const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Basics of ICU Care - MBBS";
pres.author = "NMC CBME Curriculum";
pres.subject = "Critical Care Medicine";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:     "0B2545",   // dominant dark navy
  teal:     "137B7B",   // supporting teal
  sky:      "1A9BD7",   // accent sky-blue
  white:    "FFFFFF",
  offwhite: "F0F4F8",
  gold:     "F5A623",
  red:      "D62839",
  green:    "1B8A5A",
  gray:     "5A6472",
  lightgray:"C8D3DC",
};

// ─── HELPERS ──────────────────────────────────────────────────────────────────
function addDarkSlide(pres, bg = C.navy) {
  const slide = pres.addSlide();
  slide.background = { color: bg };
  return slide;
}

function addLightSlide(pres) {
  const slide = pres.addSlide();
  slide.background = { color: C.offwhite };
  return slide;
}

// Decorative left accent bar
function accentBar(slide, color = C.teal) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: color }, line: { type: "none" },
  });
}

// Top banner on light slides
function topBanner(slide, title, subtitle = "") {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 1.05, fill: { color: C.navy }, line: { type: "none" },
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 1.05, w: 10, h: 0.07, fill: { color: C.teal }, line: { type: "none" },
  });
  slide.addText(title, {
    x: 0.35, y: 0.08, w: 9.2, h: 0.6, fontSize: 22, bold: true,
    color: C.white, fontFace: "Calibri", margin: 0,
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.35, y: 0.68, w: 9.2, h: 0.35, fontSize: 12,
      color: C.lightgray, fontFace: "Calibri", margin: 0,
    });
  }
}

// Slide number badge
function slideNum(slide, num, total) {
  slide.addText(`${num} / ${total}`, {
    x: 8.8, y: 5.25, w: 1, h: 0.3, fontSize: 9, color: C.lightgray,
    fontFace: "Calibri", align: "right", margin: 0,
  });
}

// ─── SLIDE COUNT (total) ──────────────────────────────────────────────────────
const TOTAL = 20;

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, C.navy);

  // Large teal strip left
  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.5, h: 5.625, fill: { color: C.teal }, line: { type: "none" },
  });
  // Gold accent strip
  s.addShape(pres.ShapeType.rect, {
    x: 0.5, y: 0, w: 0.06, h: 5.625, fill: { color: C.gold }, line: { type: "none" },
  });

  // Big ECG-style horizontal line
  s.addShape(pres.ShapeType.line, {
    x: 1, y: 3.0, w: 8.5, h: 0, line: { color: C.teal, width: 1.5, dashType: "dash" },
  });

  s.addText("BASICS OF", {
    x: 1, y: 0.55, w: 8.5, h: 0.55, fontSize: 20, bold: false,
    color: C.lightgray, fontFace: "Calibri", charSpacing: 8, margin: 0,
  });
  s.addText("ICU CARE", {
    x: 1, y: 1.05, w: 8.5, h: 1.2, fontSize: 68, bold: true,
    color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addText("Intensive Care Unit – Fundamentals for MBBS Students", {
    x: 1, y: 2.25, w: 8.5, h: 0.5, fontSize: 15,
    color: C.sky, fontFace: "Calibri", margin: 0,
  });

  s.addShape(pres.ShapeType.rect, {
    x: 1, y: 3.15, w: 8.5, h: 0.04, fill: { color: C.teal }, line: { type: "none" },
  });

  s.addText([
    { text: "NMC CBME Curriculum  |  ", options: { bold: true } },
    { text: "Department of Medicine / Critical Care", options: {} },
  ], {
    x: 1, y: 3.35, w: 8.5, h: 0.4, fontSize: 13,
    color: C.lightgray, fontFace: "Calibri", margin: 0,
  });

  s.addText("National Medical Commission – Competency Based Medical Education", {
    x: 1, y: 4.85, w: 8.5, h: 0.35, fontSize: 10,
    color: C.gray, fontFace: "Calibri", margin: 0,
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – TABLE OF CONTENTS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, "102232");
  accentBar(s, C.gold);

  s.addText("Contents", {
    x: 0.5, y: 0.2, w: 9, h: 0.6, fontSize: 28, bold: true,
    color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, {
    x: 0.5, y: 0.85, w: 2.5, h: 0.05, fill: { color: C.teal }, line: { type: "none" },
  });

  const topics = [
    ["01", "What is ICU & Why It Matters"],
    ["02", "ICU Team & Patient Selection"],
    ["03", "Monitoring – Vital Signs & Scoring"],
    ["04", "Airway Management & Oxygen Therapy"],
    ["05", "Mechanical Ventilation Basics"],
    ["06", "Hemodynamic Monitoring & Shock"],
    ["07", "Fluid Therapy & Vasopressors"],
    ["08", "Sepsis & Septic Shock"],
    ["09", "Renal Failure & Nutrition in ICU"],
    ["10", "Infection Control, Ethics & Communication"],
  ];

  topics.forEach(([num, title], i) => {
    const col = i < 5 ? 0 : 1;
    const row = i % 5;
    const x = col === 0 ? 0.5 : 5.25;
    const y = 1.1 + row * 0.83;

    s.addShape(pres.ShapeType.rect, {
      x, y, w: 0.45, h: 0.45, fill: { color: C.teal }, line: { type: "none" },
      rectRadius: 0.05,
    });
    s.addText(num, {
      x: x, y: y + 0.02, w: 0.45, h: 0.4, fontSize: 12, bold: true,
      color: C.white, fontFace: "Calibri", align: "center", margin: 0,
    });
    s.addText(title, {
      x: x + 0.55, y: y + 0.04, w: 4.2, h: 0.38, fontSize: 13,
      color: C.offwhite, fontFace: "Calibri", margin: 0,
    });
  });

  slideNum(s, 2, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – WHAT IS ICU?
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "What is an Intensive Care Unit (ICU)?", "Definition & Purpose");
  accentBar(s, C.sky);

  const boxes = [
    { title: "Definition", body: "A specialised hospital ward providing continuous monitoring and life support for critically ill patients with single or multiple organ failure.", color: C.navy },
    { title: "Purpose", body: "To prevent death, support failing organs, treat reversible illness, and bridge patients until recovery or definitive treatment.", color: C.teal },
    { title: "Types of ICU", body: "• General Medical/Surgical ICU\n• Cardiac Care Unit (CCU)\n• Neurological ICU (NICU)\n• Neonatal ICU (NICU)\n• Paediatric ICU (PICU)\n• Respiratory ICU", color: C.sky },
  ];

  boxes.forEach((b, i) => {
    const x = 0.3 + i * 3.22;
    s.addShape(pres.ShapeType.rect, {
      x, y: 1.25, w: 3.0, h: 3.9, fill: { color: b.color }, line: { type: "none" },
      rectRadius: 0.1,
    });
    s.addText(b.title, {
      x: x + 0.15, y: 1.35, w: 2.7, h: 0.5, fontSize: 15, bold: true,
      color: C.white, fontFace: "Calibri", margin: 0,
    });
    s.addShape(pres.ShapeType.line, {
      x: x + 0.15, y: 1.87, w: 2.7, h: 0, line: { color: "FFFFFF", width: 1.0, transparency: 50 },
    });
    s.addText(b.body, {
      x: x + 0.12, y: 1.95, w: 2.76, h: 3.0, fontSize: 12,
      color: C.offwhite, fontFace: "Calibri", margin: 0,
    });
  });

  slideNum(s, 3, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – ICU ADMISSION CRITERIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "ICU Admission Criteria", "Priority-Based Triage (NMC Competency: AN71.1, IM8.7)");
  accentBar(s, C.red);

  const priorities = [
    { pri: "Priority 1", color: C.red, text: "Critically ill, haemodynamically unstable. Need immediate monitoring & intervention.\nExamples: cardiogenic shock, ARDS, status epilepticus, severe sepsis." },
    { pri: "Priority 2", color: C.gold, text: "High risk of deterioration. Intensive monitoring required.\nExamples: post-major surgery, large MI with no shock, DKA with altered consciousness." },
    { pri: "Priority 3", color: C.green, text: "Critically ill but poor prognosis. ICU admission conditional.\nExamples: metastatic malignancy with sepsis, end-stage organ failure." },
    { pri: "Priority 4", color: C.gray, text: "Inappropriate for ICU (too well or too ill, no benefit expected).\nExamples: terminal cancer, brainstem death with no plans for organ donation." },
  ];

  priorities.forEach((p, i) => {
    const y = 1.25 + i * 1.0;
    s.addShape(pres.ShapeType.rect, {
      x: 0.35, y, w: 1.6, h: 0.72, fill: { color: p.color }, line: { type: "none" }, rectRadius: 0.07,
    });
    s.addText(p.pri, {
      x: 0.35, y: y + 0.1, w: 1.6, h: 0.5, fontSize: 13, bold: true,
      color: C.white, fontFace: "Calibri", align: "center", margin: 0,
    });
    s.addText(p.text, {
      x: 2.1, y: y + 0.04, w: 7.55, h: 0.65, fontSize: 12,
      color: C.navy, fontFace: "Calibri", margin: 0,
    });
  });

  slideNum(s, 4, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – ICU TEAM
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "The ICU Multidisciplinary Team", "Roles & Responsibilities");
  accentBar(s, C.teal);

  const members = [
    { role: "Intensivist", desc: "Specialist physician overseeing all ICU patients; leads daily rounds, manages complex decisions.", icon: "👨‍⚕️" },
    { role: "ICU Nurse", desc: "1:1 or 1:2 nurse-patient ratio; continuous bedside monitoring, medication administration.", icon: "👩‍⚕️" },
    { role: "Respiratory Therapist", desc: "Manages mechanical ventilators, weaning protocols, nebulisations.", icon: "🫁" },
    { role: "Pharmacist", desc: "Medication reconciliation, TPN formulations, antibiotic stewardship.", icon: "💊" },
    { role: "Physiotherapist", desc: "Early mobilisation, chest physiotherapy, preventing muscle wasting.", icon: "🏃" },
    { role: "Dietitian / Nutritionist", desc: "Enteral/parenteral nutrition planning, caloric calculations.", icon: "🥗" },
  ];

  members.forEach((m, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.3 + col * 3.22;
    const y = 1.25 + row * 1.95;

    s.addShape(pres.ShapeType.rect, {
      x, y, w: 3.0, h: 1.75, fill: { color: row === 0 ? C.navy : C.teal }, line: { type: "none" }, rectRadius: 0.1,
    });
    s.addText(m.icon + "  " + m.role, {
      x: x + 0.12, y: y + 0.1, w: 2.76, h: 0.45, fontSize: 14, bold: true,
      color: C.white, fontFace: "Calibri", margin: 0,
    });
    s.addText(m.desc, {
      x: x + 0.12, y: y + 0.55, w: 2.76, h: 1.1, fontSize: 11,
      color: C.offwhite, fontFace: "Calibri", margin: 0,
    });
  });

  slideNum(s, 5, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – MONITORING: VITAL SIGNS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "ICU Monitoring – Vital Signs & Parameters", "Continuous Assessment (NMC Competency: IM8.3)");
  accentBar(s, C.sky);

  const params = [
    { label: "Heart Rate", normal: "60-100 bpm", alarm: "< 40 or > 150 bpm" },
    { label: "Blood Pressure", normal: "SBP 90-140 mmHg", alarm: "MAP < 65 mmHg" },
    { label: "SpO₂", normal: "≥ 95%", alarm: "< 90%" },
    { label: "Respiratory Rate", normal: "12-20 /min", alarm: "< 8 or > 35 /min" },
    { label: "Temperature", normal: "36.5 – 37.5°C", alarm: "< 35 or > 39.5°C" },
    { label: "Urine Output", normal: "≥ 0.5 mL/kg/hr", alarm: "< 0.3 mL/kg/hr" },
    { label: "GCS (neuro)", normal: "15", alarm: "≤ 8 (consider intubation)" },
    { label: "Blood Sugar", normal: "140-180 mg/dL (ICU)", alarm: "< 70 or > 250 mg/dL" },
  ];

  // Header row
  const headerY = 1.2;
  [["Parameter", 0.35, 2.5], ["Normal Range", 2.9, 3.0], ["Alarm Threshold", 5.95, 3.6]].forEach(([txt, x, w]) => {
    s.addShape(pres.ShapeType.rect, { x, y: headerY, w, h: 0.42, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(txt, { x, y: headerY + 0.04, w, h: 0.35, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  });

  params.forEach((p, i) => {
    const y = 1.65 + i * 0.48;
    const bg = i % 2 === 0 ? "E8F0F7" : C.white;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.2, h: 0.46, fill: { color: bg }, line: { type: "none" } });
    s.addText(p.label, { x: 0.45, y: y + 0.07, w: 2.4, h: 0.32, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(p.normal, { x: 2.9, y: y + 0.07, w: 2.95, h: 0.32, fontSize: 12, color: C.teal, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(p.alarm, { x: 5.95, y: y + 0.07, w: 3.5, h: 0.32, fontSize: 12, color: C.red, fontFace: "Calibri", align: "center", margin: 0 });
  });

  slideNum(s, 6, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – SEVERITY SCORING
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, "0D2438");
  accentBar(s, C.gold);

  s.addText("ICU Severity Scoring Systems", {
    x: 0.5, y: 0.15, w: 9, h: 0.6, fontSize: 26, bold: true,
    color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.8, w: 9, h: 0.04, fill: { color: C.gold }, line: { type: "none" } });

  const scores = [
    {
      name: "APACHE II",
      full: "Acute Physiology And Chronic Health Evaluation II",
      vars: "12 acute physiology variables + age + chronic health",
      range: "0 – 71",
      use: "Predicts hospital mortality; score > 25 = high mortality",
      color: C.sky,
    },
    {
      name: "SOFA",
      full: "Sequential Organ Failure Assessment",
      vars: "6 organs: Respiratory, Coagulation, Liver, CVS, CNS, Renal",
      range: "0 – 24",
      use: "Quantifies organ dysfunction; also defines sepsis (SOFA ≥ 2)",
      color: C.teal,
    },
    {
      name: "GCS",
      full: "Glasgow Coma Scale",
      vars: "Eye (E1-4) + Verbal (V1-5) + Motor (M1-6)",
      range: "3 – 15",
      use: "Neurological assessment; ≤ 8 indicates coma, need to secure airway",
      color: C.gold,
    },
  ];

  scores.forEach((sc, i) => {
    const y = 1.0 + i * 1.48;
    s.addShape(pres.ShapeType.rect, { x: 0.5, y, w: 9, h: 1.32, fill: { color: "1A2E42" }, line: { color: sc.color, width: 1.5 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x: 0.5, y, w: 1.4, h: 1.32, fill: { color: sc.color }, line: { type: "none" }, rectRadius: 0.08 });
    s.addText(sc.name, { x: 0.5, y: y + 0.38, w: 1.4, h: 0.5, fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(sc.full, { x: 2.05, y: y + 0.08, w: 7.2, h: 0.35, fontSize: 12, bold: true, color: sc.color, fontFace: "Calibri", margin: 0 });
    s.addText(`Variables: ${sc.vars}`, { x: 2.05, y: y + 0.42, w: 7.2, h: 0.3, fontSize: 11, color: C.lightgray, fontFace: "Calibri", margin: 0 });
    s.addText(`Range: ${sc.range}  |  Use: ${sc.use}`, { x: 2.05, y: y + 0.74, w: 7.2, h: 0.45, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 7, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – AIRWAY MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Airway Management in ICU", "From Basic to Advanced (NMC: AN29.3, SU17.2)");
  accentBar(s, C.red);

  // Left column - ladder
  const steps = [
    { step: "Step 1", label: "Positioning & Jaw Thrust / Chin Lift", color: C.green },
    { step: "Step 2", label: "Oropharyngeal / Nasopharyngeal Airway", color: C.teal },
    { step: "Step 3", label: "Oxygen Mask / Non-Rebreather Mask", color: C.sky },
    { step: "Step 4", label: "Bag-Valve-Mask (BVM) Ventilation", color: C.gold },
    { step: "Step 5", label: "Endotracheal Intubation (ETT)", color: C.red },
    { step: "Step 6", label: "Surgical Airway (Cricothyrotomy)", color: "8B0000" },
  ];

  steps.forEach((st, i) => {
    const y = 1.2 + i * 0.69;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 1.2, h: 0.52, fill: { color: st.color }, line: { type: "none" }, rectRadius: 0.05 });
    s.addText(st.step, { x: 0.3, y: y + 0.08, w: 1.2, h: 0.36, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    s.addShape(pres.ShapeType.rect, { x: 1.6, y: y + 0.06, w: 4.0, h: 0.42, fill: { color: "E8F0F7" }, line: { type: "none" }, rectRadius: 0.04 });
    s.addText(st.label, { x: 1.72, y: y + 0.1, w: 3.75, h: 0.34, fontSize: 12, color: C.navy, fontFace: "Calibri", margin: 0 });
  });

  // Right column - Intubation tips box
  s.addShape(pres.ShapeType.rect, { x: 5.9, y: 1.18, w: 3.75, h: 4.2, fill: { color: C.navy }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("Endotracheal Intubation\n– Key Points", { x: 6.05, y: 1.28, w: 3.45, h: 0.65, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  const tips = [
    "Pre-oxygenate: SpO₂ ≥ 95% before attempt",
    "Rapid Sequence Intubation (RSI): Fentanyl + Propofol + Succinylcholine",
    "Confirm with: Capnography + bilateral chest auscultation",
    "Tube position: Tip 2–3 cm above carina (confirm on CXR)",
    "Cuff pressure: 20–30 cmH₂O",
    "Fix tube at 21–23 cm at lip (adult)",
    "Daily re-assess for extubation readiness",
  ];
  tips.forEach((t, i) => {
    s.addText("• " + t, { x: 6.05, y: 2.0 + i * 0.47, w: 3.45, h: 0.43, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 8, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – OXYGEN THERAPY
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Oxygen Therapy in ICU", "Devices, Flow Rates & Targets");
  accentBar(s, C.sky);

  const devices = [
    { dev: "Nasal Cannula", flow: "1–6 L/min", fio2: "24–44%", use: "Mild hypoxaemia, comfortable" },
    { dev: "Simple Face Mask", flow: "5–10 L/min", fio2: "35–55%", use: "Moderate hypoxaemia" },
    { dev: "Venturi Mask", flow: "2–15 L/min", fio2: "24, 28, 35, 40, 60%", use: "COPD – precise FiO₂ needed" },
    { dev: "Non-Rebreather Mask", flow: "10–15 L/min", fio2: "60–90%", use: "Severe hypoxaemia, near 100% O₂" },
    { dev: "HFNO (High-Flow Nasal O₂)", flow: "20–60 L/min", fio2: "21–100%", use: "ARDS, COVID-19, avoids intubation" },
    { dev: "NIV (BiPAP/CPAP)", flow: "Variable", fio2: "21–100%", use: "COPD exacerbation, pulm. oedema" },
    { dev: "Mechanical Ventilator", flow: "Variable", fio2: "21–100%", use: "Respiratory failure, need for sedation" },
  ];

  const headerY = 1.2;
  [["Device", 0.3, 2.5], ["Flow Rate", 2.85, 1.7], ["FiO₂", 4.6, 1.6], ["Clinical Use", 6.25, 3.4]].forEach(([txt, x, w]) => {
    s.addShape(pres.ShapeType.rect, { x, y: headerY, w, h: 0.4, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(txt, { x, y: headerY + 0.04, w, h: 0.32, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  });

  devices.forEach((d, i) => {
    const y = 1.63 + i * 0.53;
    const bg = i % 2 === 0 ? "E8F4FB" : C.white;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.35, h: 0.51, fill: { color: bg }, line: { type: "none" } });
    s.addText(d.dev, { x: 0.38, y: y + 0.09, w: 2.4, h: 0.34, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(d.flow, { x: 2.85, y: y + 0.09, w: 1.6, h: 0.34, fontSize: 11, color: C.teal, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(d.fio2, { x: 4.6, y: y + 0.09, w: 1.55, h: 0.34, fontSize: 11, color: C.sky, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(d.use, { x: 6.25, y: y + 0.09, w: 3.35, h: 0.34, fontSize: 11, color: C.gray, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 9, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – MECHANICAL VENTILATION BASICS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, "0B1E30");
  accentBar(s, C.sky);

  s.addText("Mechanical Ventilation – Basics", {
    x: 0.5, y: 0.15, w: 9, h: 0.65, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.82, w: 9, h: 0.04, fill: { color: C.sky }, line: { type: "none" } });

  // Indications
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0, w: 4.55, h: 2.0, fill: { color: "1A3050" }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("Indications for Intubation", { x: 0.45, y: 1.05, w: 4.2, h: 0.4, fontSize: 14, bold: true, color: C.sky, fontFace: "Calibri", margin: 0 });
  ["Apnoea or severe hypoventilation", "GCS ≤ 8 (airway protection)", "Refractory hypoxaemia (SpO₂ < 90% on high O₂)", "Respiratory failure Type I or II", "Impending airway obstruction"].forEach((t, i) => {
    s.addText("• " + t, { x: 0.45, y: 1.5 + i * 0.3, w: 4.2, h: 0.28, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  // Modes
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.0, w: 4.6, h: 2.0, fill: { color: "1A3050" }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("Common Ventilator Modes", { x: 5.25, y: 1.05, w: 4.2, h: 0.4, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  [
    ["AC/VC", "Assist-Control Volume Control – full support"],
    ["SIMV", "Synchronised Intermittent Mandatory Vent."],
    ["PSV", "Pressure Support – weaning mode"],
    ["CPAP/BiPAP", "Non-invasive support"],
  ].forEach(([mode, desc], i) => {
    s.addText([
      { text: mode + ": ", options: { bold: true, color: C.gold } },
      { text: desc, options: { color: C.offwhite } },
    ], { x: 5.25, y: 1.5 + i * 0.37, w: 4.3, h: 0.33, fontSize: 11, fontFace: "Calibri", margin: 0 });
  });

  // Key settings
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.15, w: 9.4, h: 2.2, fill: { color: "1A3050" }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("Key Ventilator Settings (Lung-Protective Strategy – ARDS)", { x: 0.45, y: 3.2, w: 9.1, h: 0.4, fontSize: 14, bold: true, color: C.sky, fontFace: "Calibri", margin: 0 });
  const settings = [
    ["Tidal Volume (VT)", "6 mL/kg Ideal Body Weight"],
    ["PEEP", "5–15 cmH₂O (maintains alveolar recruitment)"],
    ["FiO₂", "Titrate to SpO₂ 88–95%"],
    ["Respiratory Rate", "12–20 /min"],
    ["Plateau Pressure", "< 30 cmH₂O"],
    ["I:E Ratio", "1:2 (normal), 1:3 in COPD"],
  ];
  settings.forEach((st, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.45 : 5.2;
    s.addText([
      { text: st[0] + ": ", options: { bold: true, color: C.gold } },
      { text: st[1], options: { color: C.offwhite } },
    ], { x, y: 3.7 + row * 0.42, w: 4.5, h: 0.38, fontSize: 11, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 10, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – HEMODYNAMIC MONITORING & SHOCK
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Hemodynamic Monitoring & Shock", "Recognition & Approach (NMC Competency: IM8.5)");
  accentBar(s, C.red);

  // Shock types
  const shocks = [
    { type: "Distributive", eg: "Septic, Anaphylactic, Neurogenic", mechanism: "↓SVR, maldistribution of flow", HR: "↑", BP: "↓", CO: "↑", SVR: "↓↓", color: C.red },
    { type: "Cardiogenic", eg: "MI, Arrhythmia, Myocarditis", mechanism: "Pump failure: ↓CO despite ↑filling", HR: "↑", BP: "↓", CO: "↓↓", SVR: "↑", color: C.sky },
    { type: "Hypovolemic", eg: "Haemorrhage, Burns, Dehydration", mechanism: "↓Preload → ↓CO", HR: "↑", BP: "↓", CO: "↓", SVR: "↑", color: C.gold },
    { type: "Obstructive", eg: "PE, Tension Pneumothorax, Cardiac Tamponade", mechanism: "Mechanical obstruction to flow", HR: "↑", BP: "↓", CO: "↓", SVR: "↑", color: C.teal },
  ];

  // Table header
  const cols = [["Shock Type", 0.3, 1.9], ["Example", 2.25, 2.3], ["Mechanism", 4.6, 2.2], ["HR", 6.85, 0.55], ["BP", 7.45, 0.55], ["CO", 8.05, 0.55], ["SVR", 8.65, 0.9]];
  cols.forEach(([txt, x, w]) => {
    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w, h: 0.42, fill: { color: C.navy }, line: { type: "none" } });
    s.addText(txt, { x: x + 0.04, y: 1.24, w: w - 0.08, h: 0.34, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
  });

  shocks.forEach((sh, i) => {
    const y = 1.65 + i * 0.75;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.25, h: 0.7, fill: { color: i % 2 === 0 ? "EEF3F8" : C.white }, line: { type: "none" } });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.18, h: 0.7, fill: { color: sh.color }, line: { type: "none" } });
    s.addText(sh.type, { x: 0.55, y: y + 0.17, w: 1.62, h: 0.36, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(sh.eg, { x: 2.25, y: y + 0.1, w: 2.25, h: 0.52, fontSize: 10, color: C.gray, fontFace: "Calibri", margin: 0 });
    s.addText(sh.mechanism, { x: 4.6, y: y + 0.1, w: 2.15, h: 0.52, fontSize: 10, color: C.gray, fontFace: "Calibri", margin: 0 });
    [sh.HR, sh.BP, sh.CO, sh.SVR].forEach((val, j) => {
      const xv = [6.85, 7.45, 8.05, 8.65][j];
      const wv = [0.55, 0.55, 0.55, 0.9][j];
      s.addText(val, { x: xv, y: y + 0.17, w: wv, h: 0.36, fontSize: 12, bold: true, color: val.includes("↓") ? C.red : C.green, fontFace: "Calibri", align: "center", margin: 0 });
    });
  });

  // MAP target note
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.95, w: 9.25, h: 0.45, fill: { color: C.navy }, line: { type: "none" }, rectRadius: 0.06 });
  s.addText("Target MAP ≥ 65 mmHg in shock  |  Lactate < 2 mmol/L  |  Urine output ≥ 0.5 mL/kg/hr as resuscitation endpoints", {
    x: 0.45, y: 5.0, w: 9.0, h: 0.35, fontSize: 11, bold: true, color: C.gold, fontFace: "Calibri", align: "center", margin: 0,
  });

  slideNum(s, 11, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – FLUID THERAPY & VASOPRESSORS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Fluid Therapy & Vasopressors in ICU", "Resuscitation Principles");
  accentBar(s, C.teal);

  // Left: Fluid therapy
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 4.5, h: 4.1, fill: { color: C.navy }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("Fluid Therapy", { x: 0.45, y: 1.28, w: 4.1, h: 0.45, fontSize: 16, bold: true, color: C.sky, fontFace: "Calibri", margin: 0 });

  const fluids = [
    ["Normal Saline (0.9%)", "Isotonic; caution: hyperchloraemic acidosis"],
    ["Ringer's Lactate", "Preferred balanced crystalloid"],
    ["5% Dextrose", "Hypotonic; avoid for resuscitation"],
    ["Colloids (Albumin 4%)", "Volume expansion; used in hypoalbuminaemia"],
    ["Blood Products", "pRBC if Hb < 7 g/dL (< 10 if cardiac)"],
  ];
  fluids.forEach(([name, note], i) => {
    s.addText(name, { x: 0.48, y: 1.85 + i * 0.63, w: 4.0, h: 0.28, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
    s.addText(note, { x: 0.48, y: 2.13 + i * 0.63, w: 4.0, h: 0.3, fontSize: 11, color: C.lightgray, fontFace: "Calibri", margin: 0 });
  });

  // Right: Vasopressors
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.2, w: 4.55, h: 4.1, fill: { color: "0D2438" }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("Vasopressors / Inotropes", { x: 5.25, y: 1.28, w: 4.2, h: 0.45, fontSize: 16, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });

  const vasopressors = [
    { drug: "Norepinephrine", dose: "0.01–3 mcg/kg/min", note: "1st line in septic shock (alpha>beta)" },
    { drug: "Vasopressin", dose: "0.01–0.04 U/min", note: "Adjunct to NE; preserves vasopressin deficiency" },
    { drug: "Dopamine", dose: "5–20 mcg/kg/min", note: "Dose-dependent effects; less preferred" },
    { drug: "Epinephrine", dose: "0.01–1 mcg/kg/min", note: "Anaphylaxis; cardiac arrest; cardiogenic shock" },
    { drug: "Dobutamine", dose: "2.5–20 mcg/kg/min", note: "Inotrope – cardiogenic shock; ↑CO" },
  ];
  vasopressors.forEach((v, i) => {
    s.addText(v.drug, { x: 5.28, y: 1.85 + i * 0.63, w: 4.2, h: 0.28, fontSize: 12, bold: true, color: C.sky, fontFace: "Calibri", margin: 0 });
    s.addText(`${v.dose}  –  ${v.note}`, { x: 5.28, y: 2.13 + i * 0.63, w: 4.2, h: 0.3, fontSize: 10, color: C.lightgray, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 12, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – SEPSIS & SEPTIC SHOCK
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, "180A0A");
  accentBar(s, C.red);

  s.addText("Sepsis & Septic Shock", {
    x: 0.5, y: 0.15, w: 9, h: 0.65, fontSize: 28, bold: true, color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.83, w: 9, h: 0.04, fill: { color: C.red }, line: { type: "none" } });

  // Definitions
  const defs = [
    { term: "Sepsis", def: "Life-threatening organ dysfunction caused by a dysregulated host response to infection. SOFA score increase ≥ 2 points.", color: C.gold },
    { term: "Septic Shock", def: "Subset of sepsis with circulatory & cellular/metabolic abnormalities. MAP < 65 despite adequate fluids + vasopressor need + lactate > 2 mmol/L.", color: C.red },
    { term: "qSOFA", def: "Bedside screening: Altered mentation + RR ≥ 22/min + SBP ≤ 100 mmHg. Score ≥ 2 = high risk. Use outside ICU.", color: C.sky },
  ];

  defs.forEach((d, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0 + i * 1.1, w: 9.3, h: 0.98, fill: { color: "2A1010" }, line: { color: d.color, width: 1.5 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0 + i * 1.1, w: 1.5, h: 0.98, fill: { color: d.color }, line: { type: "none" }, rectRadius: 0.08 });
    s.addText(d.term, { x: 0.3, y: 1.22 + i * 1.1, w: 1.5, h: 0.5, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(d.def, { x: 1.95, y: 1.05 + i * 1.1, w: 7.5, h: 0.9, fontSize: 12, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  // Surviving Sepsis - Hour-1 Bundle
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.35, w: 9.3, h: 1.05, fill: { color: "2A1010" }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.08 });
  s.addText("Surviving Sepsis Campaign – Hour-1 Bundle:", { x: 0.45, y: 4.4, w: 9.1, h: 0.35, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
  s.addText("1. Measure lactate  2. Blood cultures before antibiotics  3. Broad-spectrum antibiotics within 1 hour  4. 30 mL/kg crystalloid for hypotension/lactate ≥ 4  5. Vasopressors if MAP < 65 after fluids", {
    x: 0.45, y: 4.78, w: 9.1, h: 0.55, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0,
  });

  slideNum(s, 13, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – RENAL FAILURE IN ICU
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Acute Kidney Injury (AKI) in ICU", "KDIGO Criteria & Management");
  accentBar(s, C.sky);

  // Left column
  s.addText("KDIGO AKI Staging", { x: 0.3, y: 1.25, w: 4.5, h: 0.42, fontSize: 16, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });

  const stages = [
    { stage: "Stage 1", scr: "1.5–1.9× baseline OR ≥ 0.3 mg/dL rise", uo: "< 0.5 mL/kg/h × 6–12 h" },
    { stage: "Stage 2", scr: "2.0–2.9× baseline", uo: "< 0.5 mL/kg/h × ≥ 12 h" },
    { stage: "Stage 3", scr: "≥ 3× baseline OR ≥ 4 mg/dL OR RRT", uo: "< 0.3 mL/kg/h × ≥ 24 h OR anuria ≥ 12 h" },
  ];
  const stageColors = [C.gold, C.red, "8B0000"];
  stages.forEach((st, i) => {
    const y = 1.75 + i * 1.05;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 4.5, h: 0.95, fill: { color: i % 2 === 0 ? "EEF3F8" : "E0EAF3" }, line: { type: "none" }, rectRadius: 0.06 });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.15, h: 0.95, fill: { color: stageColors[i] }, line: { type: "none" } });
    s.addText(st.stage, { x: 0.53, y: y + 0.08, w: 1.1, h: 0.35, fontSize: 13, bold: true, color: stageColors[i], fontFace: "Calibri", margin: 0 });
    s.addText("SCr: " + st.scr, { x: 0.53, y: y + 0.42, w: 4.2, h: 0.28, fontSize: 10, color: C.gray, fontFace: "Calibri", margin: 0 });
    s.addText("UO: " + st.uo, { x: 0.53, y: y + 0.65, w: 4.2, h: 0.26, fontSize: 10, color: C.gray, fontFace: "Calibri", italic: true, margin: 0 });
  });

  // Right column
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.2, w: 4.55, h: 3.95, fill: { color: C.navy }, line: { type: "none" }, rectRadius: 0.1 });
  s.addText("ICU AKI Management", { x: 5.25, y: 1.28, w: 4.2, h: 0.42, fontSize: 15, bold: true, color: C.sky, fontFace: "Calibri", margin: 0 });
  [
    "Identify & treat cause (pre-renal, renal, post-renal)",
    "Optimise haemodynamics: MAP ≥ 65 mmHg",
    "Stop nephrotoxic drugs (NSAIDs, aminoglycosides, contrast)",
    "Fluid resuscitation if pre-renal",
    "Avoid over/under-diuresis",
    "Monitor electrolytes (K⁺, Na⁺, HCO₃⁻, phosphate)",
    "Renal Replacement Therapy (CRRT/IHD) indications:\n  • Severe acidosis (pH < 7.1)\n  • Refractory hyperkalemia (K⁺ > 6.5)\n  • Severe fluid overload\n  • Uraemic encephalopathy",
  ].forEach((t, i) => {
    s.addText("• " + t, { x: 5.25, y: 1.8 + i * 0.47, w: 4.25, h: 0.44, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 14, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – NUTRITION IN ICU
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Nutrition Support in ICU", "Early & Goal-Directed Feeding");
  accentBar(s, C.green);

  // 2 columns
  const leftBoxes = [
    { title: "Why Nutrition Matters in ICU", items: ["Prevents muscle catabolism & ICU-acquired weakness", "Supports immune function & wound healing", "Reduces infections & length of ICU stay", "Maintains gut mucosal integrity (EN route)"] },
    { title: "Caloric Requirements", items: ["Energy: 25–30 kcal/kg/day (non-obese)", "Protein: 1.2–2.0 g/kg/day", "Carbohydrates: 50–60% of calories", "Lipids: 20–35%", "Target blood glucose: 140–180 mg/dL"] },
  ];
  leftBoxes.forEach((b, i) => {
    const y = 1.2 + i * 2.0;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 4.5, h: 1.82, fill: { color: i === 0 ? C.navy : "1B4030" }, line: { type: "none" }, rectRadius: 0.1 });
    s.addText(b.title, { x: 0.45, y: y + 0.1, w: 4.2, h: 0.42, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
    b.items.forEach((item, j) => {
      s.addText("• " + item, { x: 0.45, y: y + 0.55 + j * 0.31, w: 4.2, h: 0.29, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0 });
    });
  });

  // Right: EN vs PN comparison
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.2, w: 4.55, h: 4.1, fill: { color: C.offwhite }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Enteral (EN) vs Parenteral (PN) Nutrition", { x: 5.25, y: 1.28, w: 4.2, h: 0.5, fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });

  [[C.teal, "Enteral Nutrition (EN) – PREFERRED"], ["8B0000", "Parenteral Nutrition (PN) – Backup"]].forEach(([col, head], j) => {
    const y2 = 1.85 + j * 1.95;
    s.addShape(pres.ShapeType.rect, { x: 5.25, y: y2, w: 4.2, h: 0.38, fill: { color: col }, line: { type: "none" }, rectRadius: 0.05 });
    s.addText(head, { x: 5.3, y: y2 + 0.05, w: 4.1, h: 0.28, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });
    const items = j === 0
      ? ["Start within 24–48 hrs if haemodynamically stable", "Maintains gut flora & barrier", "Nasogastric (NGT) or nasoduodenal tube", "Check residual volume if on opioids"]
      : ["Use if EN not tolerated > 7 days", "Higher infection & line-related risks", "Requires central venous access", "Strict glucose monitoring essential"];
    items.forEach((it, k) => {
      s.addText("• " + it, { x: 5.28, y: y2 + 0.45 + k * 0.36, w: 4.15, h: 0.34, fontSize: 10.5, color: C.navy, fontFace: "Calibri", margin: 0 });
    });
  });

  slideNum(s, 15, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 – INFECTION CONTROL IN ICU
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, "0A1F0A");
  accentBar(s, C.green);

  s.addText("Infection Control & Prevention in ICU", {
    x: 0.5, y: 0.15, w: 9, h: 0.65, fontSize: 25, bold: true, color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.83, w: 9, h: 0.04, fill: { color: C.green }, line: { type: "none" } });

  const bundles = [
    {
      title: "VAP Prevention Bundle (Ventilator-Associated Pneumonia)",
      color: C.sky,
      items: ["Head of bed elevation 30–45°", "Daily interruption of sedation + SBT (Spontaneous Breathing Trial)", "Oral hygiene with chlorhexidine", "Stress ulcer prophylaxis (PPI/H2RA)", "DVT prophylaxis (LMWH + compression stockings)", "Subglottic secretion drainage ETT"],
    },
    {
      title: "CLABSI Prevention (Central-Line Associated Bloodstream Infection)",
      color: C.gold,
      items: ["Full sterile barrier during CVC insertion", "Chlorhexidine skin antisepsis", "Subclavian preferred site (lowest infection)", "Daily review: Is catheter still needed?", "Remove catheters when no longer needed"],
    },
    {
      title: "CAUTI Prevention (Catheter-Associated UTI)",
      color: C.teal,
      items: ["Insert catheter only when indicated", "Maintain closed drainage system", "Daily review of catheter necessity", "Perineal hygiene & aseptic insertion"],
    },
  ];

  bundles.forEach((b, i) => {
    const y = 1.0 + i * 1.52;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.3, h: 1.4, fill: { color: "0D2010" }, line: { color: b.color, width: 1.2 }, rectRadius: 0.08 });
    s.addText(b.title, { x: 0.45, y: y + 0.07, w: 9.1, h: 0.38, fontSize: 13, bold: true, color: b.color, fontFace: "Calibri", margin: 0 });
    const half = Math.ceil(b.items.length / 2);
    b.items.slice(0, half).forEach((it, j) => {
      s.addText("• " + it, { x: 0.45, y: y + 0.5 + j * 0.3, w: 4.5, h: 0.28, fontSize: 10.5, color: C.offwhite, fontFace: "Calibri", margin: 0 });
    });
    b.items.slice(half).forEach((it, j) => {
      s.addText("• " + it, { x: 5.1, y: y + 0.5 + j * 0.3, w: 4.4, h: 0.28, fontSize: 10.5, color: C.offwhite, fontFace: "Calibri", margin: 0 });
    });
  });

  slideNum(s, 16, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 – SEDATION, ANALGESIA & DELIRIUM
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "Sedation, Analgesia & Delirium in ICU", "Pain-Agitation-Delirium (PAD) Bundle");
  accentBar(s, C.gold);

  const cols = [
    {
      head: "Analgesia – FIRST",
      color: C.green,
      items: [
        ["Morphine / Fentanyl", "Opioid – IV infusion; fentanyl preferred in renal failure"],
        ["Paracetamol", "Adjunct – reduces opioid requirements"],
        ["NSAIDs", "Caution in ICU: renal & GI effects"],
        ["Assess with NRS or CPOT scale", "Target: CPOT ≤ 2"],
      ],
    },
    {
      head: "Sedation – Lightest Effective",
      color: C.sky,
      items: [
        ["Propofol", "Short-acting, easily titratable; monitor for PRIS"],
        ["Midazolam", "Avoid in elderly; accumulates, prolonged weaning"],
        ["Dexmedetomidine", "Light sedation; allows verbal response; reduces delirium"],
        ["RASS Target: -1 to 0", "Light sedation or alert is goal"],
      ],
    },
    {
      head: "Delirium – Monitor & Prevent",
      color: C.red,
      items: [
        ["CAM-ICU", "Validated delirium screening tool in ICU"],
        ["Risk factors", "Age, dementia, sedation, sleep deprivation, immobility"],
        ["Non-pharm", "Reorientation, day-night cycle, early mobilisation, family"],
        ["Pharmacologic", "Haloperidol (mild evidence); avoid in Parkinson's"],
      ],
    },
  ];

  cols.forEach((col, i) => {
    const x = 0.3 + i * 3.22;
    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 3.0, h: 4.1, fill: { color: C.navy }, line: { type: "none" }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 3.0, h: 0.52, fill: { color: col.color }, line: { type: "none" }, rectRadius: 0.1 });
    s.addText(col.head, { x: x + 0.1, y: 1.25, w: 2.8, h: 0.42, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    col.items.forEach(([drug, note], j) => {
      s.addText(drug, { x: x + 0.12, y: 1.82 + j * 0.82, w: 2.76, h: 0.3, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", margin: 0 });
      s.addText(note, { x: x + 0.12, y: 2.12 + j * 0.82, w: 2.76, h: 0.45, fontSize: 10, color: C.lightgray, fontFace: "Calibri", margin: 0 });
    });
  });

  slideNum(s, 17, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 – ETHICS & COMMUNICATION IN ICU
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, "0D0D25");
  accentBar(s, C.gold);

  s.addText("Ethics & Communication in ICU", {
    x: 0.5, y: 0.15, w: 9, h: 0.65, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.83, w: 9, h: 0.04, fill: { color: C.gold }, line: { type: "none" } });

  const ethicsTopics = [
    {
      head: "Informed Consent in ICU",
      body: "Patients may lack capacity due to sedation, delirium, or unconsciousness. Substitute decision-maker (family/legal guardian) acts. Emergency consent implied when life-threatening. Document clearly.",
      color: C.sky,
    },
    {
      head: "Withholding & Withdrawing Treatment",
      body: "Both are ethically equivalent. Based on patient's best interest, expressed wishes (advance directives), and futility. Shared decision-making with family. Refer to ethics committee if conflict arises.",
      color: C.gold,
    },
    {
      head: "Do Not Resuscitate (DNR) Orders",
      body: "Must be clearly documented and communicated to team. Based on patient/surrogate wishes and clinical assessment of CPR benefit. DNR does not mean withholding comfort care.",
      color: C.red,
    },
    {
      head: "Family Communication",
      body: "Daily family meetings recommended. Use SPIKES protocol: Setting, Perception, Invitation, Knowledge, Empathy, Summary. Avoid jargon. Be honest about prognosis. Cultural sensitivity essential.",
      color: C.teal,
    },
  ];

  ethicsTopics.forEach((et, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.3 : 5.15;
    const y = 1.05 + row * 2.18;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.65, h: 2.0, fill: { color: "1A1A35" }, line: { color: et.color, width: 1.2 }, rectRadius: 0.09 });
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    s.addText(et.body, { x: x + 0.15, y: y + 0.55, w: 4.35, h: 1.35, fontSize: 11, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  slideNum(s, 18, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 – ICU COMPETENCIES FOR MBBS (NMC)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  topBanner(s, "ICU Competencies for MBBS – NMC CBME Framework", "What the MBBS Graduate Must Know & Do");
  accentBar(s, C.navy);

  const comps = [
    { domain: "Knowledge (KT)", items: ["Principles of organ support in ICU", "Pathophysiology of sepsis, ARDS, AKI", "Types of ventilatory support & oxygenation", "Pharmacology of vasopressors & sedatives", "Fluid physiology & acid-base balance"], color: C.navy },
    { domain: "Skills (ST)", items: ["Assess and document AVPU / GCS", "ABG interpretation", "Interpret ECG & monitor alarms", "Assist in CPR (BLS & ACLS)", "Nasogastric tube insertion", "Blood/urine/culture sample collection"], color: C.teal },
    { domain: "Attitude (AT)", items: ["Communicate sensitively with ICU families", "Apply ethical principles to end-of-life care", "Work effectively in multidisciplinary team", "Follow infection control protocols diligently", "Document clearly and accurately"], color: C.green },
  ];

  comps.forEach((c, i) => {
    const x = 0.3 + i * 3.22;
    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 3.0, h: 4.15, fill: { color: "EEF3F8" }, line: { color: c.color, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 3.0, h: 0.52, fill: { color: c.color }, line: { type: "none" }, rectRadius: 0.1 });
    s.addText(c.domain, { x: x + 0.1, y: 1.25, w: 2.8, h: 0.42, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    c.items.forEach((item, j) => {
      s.addShape(pres.ShapeType.ellipse, { x: x + 0.15, y: 1.88 + j * 0.65, w: 0.2, h: 0.2, fill: { color: c.color }, line: { type: "none" } });
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    });
  });

  slideNum(s, 19, TOTAL);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 20 – SUMMARY / THANK YOU
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, C.navy);

  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy }, line: { type: "none" } });
  // Decorative diagonal shape
  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0, w: 3.5, h: 5.625, fill: { color: C.teal }, line: { type: "none" } });
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  s.addText("Key Takeaways", {
    x: 0.5, y: 0.3, w: 5.4, h: 0.6, fontSize: 24, bold: true, color: C.gold, fontFace: "Calibri", margin: 0,
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  const takeaways = [
    "ICU is a life-support environment – monitoring is continuous",
    "Early recognition & treatment saves lives (Sepsis Hour-1 Bundle)",
    "Airway first – Intubate when GCS ≤ 8 or impending respiratory failure",
    "Lung-protective ventilation: 6 mL/kg VT, Plateau < 30 cmH₂O",
    "Shock management: identify type, target MAP ≥ 65 mmHg",
    "Prevention = Outcome: VAP, CLABSI, CAUTI bundles matter",
    "Communicate, empathise, document – ethics is not optional",
  ];
  takeaways.forEach((t, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.05 + i * 0.6, w: 0.35, h: 0.35, fill: { color: C.teal }, line: { type: "none" }, rectRadius: 0.05 });
    s.addText((i + 1).toString(), { x: 0.5, y: 1.08 + i * 0.6, w: 0.35, h: 0.28, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText(t, { x: 0.95, y: 1.06 + i * 0.6, w: 5.0, h: 0.5, fontSize: 12, color: C.offwhite, fontFace: "Calibri", margin: 0 });
  });

  s.addText("Thank You", {
    x: 6.5, y: 1.5, w: 3.2, h: 0.75, fontSize: 32, bold: true, color: C.white, fontFace: "Calibri", align: "center", margin: 0,
  });
  s.addText("Basics of ICU Care\nMBBS – NMC CBME", {
    x: 6.5, y: 2.35, w: 3.2, h: 0.8, fontSize: 14, color: C.navy, fontFace: "Calibri", align: "center", margin: 0,
  });
  s.addShape(pres.ShapeType.rect, { x: 6.8, y: 3.25, w: 2.6, h: 0.06, fill: { color: C.gold }, line: { type: "none" } });
  s.addText("Questions & Discussion", {
    x: 6.5, y: 3.4, w: 3.2, h: 0.45, fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", align: "center", margin: 0,
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  s.addText("NMC CBME | June 2026", {
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}

// ══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/icu-basics-ppt/ICU_Basics_MBBS_NMC.pptx" })
  .then(() => console.log("PPT created successfully!"))
  .catch(err => { console.error("Error:", err); process.exit(1); });