergency Medicine 10e, Ch.53, p.703 (Bites), p.708 (Nematocyst)");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 11 — General Wound Management of Bites
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addHeaderBar(sl, "General Wound Management of Bite Injuries", "Applicable to All Mammalian Bites");

  const steps = [
    ["1. HISTORY", "Time of injury, type of animal, circumstances, provoked/unprovoked, vaccination status of animal, tetanus & immunization status of patient, immunocompromised state"],
    ["2. WOUND IRRIGATION", "High-pressure irrigation with NS (35 mL syringe + 18G needle). Remove all visible debris. Most important step to reduce infection."],
    ["3. WOUND EXPLORATION", "Assess depth, involvement of tendons, joints, bones. Probe for foreign material. X-ray if bone involved."],
    ["4. DÉBRIDEMENT", "Careful removal of necrotic tissue. Minimal in digits and hands."],
    ["5. CLOSURE DECISION", "CLOSE: Face (excellent blood supply), scalp, trunk wounds <8h\nDELAY: Hands, feet, puncture wounds, heavily contaminated, bite wounds >8h old"],
    ["6. ANTIBIOTICS", "Prophylaxis: amoxicillin-clavulanate 875/125 mg BD × 3–5 days\nTreat infection: empirical IV antibiotics + wound cultures"],
    ["7. TETANUS", "Tdap if not vaccinated in last 5 years (>5y for dirty wounds, >10y for clean).\nTIG if never vaccinated."],
    ["8. RABIES ASSESSMENT", "All mammalian bites — assess rabies risk. HRIG + vaccine if indicated."],
  ];

  steps.forEach((step, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
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    ], { x: x + 0.12, y: y + 0.05, w: 4.36, h: 0.88, valign: "top" });
  });

  addFooter(sl, "Roberts & Hedges' Clinical Procedures in Emergency Medicine, 6e, p.766 | Tintinalli's Emergency Medicine 9e | Red Book 2021, p.954–958");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 12 — Summary Table
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: LIGHT_CREAM };
  addHeaderBar(sl, "Quick Reference Summary", "Types of Bites at a Glance");

  // Table
  const rows = [
    ["Bite Type", "Key Pathogen / Toxin", "Clinical Feature", "Treatment"],
    ["Dog Bite", "Pasteurella canis, Capnocytophaga", "Crush laceration, 3–5% infection", "Amox-clav, irrigation, tetanus"],
    ["Cat Bite", "Pasteurella multocida (75%)", "Puncture wound, 50% infection", "Amox-clav, close follow-up"],
    ["Human Bite", "Eikenella, Staph, Anaerobes", "Clenched-fist: joint penetration", "Do NOT close; amox-clav, surgery"],
    ["Pit Viper", "Hemotoxin / Phospholipase", "Edema, coagulopathy, necrosis", "CroFab antivenom, labs, ICU"],
    ["Coral Snake", "α-Neurotoxin (post-synaptic)", "Delayed neuro paralysis", "Micrurus antivenom, intubate"],
    ["Black Widow", "α-Latrotoxin (neurotoxic)", "Severe muscle cramps, HTN", "Opioids, BZD, antivenom (severe)"],
    ["Brown Recluse", "Sphingomyelinase D (cytotoxic)", "Painless → necrotic ulcer", "Wound care, no validated antivenom"],
    ["Box Jellyfish", "Multiple toxins / nematocyst", "Frosted-ladder welts, cardiac arrest", "Vinegar, antivenom, CPR"],
    ["Blue-ringed Octopus", "Tetrodotoxin", "Rapid paralysis, apnea", "Respiratory support (NO antivenom)"],
    ["Scorpion", "Neurotoxin (Na-channel)", "Paresthesias, hypersalivation", "Anascorp antivenom (severe)"],
  ];

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  addFooter(sl, "Rosen's Emergency Medicine 10e | Tintinalli's Emergency Medicine 9e | Roberts & Hedges' Clinical Procedures 6e");
}

// ══════════════════════════════════════════════════════════════════
//  SLIDE 13 — Conclusion
// ══════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: DARK_RED };

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    fontSize: 32, bold: true, color: WHITE,
    fontFace: "Calibri", align: "center", charSpacing: 3
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  const points = [
    "Wound IRRIGATION is the single most important step in bite wound management",
    "Cat bites have a HIGHER infection rate (50%) than dog bites (3–5%) despite appearing less severe",
    "Coral snake bites look MINOR but can cause delayed respiratory failure — NEVER discharge without 24h observation",
    "Brown recluse bites are initially PAINLESS — necrosis develops over 24–72 hours",
    "Blue-ringed octopus envenomation: NO antivenom — respiratory support is lifesaving",
    "All mammalian bites: assess for RABIES and TETANUS regardless of wound severity",
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}

// ─── Write file ────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/bite-ppt/Types_of_Bites_EM.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/bite-ppt/Types_of_Bites_EM.pptx"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

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

ls -lh /home/daytona/workspace/bite-ppt/Types_of_Bites_EM.pptx