from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR
from pptx.dml.color import RGBColor
from pptx.enum.dml import MSO_THEME_COLOR
from pptx.enum.text import MSO_AUTO_SIZE
from pptx.oxml.xmlchemy import OxmlElement

OUT = '/tmp/workspace/safe-general-surgery-ppt/output/Principles_of_Safe_General_Surgery.pptx'

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]

# Palette
NAVY = RGBColor(13, 35, 57)
BLUE = RGBColor(25, 108, 167)
TEAL = RGBColor(26, 149, 148)
GREEN = RGBColor(41, 135, 91)
AMBER = RGBColor(222, 142, 40)
RED = RGBColor(183, 67, 66)
INK = RGBColor(29, 42, 54)
MUTED = RGBColor(93, 110, 123)
LIGHT = RGBColor(243, 247, 249)
WHITE = RGBColor(255,255,255)
PALE_BLUE = RGBColor(228, 241, 250)
PALE_TEAL = RGBColor(226, 245, 243)
PALE_AMBER = RGBColor(253, 244, 227)
PALE_RED = RGBColor(252, 235, 235)
GREY = RGBColor(218, 227, 232)

speaker_colors = [BLUE, TEAL, AMBER, GREEN]
speaker_names = ['PERSON 1 | PREOPERATIVE', 'PERSON 2 | ASEPSIS & OR', 'PERSON 3 | INTRAOPERATIVE', 'PERSON 4 | POSTOPERATIVE']


def set_bg(slide, color=WHITE):
    shape = slide.background.fill
    shape.solid(); shape.fore_color.rgb = color


def rect(slide, x,y,w,h, fill, line=None, radius=False):
    shape = slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid(); shape.fill.fore_color.rgb = fill
    shape.line.color.rgb = line if line else fill
    if radius:
        shape.adjustments[0] = 0.12
    return shape


def line(slide, x1,y1,x2,y2,color,width=1.5):
    sh = slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2))
    sh.line.color.rgb=color; sh.line.width=Pt(width)
    return sh


def tb(slide, text, x,y,w,h, size=18, color=INK, bold=False, font='Aptos', align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP, margin=0.05, italic=False):
    sh=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h))
    tf=sh.text_frame; tf.clear(); tf.word_wrap=True
    tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin)
    tf.vertical_anchor=valign
    p=tf.paragraphs[0]; p.alignment=align
    r=p.add_run(); r.text=text; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.italic=italic; r.font.color.rgb=color
    return sh


def bullets(slide, items, x,y,w,h, size=17, color=INK, bullet_color=None, line_space=1.06):
    sh=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=sh.text_frame
    tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(0.08); tf.margin_right=Inches(0.03); tf.margin_top=Inches(0.02); tf.margin_bottom=Inches(0.02)
    for i,item in enumerate(items):
        if isinstance(item, tuple): level, text = item
        else: level, text = 0, item
        p=tf.paragraphs[0] if i==0 else tf.add_paragraph()
        p.text=text; p.level=level; p.font.name='Aptos'; p.font.size=Pt(size if level==0 else size-2); p.font.color.rgb=color
        p.space_after=Pt(7 if level==0 else 3); p.line_spacing=line_space
        if level==0:
            p.text = '•  ' + text
    return sh


def title(slide, text, subtitle=None, section=None, sn=0, dark=False):
    if dark:
        color=WHITE; muted=RGBColor(210,226,237)
    else:
        color=NAVY; muted=MUTED
    tb(slide,text,0.62,0.36,11.7,0.55,29,color,True)
    line(slide,0.63,1.06,12.68,1.06, speaker_colors[sn] if section is not None else BLUE, 2.5)
    if subtitle: tb(slide,subtitle,0.64,1.16,11.5,0.34,12.5,muted)
    if section is not None:
        rect(slide,11.08,0.35,1.62,0.34,speaker_colors[sn],speaker_colors[sn],True)
        tb(slide,section,11.13,0.40,1.52,0.19,8.2,WHITE,True,align=PP_ALIGN.CENTER)


def footer(slide, num, citation='Bailey & Love, 28th ed. | educational summary'):
    line(slide,0.62,7.12,12.7,7.12,GREY,0.7)
    tb(slide,citation,0.65,7.18,10.7,0.17,7.6,MUTED)
    tb(slide,str(num).zfill(2),12.1,7.15,0.5,0.2,8.5,NAVY,True,align=PP_ALIGN.RIGHT)


def speaker_badge(slide, sn):
    x=0.66+sn*3.08
    rect(slide,x,6.55,2.82,0.31, speaker_colors[sn], speaker_colors[sn], True)
    tb(slide,speaker_names[sn],x+0.08,6.62,2.66,0.12,7.5,WHITE,True,align=PP_ALIGN.CENTER)


def card(slide, x,y,w,h, heading, body, accent=BLUE, icon=None, fs=15):
    rect(slide,x,y,w,h,WHITE,GREY,True)
    rect(slide,x,y,0.11,h,accent,accent,True)
    if icon:
        rect(slide,x+0.25,y+0.28,0.44,0.44,accent,accent,True)
        tb(slide,icon,x+0.25,y+0.36,0.44,0.18,12,WHITE,True,align=PP_ALIGN.CENTER)
        tx=x+0.82
    else: tx=x+0.3
    tb(slide,heading,tx,y+0.27,w-(tx-x)-0.22,0.28,15.5,NAVY,True)
    bullets(slide,body,tx,y+0.72,w-(tx-x)-0.23,h-0.84,fs,INK)


def checkpoint(slide, x,y,w,h, num, heading, content, accent):
    rect(slide,x,y,w,h,WHITE,GREY,True)
    rect(slide,x+0.22,y+0.22,0.46,0.46,accent,accent,True)
    tb(slide,str(num),x+0.22,y+0.30,0.46,0.18,12,WHITE,True,align=PP_ALIGN.CENTER)
    tb(slide,heading,x+0.82,y+0.22,w-1.0,0.27,15,NAVY,True)
    tb(slide,content,x+0.82,y+0.59,w-1.02,h-0.75,12.5,MUTED)

# 1 Title
s=prs.slides.add_slide(BLANK); set_bg(s,NAVY)
# decorative rings
for x,y,d,c in [(10.9,0.45,1.65,TEAL),(11.45,1.03,0.92,BLUE),(10.15,5.65,1.05,AMBER)]:
    shp=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y), Inches(d), Inches(d)); shp.fill.background(); shp.line.color.rgb=c; shp.line.width=Pt(3)
tb(s,'PRINCIPLES OF\nSAFE GENERAL SURGERY',0.72,1.22,8.7,1.55,35,WHITE,True)
tb(s,'A four-person presentation | patient-centred, team-based and systems-aware care',0.75,3.0,8.5,0.35,17,RGBColor(207,224,233))
rect(s,0.75,3.75,7.9,0.70,RGBColor(21,56,81),RGBColor(21,56,81),True)
tb(s,'Preoperative  •  Asepsis & OR  •  Intraoperative  •  Postoperative',0.97,3.97,7.45,0.22,14,WHITE,True,align=PP_ALIGN.CENTER)
tb(s,'Based primarily on Bailey & Love’s Short Practice of Surgery, 28th edition',0.76,6.56,8.8,0.24,10.5,RGBColor(171,199,215))
tb(s,'General Surgery',10.18,6.56,2.2,0.24,10.5,WHITE,True,align=PP_ALIGN.RIGHT)

# 2 Architecture
s=prs.slides.add_slide(BLANK); set_bg(s,LIGHT); title(s,'Safe surgery is a continuous safety system','Four linked phases, each with independent checks and shared accountability.')
steps=[('01','PREOPERATIVE','Right patient. Right plan. Risk reduced.',BLUE),('02','OR & ASEPSIS','Clean field. Clear team communication.',TEAL),('03','INTRAOPERATIVE','Physiology protected. Errors trapped.',AMBER),('04','POSTOPERATIVE','Deterioration detected. Recovery enabled.',GREEN)]
for i,(n,h,b,c) in enumerate(steps):
    x=0.72+i*3.12
    rect(s,x,2.05,2.68,2.72,WHITE,GREY,True)
    rect(s,x,2.05,2.68,0.12,c,c,True)
    tb(s,n,x+0.25,2.39,0.5,0.25,16,c,True)
    tb(s,h,x+0.25,2.85,2.15,0.38,17,NAVY,True)
    tb(s,b,x+0.25,3.56,2.1,0.7,13,MUTED)
    if i<3: line(s,x+2.76,3.38,x+3.00,3.38,c,2)
tb(s,'Core principle',0.72,5.46,1.5,0.28,14,NAVY,True)
tb(s,'Prevent predictable harm, identify deviation early, and make recovery safer through reliable team processes.',0.72,5.84,11.8,0.5,21,INK,True)
footer(s,2,'Bailey & Love, 28th ed., Ch. 15 Patient safety')

# 3 person 1
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'1. Preoperative safety: know the patient, plan the operation','Every avoidable risk should be identified and addressed before incision.',speaker_names[0],0)
card(s,0.72,1.76,3.85,3.82,'Structured assessment',['Confirm indication, urgency and expected physiological stress','History: comorbidity, medicines, allergies, previous anaesthesia and bleeding','Examination: airway, cardiopulmonary reserve, functional status, hydration and infection'],BLUE,'A',14)
card(s,4.75,1.76,3.85,3.82,'Risk stratification',['Use ASA physical-status grade as a communication tool, not a stand-alone prediction','Consider procedure-specific risk and patient frailty','Target investigations to the patient and planned surgery'],BLUE,'R',14)
card(s,8.78,1.76,3.85,3.82,'Shared decision-making',['Explain benefits, material risks, alternatives and consequences of no treatment','Assess capacity and allow questions','Document consent and ensure a clear postoperative plan'],BLUE,'C',14)
speaker_badge(s,0); footer(s,3,'Bailey & Love, 28th ed., Ch. 24 Perioperative care; Ch. 15 Patient safety')

#4 optimization ASA
s=prs.slides.add_slide(BLANK); set_bg(s,LIGHT); title(s,'Optimize before surgery where time allows','Aim for the best achievable physiological state, without unsafe delay in urgent disease.',speaker_names[0],0)
items=[('Diabetes','Plan perioperative glucose monitoring and medication/insulin adjustment; avoid both hypo- and hyperglycaemia.'),('Cardiovascular disease','Assess symptoms and functional capacity; control hypertension and coordinate high-risk cases with anaesthesia/medicine.'),('Anaemia','Identify cause, correct iron deficiency or other reversible factors, and plan blood conservation.'),('Nutrition & hydration','Screen for malnutrition, support nutrition when feasible, correct dehydration and electrolyte disturbance.')]
for i,(h,b) in enumerate(items):
    x=0.72+(i%2)*6.05; y=1.75+(i//2)*2.15
    checkpoint(s,x,y,5.62,1.58,i+1,h,b,BLUE)
rect(s,0.72,6.16,11.7,0.45,PALE_BLUE,PALE_BLUE,True); tb(s,'ASA I to VI describes pre-anaesthetic physical status. Document it clearly alongside procedure urgency and key risk modifiers.',0.93,6.29,11.3,0.15,11.5,NAVY,True)
speaker_badge(s,0); footer(s,4,'Bailey & Love, 28th ed., Ch. 24 Perioperative care')

#5 identity and prophylaxis
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'The pre-incision safety bundle','Verification and prophylaxis must be completed, recorded and communicated.',speaker_names[0],0)
checkpoint(s,0.75,1.72,5.75,1.42,1,'IDENTITY, PROCEDURE, SITE','Use at least two identifiers. Reconcile consent, theatre list, imaging and visible site mark. Resolve any mismatch before proceeding.',BLUE)
checkpoint(s,0.75,3.43,5.75,1.42,2,'ANTIBIOTIC PROPHYLAXIS','Select for operation and local policy. Give within an appropriate pre-incision window; re-dose during prolonged surgery or major blood loss when indicated.',BLUE)
checkpoint(s,6.78,1.72,5.75,1.42,3,'VTE PREVENTION','Assess thrombosis and bleeding risks. Use early mobilisation plus mechanical and/or pharmacological prophylaxis according to local protocol.',BLUE)
checkpoint(s,6.78,3.43,5.75,1.42,4,'READY FOR ANAESTHESIA','Confirm fasting status, allergies, blood availability if needed, equipment and postoperative destination.',BLUE)
rect(s,0.75,5.47,11.78,0.55,PALE_BLUE,PALE_BLUE,True); tb(s,'STOP THE LINE: uncertainty about identity, site, consent or readiness is a reason to pause, escalate and correct.',0.98,5.66,11.25,0.18,14,NAVY,True,align=PP_ALIGN.CENTER)
speaker_badge(s,0); footer(s,5,'Bailey & Love, 28th ed., Ch. 15 Patient safety; Ch. 24 Perioperative care')

#6 person 2
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'2. Asepsis: break the chain of infection','A sterile field is created through reliable micro-actions, not a single action.',speaker_names[1],1)
for i,(h,b,ic) in enumerate([('Hand hygiene','Before and after patient contact; surgical hand antisepsis before gowning.','1'),('Sterilization','Validated cleaning, packaging, sterilization and traceability of instruments.','2'),('Barrier technique','Sterile gown and gloves; replace contaminated or damaged barriers promptly.','3'),('Skin preparation','Appropriate hair removal only if needed; antisepsis, adequate drying and sterile draping.','4')]):
    x=0.72+(i%2)*6.02; y=1.72+(i//2)*2.1
    card(s,x,y,5.62,1.6,h,[b],TEAL,ic,13.2)
rect(s,0.72,6.10,11.72,0.54,PALE_TEAL,PALE_TEAL,True); tb(s,'The sterile field is a shared responsibility. Anyone who sees a break in asepsis should speak up immediately.',0.97,6.29,11.2,0.17,13,NAVY,True,align=PP_ALIGN.CENTER)
speaker_badge(s,1); footer(s,6,'Bailey & Love, 28th ed., Ch. 7 Operating theatre practice; Ch. 15 Patient safety')

#7 SSI prevention
s=prs.slides.add_slide(BLANK); set_bg(s,LIGHT); title(s,'Preventing surgical-site infection is a perioperative task','Control patient, procedure, environmental and team factors.',speaker_names[1],1)
cols=[('Before incision',['Treat remote infection where feasible','Optimise glycaemia, nutrition and smoking status','Appropriate hair removal and skin antisepsis','Appropriate prophylactic antibiotics'],TEAL),('During surgery',['Maintain asepsis and gentle tissue handling','Haemostasis and avoid unnecessary devascularisation','Limit contamination and operative time','Maintain normothermia and oxygenation'],TEAL),('After surgery',['Aseptic wound and drain handling','Review wound only when clinically needed','Prompt recognition of erythema, discharge, fever or pain','Use antimicrobial stewardship'],TEAL)]
for i,(h,bs,c) in enumerate(cols):
    x=0.72+i*4.1
    rect(s,x,1.78,3.72,4.45,WHITE,GREY,True); rect(s,x,1.78,3.72,0.47,c,c,True)
    tb(s,h,x+0.22,2.0,3.25,0.23,16,NAVY,True)
    bullets(s,bs,x+0.22,2.62,3.16,3.15,14.1)
speaker_badge(s,1); footer(s,7,'Bailey & Love, 28th ed., Ch. 7 Preparation of the surgical site')

#8 WHO checklist
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'WHO Surgical Safety Checklist: three deliberate team pauses','The checklist supports teamwork and communication. It does not replace clinical judgement.',speaker_names[1],1)
phases=[('SIGN IN','Before induction of anaesthesia','Identity, site, procedure and consent\nAllergy and airway/aspiration risk\nPulse oximeter functioning\nBlood-loss risk and readiness',BLUE),('TIME OUT','Before skin incision','Team introductions\nConfirm patient, procedure and site\nAntibiotic prophylaxis given\nCritical steps, concerns and imaging',TEAL),('SIGN OUT','Before patient leaves operating room','Name procedure performed\nInstrument, sponge and needle counts\nSpecimen labelling\nEquipment issues and recovery plan',AMBER)]
for i,(h,sub,b,c) in enumerate(phases):
    x=0.72+i*4.09
    rect(s,x,1.78,3.68,3.78,WHITE,GREY,True); rect(s,x,1.78,3.68,0.55,c,c,True)
    tb(s,h,x+0.22,2.08,3.1,0.25,18,NAVY,True)
    tb(s,sub,x+0.22,2.48,3.1,0.22,11.2,MUTED,italic=True)
    for j,t in enumerate(b.split('\n')):
        tb(s,'•  '+t,x+0.25,2.99+j*0.47,3.13,0.34,13.2,INK)
line(s,2.1,6.05,11.15,6.05,TEAL,2)
tb(s,'Confirm out loud. Make concerns speakable. Record completion.',1.4,6.26,10.5,0.3,15,NAVY,True,align=PP_ALIGN.CENTER)
speaker_badge(s,1); footer(s,8,'Bailey & Love, 28th ed., Ch. 15 Patient safety | WHO Surgical Safety Checklist, 2009')

#9 person3
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'3. Intraoperative safety: protect physiology and prevent error','Continuous monitoring, anticipation and communication are the operating team’s safety net.',speaker_names[2],2)
card(s,0.72,1.70,3.82,3.9,'Anaesthesia & airway',['Pre-induction check and clear airway plan','Monitor oxygenation, ventilation and circulation','Anticipate aspiration, difficult airway and postoperative respiratory support'],AMBER,'A',14)
card(s,4.76,1.70,3.82,3.9,'Physiology',['Use appropriate monitoring and trend changes','Maintain perfusion, temperature and glucose control','Escalate early when instability persists'],AMBER,'P',14)
card(s,8.80,1.70,3.82,3.9,'Team communication',['State critical operative steps and anticipated blood loss','Use closed-loop communication for key instructions','Share a plan for complications, specimen and recovery'],AMBER,'T',14)
speaker_badge(s,2); footer(s,9,'Bailey & Love, 28th ed., Ch. 15 Patient safety; Ch. 24 Perioperative care')

#10 position fluids blood
s=prs.slides.add_slide(BLANK); set_bg(s,LIGHT); title(s,'Control the preventable physiological hazards','Position, temperature, fluids and transfusion require active management, not observation alone.',speaker_names[2],2)
checkpoint(s,0.72,1.72,5.62,1.42,1,'SAFE POSITIONING','Padding, neutral alignment, protected eyes and pressure points. Avoid excessive stretch, compression and unsupported limbs.',AMBER)
checkpoint(s,6.72,1.72,5.62,1.42,2,'NORMOTHERMIA','Monitor core temperature when appropriate; reduce exposure, use active warming and warm fluids/blood when indicated.',AMBER)
checkpoint(s,0.72,3.48,5.62,1.42,3,'FLUIDS & ELECTROLYTES','Assess losses and response using clinical context and measured parameters. Correct deficits; avoid both under-resuscitation and overload.',AMBER)
checkpoint(s,6.72,3.48,5.62,1.42,4,'BLOOD SAFETY','Anticipate blood loss, ensure blood is correctly identified, use a transfusion check, monitor response and document events.',AMBER)
rect(s,0.72,5.55,11.62,0.52,PALE_AMBER,PALE_AMBER,True); tb(s,'Reassess after every major change: blood loss, positioning change, new instability or unexpected operative finding.',0.94,5.73,11.2,0.18,13.2,NAVY,True,align=PP_ALIGN.CENTER)
speaker_badge(s,2); footer(s,10,'Bailey & Love, 28th ed., Ch. 7 Patient positioning; Ch. 24 Perioperative care')

#11 instruments & never events
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'Never-event prevention: build in independent barriers','Error traps must be deliberate, visible and completed before closure or transfer.',speaker_names[2],2)
for i,(h,bul,c) in enumerate([('Wrong patient / site / procedure',['Verify identifiers, consent, marked site and imaging','Complete the time out with the entire team'],RED),('Retained swab / instrument',['Standardized counts at start, cavity closure and skin closure','Reconcile discrepancy before leaving theatre; escalate and image if unresolved'],RED),('Energy devices',['Check insulation, settings, return electrode and activation awareness','Protect adjacent structures and avoid ignition risks'],AMBER)]):
    x=0.72+i*4.1
    rect(s,x,1.78,3.72,4.65,WHITE,GREY,True); rect(s,x,1.78,3.72,0.52,c,c,True)
    tb(s,h,x+0.25,2.12,3.1,0.42,17,NAVY,True)
    bullets(s,bul,x+0.25,2.92,3.05,2.6,14)
    rect(s,x+0.25,5.76,3.1,0.35,PALE_RED if c==RED else PALE_AMBER,PALE_RED if c==RED else PALE_AMBER,True)
    tb(s,'Pause if the safety barrier fails.',x+0.37,5.88,2.86,0.12,9.5,c,True,align=PP_ALIGN.CENTER)
speaker_badge(s,2); footer(s,11,'Bailey & Love, 28th ed., Ch. 15 Patient safety | WHO Surgical Safety Checklist, 2009')

#12 person 4
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'4. Postoperative safety: detect deterioration before it becomes rescue','The recovery area and ward handover are safety-critical clinical transitions.',speaker_names[3],3)
card(s,0.72,1.72,3.82,3.82,'Immediate recovery',['Structured handover: operation, anaesthesia, losses, lines, drains, antibiotics and concerns','Assess airway, breathing, circulation, consciousness, pain and temperature','Set monitoring frequency and escalation criteria'],GREEN,'A',14)
card(s,4.76,1.72,3.82,3.82,'Support recovery',['Multimodal analgesia and antiemesis as appropriate','Fluid balance, glucose and electrolytes reviewed','Wound, drain and urinary output observed'],GREEN,'B',14)
card(s,8.80,1.72,3.82,3.82,'Prevent complications',['Early mobilisation and VTE prophylaxis','Respiratory exercises and pulmonary care','Early nutrition when safe; plan bowel and bladder care'],GREEN,'C',14)
speaker_badge(s,3); footer(s,12,'Bailey & Love, 28th ed., Ch. 24 General postoperative complications')

#13 complications
s=prs.slides.add_slide(BLANK); set_bg(s,LIGHT); title(s,'Prevent, look for, and respond to common postoperative complications','Trends in observations and clinical examination matter more than a single normal value.',speaker_names[3],3)
risks=[('Bleeding','Tachycardia, hypotension, increasing drain loss, swelling, falling Hb','Resuscitate, cross-match, investigate if stable; return to theatre if unstable'),('SSI / sepsis','Fever, wound pain, erythema, discharge, systemic deterioration','Cultures where relevant, antibiotics/source control, escalate'),('DVT / PE','Leg swelling or pain, hypoxia, tachycardia, pleuritic symptoms','Risk assessment, prophylaxis, urgent diagnostic pathway'),('Respiratory','Hypoxia, atelectasis, pneumonia, reduced respiratory effort','Oxygen, analgesia, mobilisation, chest physiotherapy and investigation'),('GI / urinary','Ileus, vomiting, distension, retention or UTI','Review medications/fluids, examine, catheter strategy and investigate')]
for i,(h,signs,act) in enumerate(risks):
    y=1.60+i*0.94
    rect(s,0.72,y,11.85,0.76,WHITE,GREY,True)
    rect(s,0.72,y,1.65,0.76,GREEN,GREEN,True)
    tb(s,h,0.83,y+0.25,1.42,0.18,11.7,WHITE,True,align=PP_ALIGN.CENTER)
    tb(s,signs,2.62,y+0.18,4.65,0.38,11.3,INK)
    tb(s,act,7.52,y+0.18,4.75,0.38,11.3,MUTED)
tb(s,'What to look for',2.62,1.17,2,0.19,10,MUTED,True); tb(s,'First response',7.52,1.17,2,0.19,10,MUTED,True)
speaker_badge(s,3); footer(s,13,'Bailey & Love, 28th ed., Ch. 24 General postoperative complications')

#14 deterioration/discharge
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'Recognize deterioration. Escalate early. Discharge safely.','A safe endpoint includes a shared plan for recovery beyond the hospital.',speaker_names[3],3)
checkpoint(s,0.75,1.72,5.6,1.54,1,'WHEN THE PATIENT DETERIORATES','Use an ABCDE assessment, call for senior help, give oxygen/resuscitation as needed, identify likely cause and reassess response.',GREEN)
checkpoint(s,6.72,1.72,5.6,1.54,2,'Handover AND DOCUMENTATION','Communicate operation details, complications, fluids/blood, drains, medications, test results, ceilings of care and outstanding tasks.',GREEN)
checkpoint(s,0.75,3.68,5.6,1.54,3,'DISCHARGE CHECK','Physiologically stable, pain controlled, eating/drinking as appropriate, mobilising safely, medications reconciled and follow-up arranged.',GREEN)
checkpoint(s,6.72,3.68,5.6,1.54,4,'PATIENT SAFETY-NETTING','Give written wound, drain and medication advice. Explain danger signs and how, when and where to seek urgent help.',GREEN)
rect(s,0.75,5.78,11.58,0.48,PALE_TEAL,PALE_TEAL,True); tb(s,'Early mobilisation, adequate nutrition and clear follow-up convert complication prevention into recovery.',0.98,5.94,11.05,0.16,12.6,NAVY,True,align=PP_ALIGN.CENTER)
speaker_badge(s,3); footer(s,14,'Bailey & Love, 28th ed., Ch. 24 Perioperative care and postoperative complications')

#15 close
s=prs.slides.add_slide(BLANK); set_bg(s,NAVY); title(s,'Five habits that make surgery safer',None,None,0,True)
items=[('1','PREPARE','Identify and reduce risk before surgery.'),('2','VERIFY','Use patient, site, procedure and team checks.'),('3','MAINTAIN','Protect asepsis and physiology throughout.'),('4','COUNT & COMMUNICATE','Make safety-critical steps visible and spoken.'),('5','RECOGNIZE','Act on postoperative deterioration early.')]
for i,(n,h,b) in enumerate(items):
    y=1.48+i*0.87
    rect(s,0.78,y,11.86,0.67,RGBColor(23,55,78),RGBColor(23,55,78),True)
    rect(s,0.95,y+0.12,0.42,0.42,[BLUE,TEAL,AMBER,GREEN,RED][i],[BLUE,TEAL,AMBER,GREEN,RED][i],True)
    tb(s,n,0.95,y+0.20,0.42,0.13,11,WHITE,True,align=PP_ALIGN.CENTER)
    tb(s,h,1.64,y+0.19,2.35,0.18,13.2,WHITE,True)
    tb(s,b,4.0,y+0.19,7.85,0.18,13,RGBColor(211,229,238))
tb(s,'Safe surgery is reliable care by an informed patient and a prepared team.',0.78,6.50,11.7,0.27,15,WHITE,True,align=PP_ALIGN.CENTER)
footer(s,15,'Bailey & Love, 28th ed. | WHO Surgical Safety Checklist, 2009')

#16 references
s=prs.slides.add_slide(BLANK); set_bg(s,WHITE); title(s,'References and suggested reading','Primary reference used for slide content.')
refs=[
"O’Connell PR, McCaskie AW, Williams NS, eds. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapters 7, 15 and 24.",
"World Health Organization. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. WHO; 2009.",
"World Health Organization. WHO Surgical Safety Checklist (First Edition). 2009. https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery/tool-and-resources",
"Local hospital policies should determine specific antibiotic prophylaxis, venous thromboembolism prophylaxis, transfusion and escalation protocols."
]
for i,r in enumerate(refs):
    rect(s,0.72,1.6+i*1.06,11.85,0.77,LIGHT,LIGHT,True)
    tb(s,str(i+1).zfill(2),0.98,1.87+i*1.06,0.42,0.18,12,BLUE,True)
    tb(s,r,1.58,1.77+i*1.06,10.4,0.39,13.2,INK)
rect(s,0.72,6.14,11.85,0.52,PALE_AMBER,PALE_AMBER,True)
tb(s,'Educational presentation only. Adapt decisions to the individual patient, supervising team and current local protocol.',0.96,6.32,11.3,0.16,12.1,NAVY,True,align=PP_ALIGN.CENTER)
footer(s,16,'References')

# Speaker notes: add notes text through XML
notes = [
'Introduce the presentation and the four linked stages of safe surgery.',
'Stress that safety depends on systems, communication and clinical judgement at every phase.',
'Person 1: Explain how structured preoperative assessment makes the operation safer before the patient reaches theatre.',
'Person 1: Give examples of reversible factors and explain ASA as a concise description of physical status.',
'Person 1: Emphasize that identifiers, consent and site verification cannot be assumed. They must be actively confirmed.',
'Person 2: Explain that asepsis is maintained through several reliable practices performed by the entire team.',
'Person 2: Relate each stage of SSI prevention to the patient journey rather than treating infection prevention as only an intraoperative issue.',
'Person 2: Walk through the three pauses. The checklist should be audible, participatory and adapted to local workflow.',
'Person 3: Explain that safe anaesthesia and surgery require situational awareness and early response to changes.',
'Person 3: Highlight typical pressure/nerve injury risks and why fluid, temperature and blood management are active processes.',
'Person 3: Make the message explicit: counts and time out are independent barriers, and a mismatch requires a stop.',
'Person 4: Discuss a structured recovery handover and the use of observations plus bedside examination.',
'Person 4: Ask the audience which complication may be missed if a patient is observed only intermittently.',
'Person 4: End by linking early escalation and safety-netting to continuous care after surgery.',
'Summarize the five habits, one sentence each.',
'Invite questions. Remind the audience to consult local protocols for operational details.'
]
for slide, note in zip(prs.slides, notes):
    notes_slide = slide.notes_slide
    tf = notes_slide.notes_text_frame
    tf.text = note

prs.save(OUT)
print(OUT)

from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.dml.color import RGBColor
from pptx.enum.dml import MSO_LINE_DASH_STYLE

OUT='/tmp/workspace/safe-general-surgery-ppt/output/Principles_of_Safe_General_Surgery_60_Slides.pptx'
prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5)
blank=prs.slide_layouts[6]
NAVY=RGBColor(10,31,52); BLUE=RGBColor(20,103,164); TEAL=RGBColor(0,137,137); AMBER=RGBColor(203,125,26); GREEN=RGBColor(35,126,83); INK=RGBColor(27,43,56); MUTED=RGBColor(90,105,116); LIGHT=RGBColor(245,248,250); WHITE=RGBColor(255,255,255); BORDER=RGBColor(216,226,232)
COLORS=[BLUE,TEAL,AMBER,GREEN]
NAMES=['PERSON 1  |  PREOPERATIVE SAFETY','PERSON 2  |  ASEPSIS & OR SAFETY','PERSON 3  |  INTRAOPERATIVE SAFETY','PERSON 4  |  POSTOPERATIVE SAFETY']

def shp(slide,x,y,w,h,fill,line=None,rounded=False):
    s=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rounded else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)); s.fill.solid(); s.fill.fore_color.rgb=fill; s.line.color.rgb=line or fill
    if rounded: s.adjustments[0]=0.08
    return s

def text(slide,txt,x,y,w,h,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT,italic=False):
    t=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); f=t.text_frame; f.clear(); f.word_wrap=True; f.margin_left=f.margin_right=Inches(.06); f.margin_top=f.margin_bottom=Inches(.03); f.vertical_anchor=MSO_ANCHOR.TOP
    p=f.paragraphs[0]; p.alignment=align; r=p.add_run(); r.text=txt; r.font.name='Aptos'; r.font.size=Pt(size); r.font.bold=bold; r.font.italic=italic; r.font.color.rgb=color
    return t

def add_notes(slide, note):
    notes=slide.notes_slide.notes_text_frame
    notes.text='Speaker notes\n'+note+'\n\nSource: Bailey & Love’s Short Practice of Surgery, 28th ed.; WHO Surgical Safety Checklist (2009), where applicable.'

def header(slide,num,person,title,kicker=''):
    color=COLORS[person]; shp(slide,0,0,13.333,.22,color); text(slide,NAMES[person],.55,.36,5.5,.28,10,color,bold=True); text(slide,f'{num:02d} / 60',11.65,.36,1.1,.28,10,MUTED,bold=True,align=PP_ALIGN.RIGHT); text(slide,title,.55,.78,12.1,.55,27,NAVY,bold=True)
    if kicker: text(slide,kicker,.57,1.38,11.8,.30,11,MUTED,italic=True)
    shp(slide,.55,1.78,12.22,.012,BORDER)

def bullets(slide, items, x=.72,y=2.03,w=11.85,h=4.6, size=17):
    box=shp(slide,x-.16,y-.10,w+.22,h+.15,WHITE,BORDER,True); box.line.width=Pt(.8)
    t=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); f=t.text_frame; f.clear(); f.word_wrap=True; f.margin_left=f.margin_right=Inches(.08); f.margin_top=Inches(.08)
    for j,item in enumerate(items):
        p=f.paragraphs[0] if j==0 else f.add_paragraph(); p.text=item; p.level=0; p.font.name='Aptos'; p.font.size=Pt(size); p.font.color.rgb=INK; p.space_after=Pt(9); p.bullet=True

def slide(num,person,title,items,note,kicker=''):
    s=prs.slides.add_slide(blank); shp(s,0,0,13.333,7.5,LIGHT); header(s,num,person,title,kicker); bullets(s,items); text(s,'Principles of Safe General Surgery',.57,7.05,4,.2,8,MUTED); add_notes(s,note)

def section_slide(num,person,title,subtitle,points):
    s=prs.slides.add_slide(blank); c=COLORS[person]; shp(s,0,0,13.333,7.5,NAVY); shp(s,0,0,13.333,.22,c); text(s,NAMES[person],.7,.56,6,.32,12,c,bold=True); text(s,title,.7,1.32,11.5,1.0,32,WHITE,bold=True); text(s,subtitle,.73,2.42,10.9,.45,16,RGBColor(207,221,230));
    for i,p in enumerate(points):
        x=.75+(i%3)*4.15; y=3.35+(i//3)*1.35; shp(s,x,y,3.72,.88,RGBColor(23,53,75),RGBColor(46,78,99),True); text(s,p,x+.2,y+.18,3.3,.42,14,WHITE,bold=True,align=PP_ALIGN.CENTER)
    text(s,f'{num:02d} / 60',11.65,.58,.9,.25,10,RGBColor(207,221,230),align=PP_ALIGN.RIGHT); add_notes(s,'Introduce this section and state the learning objectives. Link the section to prevention of avoidable harm across the perioperative pathway.')

# 1-15
section_slide(1,0,'Principles of Safe General Surgery','A 60-slide team presentation: 15 slides per speaker',['Safe systems','Prepared patient','Sterile field','Vigilant recovery'])
slide(2,0,'What makes surgery safe?',['Safety is the prevention of avoidable harm through reliable systems, competent teams and timely escalation.','It extends from the decision to operate through discharge, not only the technical act of surgery.','Key domains: correct patient and procedure, physiological preparedness, infection prevention, communication and surveillance.'],'Define safety as a system property. Explain that safe surgery combines clinical judgement with standardised checks and teamwork.')
slide(3,0,'Preoperative pathway: the safety chain',['Confirm indication and urgency, then match the operation to the patient’s goals and physiological reserve.','Identify modifiable risk, investigate only when results will change management, and optimise before elective surgery.','Plan anaesthesia, blood requirements, antibiotics, thromboprophylaxis, postoperative destination and rehabilitation.'],'Use this slide as the roadmap for Person 1. Emphasise that unrecognised risk becomes intraoperative or postoperative harm.')
slide(4,0,'History: identify risk before it becomes harm',['Clarify symptoms, diagnosis, previous operations and prior anaesthetic problems, including difficult airway, nausea or malignant hyperthermia history.','Ask about allergies, prescribed and non-prescribed drugs, anticoagulants, corticosteroids, smoking, alcohol and recreational substances.','Elicit cardiac, respiratory, renal, liver, endocrine and neurological disease; record functional capacity and baseline independence.'],'A focused history informs both risk assessment and the perioperative plan. Medication reconciliation prevents omission, duplication and bleeding or glycaemic errors.')
slide(5,0,'Examination and functional assessment',['Record weight, nutritional status, hydration, vital signs and signs of sepsis or cardiopulmonary decompensation.','Examine heart, lungs, abdomen and the planned operative region; document skin integrity, infection and peripheral perfusion.','Functional capacity and frailty are practical indicators of reserve: poor exercise tolerance warrants careful assessment and planning.'],'Explain that examination confirms the diagnosis and reveals physiologic limitations that may not be obvious from history.')
slide(6,0,'Comorbidity and surgical risk',['Cardiovascular disease: assess symptoms, exercise tolerance, blood pressure control and active cardiac conditions.','Respiratory disease: treat acute infection or exacerbation, encourage smoking cessation, optimise inhalers and plan chest care.','Renal, hepatic and neurological disease alter drug handling, fluid strategy, bleeding risk and postoperative monitoring.'],'Risk is cumulative. Major surgery, urgent surgery, frailty and multiple comorbidities increase the need for senior multidisciplinary planning.')
slide(7,0,'Investigations: targeted, interpretable, actionable',['Choose tests from history, examination, procedure magnitude and anticipated blood loss, not as a routine panel.','Common examples include FBC for anaemia or infection, renal profile for electrolyte and renal status, glucose/HbA1c where relevant, ECG in selected patients.','Group and screen or cross-match when transfusion is possible; investigate suspected coagulopathy or anticoagulant effect.'],'Tests should answer a clinical question. Abnormal results require interpretation and a documented response, rather than simply being filed.')
slide(8,0,'ASA physical status: communicating anaesthetic risk',['ASA I: healthy patient. ASA II: mild systemic disease. ASA III: severe systemic disease.','ASA IV: severe disease that is a constant threat to life. ASA V: moribund patient not expected to survive without operation.','Add E for emergency. ASA describes physical status; it does not replace procedure-specific or patient-specific risk assessment.'],'Describe ASA as a common language for anaesthetic risk communication, not a predictor used in isolation.')
slide(9,0,'Optimising diabetes and glycaemic safety',['Identify diabetes type, usual treatment, recent control, hypoglycaemia history and end-organ complications.','Make a written plan for fasting, insulin or oral medicines, perioperative glucose monitoring and treatment of hypo- or hyperglycaemia.','Avoid unnecessary prolonged fasting; coordinate surgery timing and postoperative nutritional plan with the diabetes plan.'],'Do not give local drug-dose instructions. Stress individual protocols and involvement of anaesthesia or diabetes teams for complex patients.')
slide(10,0,'Optimising blood pressure, cardiac and respiratory disease',['Postpone elective surgery when there is uncontrolled active disease requiring assessment or treatment; urgency changes this balance.','Continue or modify chronic medicines according to an individual anaesthetic plan, especially antihypertensives, antiplatelets and anticoagulants.','Treat bronchospasm, infection, fluid overload and ischaemia before surgery where possible; plan perioperative monitoring level.'],'The objective is not a perfect number but stable physiology, clarified risk and a realistic plan for perioperative care.')
slide(11,0,'Anaemia, nutrition and hydration',['Identify and investigate anaemia early. Correct reversible causes and prepare blood management strategies when blood loss is expected.','Screen for weight loss, low intake, malabsorption and frailty; involve nutrition support when risk is high.','Correct dehydration and major electrolyte abnormality. Balance fasting safety with avoidance of unnecessary fluid and calorie deficit.'],'Bailey & Love emphasises nutrition support and perioperative fluid assessment. Adequate preparation improves wound healing and recovery capacity.')
slide(12,0,'Informed consent: a continuing conversation',['Confirm capacity and voluntariness. Explain diagnosis, purpose of operation, expected benefits, material risks and reasonable alternatives, including no operation.','Use language the patient understands; allow questions and adequate time when circumstances permit. Document the discussion and decision.','Consent is patient-centred and must be revisited if the plan, findings or material risk changes.'],'Consent is not merely a signed form. It supports autonomy, shared decisions and safer expectations.')
slide(13,0,'Correct patient, correct procedure, correct site',['Use at least two identifiers and compare them with records, consent, imaging and wristband.','Mark the surgical site when applicable using an agreed, visible method; ensure marks remain visible after preparation and draping.','Conduct team verification before induction and again before incision. Stop when information conflicts.'],'Wrong-patient and wrong-site events are preventable system failures. Any team member must be able to raise a concern.')
slide(14,0,'Antibiotics and VTE prophylaxis',['Antibiotic prophylaxis: select for procedure and local policy, give so adequate tissue levels exist at incision, and redose when indicated.','Assess VTE risk alongside bleeding risk. Use early mobilisation, mechanical methods and pharmacological prophylaxis when appropriate.','Document timing, agent, contraindications and postoperative plan. Prophylaxis does not replace vigilance for infection or thrombosis.'],'Bailey & Love recommends preoperative assessment of VTE risk factors and appropriate prophylactic measures. Follow local antimicrobial and VTE protocols.')
slide(15,0,'Person 1: safety checkpoint',['Can we justify the operation and define the patient’s goals?','Have risks, comorbidity, medications, investigations and optimisation been addressed?','Are consent, identity, site, antibiotics, thromboprophylaxis and postoperative plan confirmed?'],'Conclude the preoperative section with a three-question pause. Hand over to Person 2: the prepared patient now enters a safe operating environment.')

#16-30
section_slide(16,1,'Asepsis, Infection Prevention & OR Safety','Person 2: preventing microbial contamination and communication failure',['Aseptic technique','Sterile equipment','SSI prevention','Checklist discipline'])
slide(17,1,'Aseptic surgery: the central concept',['Asepsis prevents transfer of microorganisms from staff, instruments, environment or patient flora to a vulnerable operative site.','A sterile field depends on every link: clean hands, sterile items, appropriate attire, skin preparation, draping and minimal contamination.','If sterility is in doubt, treat the item or field as contaminated and correct it immediately.'],'Introduce the difference: cleaning removes soil, disinfection reduces organisms, sterilisation eliminates viable microorganisms including spores when correctly performed.')
slide(18,1,'Hand hygiene: before and after every patient contact',['Hand hygiene interrupts transmission between patients, staff and the theatre environment.','Alcohol-based hand rub is effective for many routine indications; visible contamination and spore-forming organisms require appropriate handwashing.','Keep nails short; remove jewellery according to policy; cover or exclude staff with infected skin lesions.'],'Bailey & Love notes that hand hygiene campaigns have reduced healthcare-associated infection. Technique and compliance matter as much as product selection.')
slide(19,1,'Surgical hand antisepsis',['Perform a surgical scrub or approved alcohol-based surgical hand preparation before gowning and gloving.','Clean under nails first; use a systematic technique covering fingers, hands and forearms; avoid recontamination while drying.','Keep hands above elbows after preparation and proceed directly to sterile gowning.'],'Demonstrate the principles without prescribing a single timed technique, because products and local policies differ.')
slide(20,1,'Sterilisation, disinfection and instrument processing',['Cleaning is essential before disinfection or sterilisation because organic debris shields microorganisms.','Sterilisation is used for critical instruments that enter sterile tissue or the vascular system; verify packaging, indicators and integrity.','Store sterile packs dry and intact. Do not use a package that is wet, torn, expired or has an uncertain processing history.'],'Explain that reprocessing is a chain of cleaning, inspection, packaging, cycle validation, storage and traceability.')
slide(21,1,'Gowning and gloving: creating a sterile barrier',['Sterile gowning and closed gloving minimise hand contact with the outer gown surface.','Only sterile-to-sterile contact is acceptable within the field. Keep hands in view and above waist level.','Replace a torn, punctured, visibly contaminated or doubtful glove promptly; double gloving may be used for selected higher-risk procedures.'],'Stress awareness of the sterile boundary. The circulator helps protect the field by supplying items without crossing it.')
slide(22,1,'Preparing the patient’s skin',['Inspect the site for infection, wounds and hair that may interfere with the procedure. Hair removal is not routine.','If needed, remove hair as close to surgery as possible with a method that avoids skin trauma; shaving early can increase bacterial colonisation.','Apply the chosen antiseptic according to product instructions, allow adequate drying and prevent pooling beneath the patient.'],'Bailey & Love highlights that hair removal causes microabrasions and can increase cellulitis and SSI. Correct skin preparation reduces SSI risk.')
slide(23,1,'Draping and maintaining the sterile field',['Drape after skin antisepsis has dried. Expose only the required operative area and secure drapes to prevent shifting.','Treat the outer edges and below-table areas as unsterile; avoid reaching over non-sterile surfaces.','Limit door opening, unnecessary movement and unnecessary traffic, all of which disrupt disciplined work.'],'Draping is a barrier strategy. It does not compensate for poor hand hygiene, contaminated instruments or an untreated infection source.')
slide(24,1,'Surgical-site infection: how it develops',['SSI risk reflects patient factors, microbial burden, operative duration, tissue handling, foreign material, haemostasis and wound environment.','Patient factors include diabetes, malnutrition, smoking, obesity, colonisation and immunosuppression.','Prevention combines preparation, asepsis, appropriate antibiotic use, gentle technique, haemostasis and postoperative wound surveillance.'],'A major SSI may discharge pus or require drainage, and systemic signs may occur. Explain that prevention is multi-factorial, not solely antibiotic-related.')
slide(25,1,'Practical SSI prevention bundle',['Keep preoperative stay as short as practical; identify and treat infection remote from the operative site when possible.','Give prophylactic antibiotics correctly; prepare skin, maintain asepsis and minimise tissue trauma, dead space and devitalised tissue.','Maintain oxygenation, temperature and glucose control according to the anaesthetic and surgical plan.'],'Bundles are valuable because each action is simple but failure at several points can align to cause infection.')
slide(26,1,'Operating-room safety culture',['Safety requires briefings, explicit roles, respect for speaking up, closed-loop communication and reporting of near misses.','Distraction, workload, hierarchy and ambiguous responsibility can make minor errors align into major harm.','Use standardised processes but allow the team to stop, challenge and adapt for patient-specific risk.'],'Relate this to the Swiss cheese model discussed in Bailey & Love: multiple layers of defence reduce the chance that errors combine.')
slide(27,1,'WHO checklist: why teams pause',['The WHO Surgical Safety Checklist is a team communication tool, not a paperwork exercise.','It structures confirmation before anaesthesia, before incision and before the patient leaves the operating room.','It reinforces correct identity, airway and blood-loss risk, antibiotics, imaging, sterility, counts, specimens and recovery concerns.'],'WHO describes the checklist as a 19-item tool intended to decrease errors and adverse events and improve teamwork and communication.')
slide(28,1,'Sign In: before induction of anaesthesia',['Confirm identity, procedure, site and consent. Verify site marking when applicable.','Check pulse oximeter function; identify allergies, difficult airway or aspiration risk, and blood-loss risk.','Ensure relevant plans, equipment and assistance are ready before anaesthesia begins.'],'This phase is led before induction. The goal is to anticipate anaesthetic and surgical hazards while the patient can still participate in identification.')
slide(29,1,'Time Out and Sign Out',['Time Out before incision: all team members introduce themselves, confirm patient/procedure/site, antibiotic timing, sterility and anticipated critical events.','Sign Out before leaving theatre: confirm procedure performed, counts, specimen labels, equipment problems and recovery concerns.','Make the pause audible, active and inclusive. Silence or unchecked boxes are not a completed checklist.'],'Explain how Time Out plans the next stage and Sign Out turns the operation into a safe handover to recovery.')
slide(30,1,'Person 2: safety checkpoint',['Are hand preparation, sterile instruments, skin preparation and drapes reliable?','Has the SSI bundle been delivered and are breaches corrected without delay?','Has the team completed meaningful Sign In, Time Out and Sign Out?'],'Hand over to Person 3. The sterile environment must now be matched by safe anaesthesia, physiology and technical execution.')

#31-45
section_slide(31,2,'Intraoperative Safety & Complication Prevention','Person 3: maintaining physiology and preventing technical harm',['Airway & monitoring','Position & temperature','Fluids & blood','Counts & devices'])
slide(32,2,'Safe anaesthesia: shared responsibility',['Anaesthesia safety begins with pre-anaesthetic assessment, preparation of equipment, drugs and rescue plans.','The surgical team must communicate positioning, anticipated blood loss, duration, access limitations and critical steps.','A safe plan includes escalation: who will call for help, how haemorrhage or airway difficulty will be managed, and postoperative destination.'],'Although the anaesthetist leads anaesthesia, every team member contributes by anticipating hazards and sharing information early.')
slide(33,2,'Airway and respiratory safety',['Assess airway difficulty, aspiration risk and respiratory reserve before induction; ensure appropriate equipment and skilled help are available.','Confirm ventilation and oxygenation continuously. Secure the airway and recheck after positioning, transfers and major table movement.','Prevent atelectasis and hypoxia through appropriate ventilation, recruitment strategies where appropriate, analgesia and postoperative respiratory care.'],'Emphasise that airway risk can change after positioning or surgical insufflation. Communication before these events is essential.')
slide(34,2,'Monitoring: detect deterioration early',['Standard monitoring commonly includes oxygen saturation, ECG, blood pressure, capnography during general anaesthesia, temperature and inspired oxygen where applicable.','Choose invasive monitoring and urine output monitoring according to patient condition, procedure and expected blood loss.','Trend data and clinical context, rather than reacting to a single isolated number. Escalate unexpected change promptly.'],'Monitoring does not itself prevent harm; it must be interpreted and acted upon. Establish baseline values before incision.')
slide(35,2,'Maintaining haemodynamic stability',['Match anaesthetic depth, analgesia, fluid therapy, vasopressors and surgical technique to the patient’s physiology.','Consider haemorrhage, sepsis, myocardial dysfunction, vasodilation, obstruction or drug effect when blood pressure falls.','Communicate changes in surgical bleeding, traction, insufflation and critical manoeuvres before they cause instability.'],'The key lesson is rapid recognition of cause, resuscitation and source control. Persistent instability requires senior help and a change of plan.')
slide(36,2,'Safe patient positioning',['Position provides exposure but can harm nerves, eyes, pressure points, circulation and ventilation.','Confirm neutral alignment, padding, limb support, protection of eyes and genitalia, and safe placement of lines and tubes.','Recheck after every position change, after draping, and during long procedures. Document special positioning.'],'Bailey & Love details risks of supine, prone, lateral and lithotomy positions. Positioning is a team procedure, not a task delegated without verification.')
slide(37,2,'Prevent pressure, nerve and limb injury',['Avoid prolonged compression and extreme joint angles. Pad pressure points and avoid traction or direct pressure over superficial nerves.','In lithotomy, move both legs together, avoid excessive abduction or external rotation, and protect fingers from table edges.','Long procedures increase risk of neuropraxia, compartment syndrome, venous stasis and pressure injury; plan breaks and checks.'],'Use the lithotomy example from Bailey & Love: simultaneous leg movement and avoiding hyperflexion help reduce sciatic, saphenous and peroneal injury.')
slide(38,2,'Prevent inadvertent hypothermia',['Anaesthesia and exposure impair thermoregulation. Hypothermia can worsen coagulopathy, discomfort and recovery.','Measure core temperature in appropriate cases; use forced-air warming, warmed fluids and warmed humidified gases when indicated.','Minimise unnecessary exposure and coordinate warming with infection-control and access needs.'],'Bailey & Love notes higher heat and fluid loss in children, but the principle of temperature surveillance and active warming applies broadly.')
slide(39,2,'Fluid and electrolyte management',['Prescribe fluids for a defined purpose: resuscitation, correction of prior deficit, replacement of ongoing loss or maintenance.','Use patient weight, vital signs, urine output, blood loss, biochemical data and clinical examination to guide reassessment.','Avoid both under-resuscitation and fluid overload. Replace measured losses and correct clinically relevant electrolyte disturbance.'],'Bailey & Love describes these four indications for intravenous fluid. Fluid therapy is a cycle of assess, prescribe, administer and reassess.')
slide(40,2,'Blood loss and transfusion safety',['Anticipate blood loss from procedure, anticoagulation, anaemia, adhesions, inflammation and vascular anatomy. Ensure blood availability when necessary.','Recognise bleeding early: communicate clearly, expose the field, apply pressure, obtain control and resuscitate concurrently.','Use correct patient identification at every sampling and transfusion step; monitor for reaction and document products given.'],'Bleeding control is both surgical and resuscitative. Bailey & Love advises early, clear team communication and a low threshold for a controlled change of approach when necessary.')
slide(41,2,'Energy devices: effective but not harmless',['Use electrosurgery, ultrasonic or vessel-sealing devices only with a clear understanding of tissue effect, insulation integrity and activation risks.','Avoid activating near unintended tissue, pooled prep solution, implanted devices or oxygen-enriched environments without safeguards.','Inspect devices and cords; announce activation when needed; use the lowest effective setting and correct accessory.'],'Energy-related injury can be immediate or delayed. The safe operator respects lateral thermal spread and avoids blind activation.')
slide(42,2,'Instrument safety and reliable counts',['Standardise setup, instrument handling and passing. Keep sharp items controlled and use a neutral zone when appropriate.','Perform swab, needle and instrument counts at agreed stages and whenever staff change or cavity closure begins.','If count is incorrect: stop closure if possible, search systematically, communicate, document and follow local imaging policy.'],'Counts are a team responsibility. A correct count supports safety but does not replace a deliberate wound and field inspection.')
slide(43,2,'Prevent wrong-site and wrong-patient surgery',['Identity, procedure and laterality must remain visible in records, imaging, site mark, team discussion and checklist.','Resolve discrepancies before induction or incision. Do not accept assumptions based on list order, room location or verbal shorthand.','For multiple lesions or levels, use imaging and explicit confirmation at the point of action.'],'This repeats earlier checks because high-consequence errors need multiple independent barriers.')
slide(44,2,'Retained items: prevention and response',['Use standard counts, radiopaque materials where appropriate, organised instrument trays and a deliberate methodical wound sweep.','Risk rises with emergency surgery, unexpected procedural change, high blood loss, multiple teams and staff turnover.','A discrepancy triggers an immediate search and escalation, not a retrospective explanation. Document actions and outcome.'],'A retained swab or instrument is a preventable never event. Reliable systems and psychological safety are required for staff to speak up.')
slide(45,2,'Person 3: safety checkpoint',['Is the airway secure, ventilation adequate and monitoring appropriate for this patient and procedure?','Are position, temperature, fluids, blood and energy devices being actively checked?','Have counts and identity barriers remained reliable through the final critical steps?'],'Hand over to Person 4. Safe technical completion is only the beginning of postoperative safety.')

#46-60
section_slide(46,3,'Postoperative Safety & Management','Person 4: recovery, complication prevention, rescue and discharge',['ABC recovery','Pain & fluids','Complication prevention','Discharge & follow-up'])
slide(47,3,'Recovery room: the immediate priorities',['Receive a structured handover: procedure, anaesthesia, blood loss, fluids, analgesia, antibiotics, lines, drains, complications and specific concerns.','Assess airway, breathing, circulation, consciousness, pain, temperature, nausea, wound and drains.','Set monitoring frequency and escalation thresholds based on procedure, comorbidity and intraoperative events.'],'The recovery handover connects theatre to ward care. Information lost here may be mistaken later for new deterioration.')
slide(48,3,'Airway, breathing and circulation after surgery',['Airway obstruction, hypoventilation and aspiration can occur during emergence and after opioid administration. Observe consciousness, work of breathing and oxygenation.','Assess circulation using pulse, blood pressure, perfusion, urine output, drains and wound. Consider bleeding, hypovolaemia, sepsis or cardiac causes.','Treat immediate threats, call for senior help early and reassess response after every intervention.'],'ABC is a prioritisation method. Never focus on a wound or chart abnormality while airway or respiratory compromise is unresolved.')
slide(49,3,'Pain management: effective and safe',['Use multimodal analgesia tailored to surgery, renal function, bleeding risk, opioid tolerance and patient preference.','Assess pain at rest and movement, sedation, respiratory rate, nausea, bowel function and ability to mobilise.','Avoid both undertreatment, which impairs breathing and mobilisation, and oversedation, which threatens ventilation and safety.'],'Analgesia is part of recovery, not an isolated prescription. Use local protocols and seek acute pain support for complex patients.')
slide(50,3,'Postoperative fluids, electrolytes and glucose',['Review input, output, weight, clinical examination and laboratory results. Replace ongoing losses and stop unnecessary intravenous fluid early.','Monitor sodium, potassium, renal function and glucose in patients at risk or after major surgery; correct abnormalities with a clear cause in mind.','Resume safe oral intake as early as clinically appropriate, integrating nutrition, diabetes and aspiration-risk plans.'],'Fluid management must continue beyond theatre. Oliguria is a clinical sign requiring assessment, not an automatic trigger for fluid.')
slide(51,3,'Wound and drain care',['Inspect wound, dressings and drain output regularly for bleeding, leakage, tension, infection or unexpected change.','Keep dressings and drains clean; record output volume and character, and remove invasive devices as soon as no longer needed.','Do not use a drain as a substitute for haemostasis or an unformed postoperative plan.'],'Bailey & Love advises regular inspection of dressings and drains in the first 24 hours, particularly when bleeding is possible.')
slide(52,3,'Prevent and recognise surgical-site infection',['Prevent SSI through correct antibiotic prophylaxis, glucose and temperature control, aseptic wound care, early device removal and patient education.','Suspect infection with increasing pain, erythema, warmth, discharge, fever, tachycardia or systemic deterioration.','Assess severity and source control needs. Obtain appropriate samples before antibiotics when this does not delay resuscitation or urgent treatment.'],'Distinguish a minor local issue from deep infection, sepsis or necrotising infection. Deterioration needs urgent escalation and source control.')
slide(53,3,'VTE prevention and recognition',['Continue prophylaxis according to individual thrombosis and bleeding risk. Mobilise early, use mechanical methods correctly and maintain hydration where appropriate.','Consider DVT with limb swelling, pain or asymmetry; consider PE with unexplained dyspnoea, pleuritic pain, tachycardia, hypoxia or collapse.','Assess and escalate suspected PE urgently; prevention is safer than delayed diagnosis.'],'Risk does not end at discharge. Explain that patients must know symptoms and the duration of any prescribed prophylaxis.')
slide(54,3,'Pulmonary complications: prevent and respond',['Encourage upright posture, adequate analgesia, deep breathing, coughing, physiotherapy and early mobilisation as clinically appropriate.','Identify atelectasis, pneumonia, aspiration, pulmonary oedema or PE when oxygen needs rise, fever develops or respiratory work increases.','Review analgesia, fluid balance, infection risk and mobility. Escalate respiratory deterioration early.'],'Good pain control helps patients breathe and cough. Excess sedation and fluid overload can undermine respiratory recovery.')
slide(55,3,'Urinary retention, UTI and ileus',['Remove urinary catheters as soon as possible to reduce infection risk; monitor ability to void and use bladder assessment when retention is suspected.','Minimise opioids where possible, correct electrolyte problems and encourage mobilisation to support bowel recovery.','Persistent vomiting, distension, severe pain, absent function or systemic signs require assessment for ileus, obstruction, leak or other complication.'],'Avoid treating postoperative ileus as routine without examining the patient and considering mechanical obstruction or intra-abdominal sepsis.')
slide(56,3,'Postoperative bleeding: act before collapse',['Warning signs include tachycardia, hypotension, pallor, increasing drain output, swelling, falling haemoglobin, reduced urine output or altered mental state.','Assess ABC, call for help, obtain IV access, send FBC/coagulation/cross-match, start resuscitation and identify the bleeding source.','Unstable patients or airway-threatening haematoma require urgent surgical control rather than prolonged investigation.'],'Bailey & Love notes that slow postoperative bleeding may be missed for hours before sudden decompensation. Inspect wounds and drains, and trend vital signs.')
slide(57,3,'Recognising deterioration: structured rescue',['Use an early-warning system and clinical concern, not only a numerical score. A worried team member should trigger review.','Apply ABCDE, review observations and trends, examine the patient, check medications, drains, fluid balance and recent events.','Escalate to senior surgical, anaesthetic or critical care teams early. Communicate using a structured handover such as SBAR.'],'Deterioration is often preceded by subtle changes. Reassessment and escalation are active safety interventions, not admissions of failure.')
slide(58,3,'Early mobilisation and nutrition',['Mobilisation reduces deconditioning and supports respiratory function, circulation and bowel recovery; set realistic daily goals.','Restart oral or enteral nutrition when safe and suitable. Address nausea, swallowing risk, diabetes and nutritional deficits.','Coordinate surgeons, nurses, physiotherapists, dietitians and the patient around a recovery plan.'],'Enhanced recovery principles centre on reducing avoidable stress, restoring function and involving the patient in goals.')
slide(59,3,'Safe discharge and follow-up',['Discharge when physiology, pain, mobility, oral intake, wound plan and support needs are appropriate for the setting.','Provide clear written advice on medicines, wound and drain care, activity, diet, warning signs, contact routes and planned review.','Reconcile medicines and communicate the operation, complications, pathology plan and follow-up needs to the next care team.'],'Safe discharge is a clinical handover to the patient and community. Check understanding rather than merely giving instructions.')
slide(60,3,'Take-home message and references',['Safe surgery is continuous: prepare the patient, protect the sterile field, maintain physiology, and actively monitor recovery.','Use checklists and protocols to support, not replace, clinical judgement, communication and escalation.','Primary reference: Bailey & Love’s Short Practice of Surgery, 28th ed. Supporting resource: WHO Surgical Safety Checklist, 2009.'],'Close the presentation by connecting every stage. Thank the audience and invite questions. Note: local policies govern medicine doses, antimicrobial choices and emergency escalation pathways.')

# add consistent footer / ensure exactly 60
assert len(prs.slides)==60, len(prs.slides)
prs.save(OUT)
print(OUT)