const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Surviving Sepsis Campaign Bundles";
pres.author = "Orris Medical";

// ─── THEME COLORS ────────────────────────────────────────────────────────────
const DARK_NAVY   = "0D1B2A";
const MID_NAVY    = "1B2D45";
const TEAL        = "00B4D8";
const TEAL_LIGHT  = "90E0EF";
const AMBER       = "F4A261";
const RED_ALERT   = "E63946";
const WHITE       = "FFFFFF";
const LIGHT_GRAY  = "E8EEF4";
const MID_GRAY    = "8FA3B1";
const GREEN       = "2DC653";
const ORANGE      = "F77F00";

// ─── HELPER: accent bar ──────────────────────────────────────────────────────
function accentBar(slide, color = TEAL) {
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}

// ─── HELPER: section header background ──────────────────────────────────────
function darkBackground(slide) {
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}

function midBackground(slide) {
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}

// ─── HELPER: slide title ─────────────────────────────────────────────────────
function slideTitle(slide, text, y = 0.18, color = WHITE) {
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}

// ─── HELPER: divider line ────────────────────────────────────────────────────
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    x: 0.3, y, w: 9.4, h: 0,
    line: { color, width: 1.5 }
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}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE SLIDE
// ─────────────────────────────────────────────────────────────────────────────
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    fill: { color: MID_NAVY }, line: { color: TEAL, width: 2 }
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  s.addText("SURVIVING SEPSIS", {
    x: 0.5, y: 1.1, w: 8.5, h: 0.75,
    fontSize: 42, bold: true, color: WHITE, fontFace: "Calibri",
    charSpacing: 4, margin: 0
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  s.addText("CAMPAIGN BUNDLES", {
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  s.addText("From Evidence to Action: The Hour-1 Bundle & SSC 2021 Guidelines", {
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    fontSize: 14, color: TEAL_LIGHT, fontFace: "Calibri", italic: true, margin: 0
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  s.addText("Based on: Surviving Sepsis Campaign Guidelines 2021  |  SSC Hour-1 Bundle 2018  |  Bailey & Love Surgery 28e", {
    x: 0.5, y: 4.8, w: 9, h: 0.3,
    fontSize: 8.5, color: MID_GRAY, fontFace: "Calibri", margin: 0
  });

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}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 – OVERVIEW / AGENDA
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY } });
  accentBar(s, TEAL);

  sectionLabel(s, "AGENDA", TEAL);
  slideTitle(s, "What We Will Cover", 0.28, DARK_NAVY);
  divider(s, 0.88, TEAL);

  const topics = [
    ["01", "What is the Surviving Sepsis Campaign?", "Origins, goals, and evolution (2002–2021)"],
    ["02", "Sepsis Definitions", "Sepsis-3: SOFA, qSOFA, septic shock criteria"],
    ["03", "The Hour-1 Bundle (2018)", "Five elements — measure, obtain, give, give, give"],
    ["04", "Fluid Resuscitation", "30 mL/kg crystalloid, balanced fluids, dynamic markers"],
    ["05", "Antimicrobials", "Timing, source control, empiric coverage principles"],
    ["06", "Vasopressors & Steroids", "Norepinephrine, vasopressin, hydrocortisone"],
    ["07", "Lactate & Monitoring", "Serial lactate, capillary refill time, organ perfusion"],
    ["08", "The Sepsis Six (Bailey & Love)", "UK Sepsis Trust practical bedside bundle"],
    ["09", "2021 SSC Key Updates", "New recommendations vs 2016 guidelines"],
    ["10", "Outcomes & Evidence", "Mortality impact of bundle compliance"],
  ];

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    const row = i < 5 ? i : i - 5;
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    const y = 0.98 + row * 0.84;

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      x, y, w: colW - 0.15, h: 0.72,
      fill: { color: WHITE },
      line: { color: "D0DDE8", width: 0.8 },
      shadow: { type: "outer", blur: 3, offset: 1, angle: 45, color: "C0C8D0", opacity: 0.3 }
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      fontSize: 7.5, color: MID_GRAY, fontFace: "Calibri", italic: true, margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 – WHAT IS THE SSC?
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  midBackground(s);
  accentBar(s, TEAL);

  sectionLabel(s, "BACKGROUND", TEAL);
  slideTitle(s, "The Surviving Sepsis Campaign", 0.28, WHITE);
  divider(s, 0.88, TEAL);

  // Left panel – history timeline
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 1.0, w: 3.6, h: 4.3,
    fill: { color: DARK_NAVY }, line: { color: TEAL, width: 1 }
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  s.addText("TIMELINE", {
    x: 0.35, y: 1.05, w: 3.4, h: 0.3,
    fontSize: 9, bold: true, color: TEAL, charSpacing: 3, fontFace: "Calibri", margin: 0
  });

  const timeline = [
    ["2002", "SSC Initiated by ESICM & SCCM"],
    ["2004", "First adult sepsis guidelines published"],
    ["2005", "6-hr resuscitation + 24-hr management bundles"],
    ["2008", "Updated guidelines"],
    ["2012", "Updated guidelines"],
    ["2013", "3-hour and 6-hour bundles introduced"],
    ["2016", "Major guideline revision; Sepsis-3 definitions"],
    ["2018", "Single Hour-1 Bundle released"],
    ["2021", "Latest comprehensive guideline update"],
  ];

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    x: 4.1, y: 1.0, w: 5.6, h: 0.35,
    fontSize: 11, bold: true, color: TEAL, fontFace: "Calibri", charSpacing: 2, margin: 0
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    ["📋", "Develop evidence-based clinical practice guidelines"],
    ["🎓", "Educate healthcare professionals worldwide"],
    ["🏥", "Implement performance improvement programs"],
    ["🔬", "Improve early diagnosis and recognition"],
    ["💉", "Increase use of appropriate and timely treatment"],
    ["🏠", "Improve post-ICU care and long-term recovery"],
  ];

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    x: 4.1, y: 5.25, w: 5.65, h: 0.25,
    fontSize: 8, color: MID_GRAY, italic: true, fontFace: "Calibri", margin: 0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 – SEPSIS DEFINITIONS (Sepsis-3)
// ─────────────────────────────────────────────────────────────────────────────
{
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY } });
  accentBar(s, RED_ALERT);

  sectionLabel(s, "DEFINITIONS", RED_ALERT);
  slideTitle(s, "Sepsis-3 Definitions (2016)", 0.28, DARK_NAVY);
  divider(s, 0.88, RED_ALERT);

  const defs = [
    {
      label: "INFECTION",
      color: TEAL,
      desc: "Microbial invasion of normally sterile host tissue",
      detail: "Gram-positive (most common) > Gram-negative > Fungi > Viruses (e.g., SARS-CoV-2)"
    },
    {
      label: "SIRS",
      color: ORANGE,
      desc: "≥2 of: Temp >38°C or <36°C  |  HR >90/min  |  RR >20/min  |  WBC >12 or <4 × 10⁹/L",
      detail: "Nonspecific — can occur without infection (trauma, burns, pancreatitis)"
    },
    {
      label: "SEPSIS",
      color: RED_ALERT,
      desc: "Life-threatening organ dysfunction caused by a dysregulated host response to infection",
      detail: "SOFA score increase ≥2 from baseline  |  Presumed or confirmed infection"
    },
    {
      label: "SEPTIC SHOCK",
      color: "9B0000",
      desc: "Sepsis + vasopressor requirement to maintain MAP ≥65 mmHg + lactate >2 mmol/L (despite fluid resuscitation)",
      detail: "Hospital mortality >40%  |  Profound circulatory, cellular, metabolic abnormalities"
    },
  ];

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      x: 0.25, y, w: 9.5, h: 1.0,
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      fontSize: 9, color: "4A5568", fontFace: "Calibri", italic: true, margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 – THE HOUR-1 BUNDLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  darkBackground(s);
  accentBar(s, AMBER);

  sectionLabel(s, "HOUR-1 BUNDLE", AMBER);
  slideTitle(s, "The SSC Hour-1 Bundle (2018 Update)", 0.28, WHITE);
  divider(s, 0.88, AMBER);

  s.addText("Begin resuscitation and management IMMEDIATELY upon recognition of sepsis/septic shock", {
    x: 0.3, y: 0.92, w: 9.4, h: 0.28,
    fontSize: 9.5, color: TEAL_LIGHT, fontFace: "Calibri", italic: true, margin: 0
  });

  const elements = [
    {
      num: "1",
      title: "Measure Lactate",
      body: "Obtain serum lactate level\nRemeasure if initial lactate >2 mmol/L\nLactate >2 indicates tissue hypoperfusion",
      color: TEAL,
      icon: "🧪"
    },
    {
      num: "2",
      title: "Blood Cultures",
      body: "Obtain blood cultures BEFORE administering antibiotics\n≥2 sets from different sites\nDo NOT delay antibiotics >45 min to obtain cultures",
      color: ORANGE,
      icon: "🩸"
    },
    {
      num: "3",
      title: "Broad-Spectrum Antibiotics",
      body: "Administer IV antimicrobials immediately\nWithin 1 hour for septic shock\nWithin 3 hours for sepsis without shock\nEmpiric coverage; de-escalate with culture results",
      color: RED_ALERT,
      icon: "💊"
    },
    {
      num: "4",
      title: "IV Crystalloid Fluids",
      body: "Give 30 mL/kg IV crystalloid within first 3 hours\nBalanced crystalloids preferred over 0.9% saline\nReassess fluid responsiveness dynamically",
      color: "5B9BD5",
      icon: "💧"
    },
    {
      num: "5",
      title: "Vasopressors",
      body: "Apply vasopressors if hypotension persists during/after fluid resuscitation\nTarget MAP ≥65 mmHg\nNorepinephrine = first-line vasopressor",
      color: GREEN,
      icon: "💉"
    },
  ];

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    const row = i < 3 ? i : 0;
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    const h = isBottom ? 1.45 : 0.72;

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      x, y, w, h,
      fill: { color: "152035" }, line: { color: el.color, width: 1.5 }
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    s.addText(el.num, {
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      fontSize: 18, bold: true, color: WHITE, align: "center", fontFace: "Calibri", margin: 0
    });

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        fontSize: 7.8, color: WHITE, fontFace: "Calibri", margin: 0
      });
    }
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 – FLUID RESUSCITATION
// ─────────────────────────────────────────────────────────────────────────────
{
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY } });
  accentBar(s, "5B9BD5");

  sectionLabel(s, "BUNDLE ELEMENT 4", "5B9BD5");
  slideTitle(s, "Fluid Resuscitation", 0.28, DARK_NAVY);
  divider(s, 0.88, "5B9BD5");

  // Central recommendation box
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 1.0, w: 9.5, h: 0.75,
    fill: { color: "5B9BD5" }, line: { color: "2574A9", width: 1.5 }
  });
  s.addText("⭐  STRONG RECOMMENDATION (Weak evidence):  Give ≥30 mL/kg IV crystalloid within the first 3 hours of sepsis-induced hypoperfusion or septic shock", {
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    fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

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      title: "Fluid Choice",
      color: "2574A9",
      points: [
        "Balanced crystalloids (e.g. Hartmann's/Ringer's lactate) preferred over 0.9% NaCl (NEW – 2021)",
        "Normal saline associated with hyperchloraemic acidosis",
        "Albumin may be used as adjunct (not first-line)",
        "Avoid synthetic colloids (HES) — associated with AKI"
      ]
    },
    {
      title: "Dynamic Assessment",
      color: TEAL,
      points: [
        "Reassess fluid responsiveness after each bolus",
        "Passive leg raising test (PLR) — predicts fluid responsiveness",
        "Pulse pressure variation (PPV) in ventilated patients",
        "Capillary refill time as adjunct (NEW – 2021)"
      ]
    },
    {
      title: "When to Stop Fluids",
      color: ORANGE,
      points: [
        "Fluid overload worsens outcomes (pulmonary edema, abdominal compartment syndrome)",
        "Use de-resuscitation once patient stabilised",
        "CVP alone is NOT reliable for guiding fluid therapy",
        "Target: MAP ≥65 mmHg, UO ≥0.5 mL/kg/hr, falling lactate"
      ]
    }
  ];

  fluidCards.forEach((card, i) => {
    const x = 0.25 + i * 3.2;
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      x, y: 1.88, w: 3.08, h: 3.5,
      fill: { color: WHITE }, line: { color: card.color, width: 1.5 }
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    s.addText(card.title, {
      x: x + 0.08, y: 1.92, w: 2.92, h: 0.32,
      fontSize: 10, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
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        fontSize: 8.5, color: DARK_NAVY, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 – ANTIMICROBIALS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  darkBackground(s);
  accentBar(s, RED_ALERT);

  sectionLabel(s, "BUNDLE ELEMENT 3", RED_ALERT);
  slideTitle(s, "Antimicrobial Therapy", 0.28, WHITE);
  divider(s, 0.88, RED_ALERT);

  // Timing recommendation
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 1.0, w: 9.5, h: 0.65,
    fill: { color: RED_ALERT }
  });
  s.addText("⚠  STRONG RECOMMENDATION:  Administer IV antimicrobials as soon as possible after recognition — within 1 HOUR for septic shock; within 3 HOURS when sepsis is possible but shock absent", {
    x: 0.35, y: 1.07, w: 9.2, h: 0.5,
    fontSize: 10, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Boxes
  const antiCards = [
    {
      title: "Empiric Coverage Principles",
      color: ORANGE,
      points: [
        "Broad-spectrum coverage guided by likely source & local antibiogram",
        "Consider MRSA coverage if risk factors present",
        "Anti-fungal if immunocompromised or prolonged ICU stay",
        "Combination therapy for septic shock (improve coverage breadth)",
        "De-escalate based on culture results within 24–48 hours"
      ]
    },
    {
      title: "Source Control",
      color: TEAL,
      points: [
        "Identify and control source within 6–12 hours of diagnosis",
        "Drainage of abscesses, debridement of infected tissue",
        "Removal of infected devices/lines/catheters",
        "Timing: as soon as medically/logistically feasible",
        "Insufficient source control = treatment failure"
      ]
    },
    {
      title: "Antibiotic Stewardship",
      color: GREEN,
      points: [
        "Reassess antibiotic regimen daily",
        "Discontinue if non-infectious cause confirmed",
        "Use procalcitonin to guide de-escalation",
        "Avoid prolonged empiric broad-spectrum use",
        "Duration: typically 7–10 days (guided by clinical response)"
      ]
    }
  ];

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      x, y: 1.75, w: 3.08, h: 3.62,
      fill: { color: "152035" }, line: { color: card.color, width: 1.5 }
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    s.addText(card.title, {
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      fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
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        x: x + 0.1, y: 2.22 + j * 0.64, w: 2.88, h: 0.58,
        fontSize: 8.5, color: TEAL_LIGHT, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 – VASOPRESSORS & STEROIDS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY } });
  accentBar(s, GREEN);

  sectionLabel(s, "BUNDLE ELEMENT 5 + ADJUNCTS", GREEN);
  slideTitle(s, "Vasopressors, Steroids & Adjunct Therapies", 0.28, DARK_NAVY);
  divider(s, 0.88, GREEN);

  // Vasopressor table
  s.addText("VASOPRESSOR THERAPY  (Target MAP ≥65 mmHg)", {
    x: 0.25, y: 1.0, w: 9.5, h: 0.3,
    fontSize: 11, bold: true, color: DARK_NAVY, fontFace: "Calibri", charSpacing: 1, margin: 0
  });

  const vasRows = [
    ["Agent", "Role", "Dose", "Evidence"],
    ["Norepinephrine", "First-line vasopressor", "0.01–3.3 mcg/kg/min", "STRONG – 2021"],
    ["Vasopressin", "Add-on to reduce NE dose", "0.03–0.04 units/min", "Weak – 2021"],
    ["Epinephrine", "Second-line or cardiac arrest", "0.01–0.3 mcg/kg/min", "Weak suggestion"],
    ["Dopamine", "NOT recommended routinely", "—", "Against use (arrhythmias)"],
    ["Phenylephrine", "Avoid in septic shock", "—", "Weak – avoid"],
  ];

  vasRows.forEach((row, i) => {
    const isHeader = i === 0;
    const bg = isHeader ? GREEN : (i % 2 === 0 ? "EEF5EE" : WHITE);
    const textColor = isHeader ? WHITE : DARK_NAVY;
    const colWidths = [2.3, 2.5, 2.2, 2.5];
    let xPos = 0.25;
    row.forEach((cell, j) => {
      s.addShape(pres.ShapeType.rect, {
        x: xPos, y: 1.35 + i * 0.38, w: colWidths[j], h: 0.38,
        fill: { color: bg }, line: { color: "C8D8C8", width: 0.5 }
      });
      s.addText(cell, {
        x: xPos + 0.05, y: 1.38 + i * 0.38, w: colWidths[j] - 0.1, h: 0.3,
        fontSize: isHeader ? 9 : 8.8, bold: isHeader, color: textColor, fontFace: "Calibri", margin: 0
      });
      xPos += colWidths[j];
    });
  });

  // Peripheral vasopressor note (new 2021)
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 3.7, w: 9.5, h: 0.38,
    fill: { color: TEAL }, line: { color: TEAL, width: 1 }
  });
  s.addText("NEW 2021: Peripheral IV vasopressors may be initiated while awaiting central venous access — do NOT delay vasopressors to obtain CVC (Weak recommendation)", {
    x: 0.35, y: 3.76, w: 9.2, h: 0.28,
    fontSize: 9, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Steroid box
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 4.18, w: 4.6, h: 1.15,
    fill: { color: WHITE }, line: { color: AMBER, width: 1.5 }
  });
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 4.18, w: 4.6, h: 0.35, fill: { color: AMBER } });
  s.addText("CORTICOSTEROIDS (NEW 2021)", {
    x: 0.35, y: 4.22, w: 4.4, h: 0.28,
    fontSize: 9, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });
  s.addText("IV hydrocortisone 200 mg/day if vasopressor requirement is ongoing despite adequate fluid resuscitation.\nWeak recommendation — not routine; indicated for refractory septic shock.", {
    x: 0.35, y: 4.58, w: 4.4, h: 0.68,
    fontSize: 8.5, color: DARK_NAVY, fontFace: "Calibri", margin: 0
  });

  // Blood glucose box
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    x: 5.1, y: 4.18, w: 4.65, h: 1.15,
    fill: { color: WHITE }, line: { color: RED_ALERT, width: 1.5 }
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  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 4.18, w: 4.65, h: 0.35, fill: { color: RED_ALERT } });
  s.addText("GLYCAEMIC CONTROL", {
    x: 5.2, y: 4.22, w: 4.45, h: 0.28,
    fontSize: 9, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });
  s.addText("Target blood glucose 7.8–10.0 mmol/L (140–180 mg/dL).\nUse insulin infusion protocol if 2 consecutive readings >10 mmol/L.\nAvoid hypoglycaemia — increases mortality.", {
    x: 5.2, y: 4.58, w: 4.45, h: 0.68,
    fontSize: 8.5, color: DARK_NAVY, fontFace: "Calibri", margin: 0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 – LACTATE & MONITORING
// ─────────────────────────────────────────────────────────────────────────────
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  darkBackground(s);
  accentBar(s, TEAL);

  sectionLabel(s, "BUNDLE ELEMENT 1 + MONITORING", TEAL);
  slideTitle(s, "Lactate Monitoring & Perfusion Assessment", 0.28, WHITE);
  divider(s, 0.88, TEAL);

  // Lactate significance
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 1.0, w: 9.5, h: 0.6,
    fill: { color: "152035" }, line: { color: TEAL, width: 1.5 }
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  s.addText("Serum lactate is a biomarker of tissue hypoperfusion and cellular energy failure (anaerobic glycolysis). Elevated lactate >2 mmol/L identifies occult shock even when BP appears normal.", {
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    fontSize: 9.5, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Lactate levels
  const lactateData = [
    { range: "<2 mmol/L", label: "Normal", color: GREEN, action: "Continue monitoring; optimise fluid status" },
    { range: "2–4 mmol/L", label: "Elevated", color: AMBER, action: "30 mL/kg crystalloid; repeat lactate in 2 hrs; antibiotics within 1 hr" },
    { range: ">4 mmol/L", label: "Severe / Septic Shock", color: RED_ALERT, action: "ICU admission; vasopressors; aggressive resuscitation; source control" },
  ];

  lactateData.forEach((ld, i) => {
    const y = 1.72 + i * 0.82;
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      x: 0.25, y, w: 9.5, h: 0.72,
      fill: { color: "152035" }, line: { color: ld.color, width: 1.5 }
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    s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 1.6, h: 0.72, fill: { color: ld.color } });
    s.addText(ld.range, {
      x: 0.3, y: y + 0.05, w: 1.5, h: 0.3,
      fontSize: 10, bold: true, color: WHITE, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(ld.label, {
      x: 0.3, y: y + 0.38, w: 1.5, h: 0.28,
      fontSize: 8, color: WHITE, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText("▸  " + ld.action, {
      x: 1.95, y: y + 0.17, w: 7.65, h: 0.38,
      fontSize: 10, color: WHITE, fontFace: "Calibri", margin: 0
    });
  });

  // Monitoring targets
  s.addText("RESUSCITATION TARGETS", {
    x: 0.25, y: 4.26, w: 4.5, h: 0.28,
    fontSize: 10, bold: true, color: TEAL, charSpacing: 2, fontFace: "Calibri", margin: 0
  });

  const targets = [
    "MAP ≥65 mmHg",
    "Urine output ≥0.5 mL/kg/hr",
    "Lactate normalisation / ↓ by 10–20%",
    "Capillary refill time ≤3 sec (NEW 2021)",
    "ScvO₂ ≥70% (if measuring)",
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    s.addText("✓  " + t, {
      x: 0.25, y: 4.58 + i * 0.19, w: 4.4, h: 0.18,
      fontSize: 8.5, color: WHITE, fontFace: "Calibri", margin: 0
    });
  });

  s.addText("SCREENING TOOLS", {
    x: 5.1, y: 4.26, w: 4.65, h: 0.28,
    fontSize: 10, bold: true, color: TEAL, charSpacing: 2, fontFace: "Calibri", margin: 0
  });
  const tools = [
    "SOFA: Organ dysfunction score (0–24)",
    "qSOFA: RR ≥22 + AMS + SBP ≤100 mmHg",
    "NEWS-2: Early warning score",
    "SIRS criteria (Bailey & Love: ≥2 of fever/HR/RR/WBC)",
    "Procalcitonin: guides antibiotic de-escalation",
  ];
  tools.forEach((t, i) => {
    s.addText("✓  " + t, {
      x: 5.1, y: 4.58 + i * 0.19, w: 4.6, h: 0.18,
      fontSize: 8.5, color: WHITE, fontFace: "Calibri", margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 – THE SEPSIS SIX (Bailey & Love)
// ─────────────────────────────────────────────────────────────────────────────
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY } });
  accentBar(s, ORANGE);

  sectionLabel(s, "BAILEY & LOVE SURGERY 28E", ORANGE);
  slideTitle(s, "The Sepsis Six (UK Sepsis Trust)", 0.28, DARK_NAVY);
  divider(s, 0.88, ORANGE);

  s.addText("Derived from SSC international guidelines by the UK Sepsis Trust — a practical bedside bundle for immediate action within 1 hour of sepsis recognition", {
    x: 0.3, y: 0.95, w: 9.4, h: 0.3,
    fontSize: 9.5, color: "4A5568", italic: true, fontFace: "Calibri", margin: 0
  });

  // Two columns: Give Three / Take Three
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    x: 0.25, y: 1.35, w: 4.55, h: 0.42,
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    x: 0.35, y: 1.42, w: 4.35, h: 0.28,
    fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 1, margin: 0
  });

  s.addShape(pres.ShapeType.rect, {
    x: 5.0, y: 1.35, w: 4.75, h: 0.42,
    fill: { color: ORANGE }
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  s.addText("TAKE THREE  ←  From the Patient", {
    x: 5.1, y: 1.42, w: 4.55, h: 0.28,
    fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 1, margin: 0
  });

  const giveThree = [
    {
      n: "1",
      title: "IV Fluid Challenge",
      detail: "30 mL/kg crystalloid (Ringer's lactate preferred)\nRapid infusion for hypotension or lactate >2\nReassess response dynamically"
    },
    {
      n: "2",
      title: "IV Broad-Spectrum Antibiotics",
      detail: "Empiric coverage for likely source\nBlood cultures first (do not delay >45 min)\nLocal protocol / microbiologist advice"
    },
    {
      n: "3",
      title: "Oxygen + Monitor Urine Output",
      detail: "High-flow O₂ targeting SpO₂ ≥94%\nUrinary catheter for hourly UO monitoring\nTarget ≥0.5 mL/kg/hr"
    }
  ];

  const takeThree = [
    {
      n: "4",
      title: "Blood Cultures",
      detail: "≥2 sets — peripheral + central (if present)\nBefore antibiotics — do not delay >45 min\nInclude fungal cultures if immunocompromised"
    },
    {
      n: "5",
      title: "Full Blood Count",
      detail: "Check WBC (>12 or <4 × 10⁹/L = SIRS)\nThromobocytopenia may indicate DIC\nHaemoglobin — guide transfusion decisions"
    },
    {
      n: "6",
      title: "Serum Lactate",
      detail: "Tissue hypoperfusion marker\n>2 mmol/L → resuscitate aggressively\n>4 mmol/L → septic shock; ICU"
    }
  ];

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    const y = 1.85 + i * 1.2;
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      x: 0.25, y, w: 4.55, h: 1.1,
      fill: { color: WHITE }, line: { color: TEAL, width: 1.2 }
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    s.addShape(pres.ShapeType.ellipse, { x: 0.33, y: y + 0.12, w: 0.55, h: 0.55, fill: { color: TEAL } });
    s.addText(item.n, {
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      fontSize: 14, bold: true, color: WHITE, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(item.title, {
      x: 1.0, y: y + 0.1, w: 3.65, h: 0.3,
      fontSize: 10, bold: true, color: DARK_NAVY, fontFace: "Calibri", margin: 0
    });
    s.addText(item.detail, {
      x: 1.0, y: y + 0.42, w: 3.65, h: 0.6,
      fontSize: 8.2, color: "4A5568", fontFace: "Calibri", margin: 0
    });
  });

  takeThree.forEach((item, i) => {
    const y = 1.85 + i * 1.2;
    s.addShape(pres.ShapeType.rect, {
      x: 5.0, y, w: 4.75, h: 1.1,
      fill: { color: WHITE }, line: { color: ORANGE, width: 1.2 }
    });
    s.addShape(pres.ShapeType.ellipse, { x: 5.08, y: y + 0.12, w: 0.55, h: 0.55, fill: { color: ORANGE } });
    s.addText(item.n, {
      x: 5.08, y: y + 0.2, w: 0.55, h: 0.38,
      fontSize: 14, bold: true, color: WHITE, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(item.title, {
      x: 5.73, y: y + 0.1, w: 3.85, h: 0.3,
      fontSize: 10, bold: true, color: DARK_NAVY, fontFace: "Calibri", margin: 0
    });
    s.addText(item.detail, {
      x: 5.73, y: y + 0.42, w: 3.85, h: 0.6,
      fontSize: 8.2, color: "4A5568", fontFace: "Calibri", margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 – SSC 2021 KEY UPDATES
// ─────────────────────────────────────────────────────────────────────────────
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  const s = pres.addSlide();
  midBackground(s);
  accentBar(s, GREEN);

  sectionLabel(s, "2021 GUIDELINE UPDATES", GREEN);
  slideTitle(s, "What's New in SSC 2021 vs 2016?", 0.28, WHITE);
  divider(s, 0.88, GREEN);

  const updates = [
    {
      topic: "Fluid Choice",
      old: "Crystalloids (unspecified)",
      new2021: "Balanced crystalloids PREFERRED over 0.9% NaCl",
      strength: "Weak"
    },
    {
      topic: "Vasopressors",
      old: "Start via CVC",
      new2021: "Peripheral IV vasopressors acceptable while awaiting CVC — do not delay",
      strength: "Weak"
    },
    {
      topic: "Antimicrobial Timing",
      old: "Within 1 hr for sepsis and septic shock",
      new2021: "Immediate for septic shock; within 3 hrs for possible sepsis without shock",
      strength: "Strong"
    },
    {
      topic: "Corticosteroids",
      old: "Not recommended unless ACTH-unresponsive",
      new2021: "IV hydrocortisone 200 mg/day if vasopressors ongoing — new clear indication",
      strength: "Weak"
    },
    {
      topic: "Capillary Refill Time",
      old: "Not mentioned",
      new2021: "Use CRT as adjunct to other measures of perfusion to guide resuscitation",
      strength: "Weak"
    },
    {
      topic: "Post-ICU Care",
      old: "Not addressed",
      new2021: "Expanded section on rehabilitation, follow-up, cognitive impairment, PTSD",
      strength: "NEW"
    },
    {
      topic: "Diversity",
      old: "Limited geographic/gender diversity",
      new2021: "Greater geographic and gender diversity in guideline committee membership",
      strength: "NEW"
    },
  ];

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  const headers = ["Topic", "2016 Recommendation", "2021 Update", "Strength"];
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  let xH = 0.2;
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      x: xH, y: 1.0, w: colW2[j], h: 0.35,
      fill: { color: GREEN }
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      fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
    });
    xH += colW2[j];
  });

  updates.forEach((row, i) => {
    const rowH = 0.52;
    const y = 1.38 + i * rowH;
    const bg = i % 2 === 0 ? "1B2D45" : "152035";
    let xC = 0.2;

    const cells = [row.topic, row.old, row.new2021, row.strength];
    cells.forEach((cell, j) => {
      s.addShape(pres.ShapeType.rect, {
        x: xC, y, w: colW2[j], h: rowH,
        fill: { color: bg }, line: { color: "2A4060", width: 0.5 }
      });
      const isNew = j === 3;
      const textColor = isNew ? (row.strength === "NEW" ? GREEN : row.strength === "Strong" ? RED_ALERT : AMBER) : WHITE;
      s.addText(cell, {
        x: xC + 0.05, y: y + 0.1, w: colW2[j] - 0.1, h: rowH - 0.12,
        fontSize: j === 0 ? 9 : 8.2, bold: (j === 0 || j === 3), color: textColor,
        fontFace: "Calibri", margin: 0
      });
      xC += colW2[j];
    });
  });

  s.addText("Source: Evans L et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021;49:e1063.", {
    x: 0.2, y: 5.3, w: 9.6, h: 0.22,
    fontSize: 7.5, color: MID_GRAY, italic: true, fontFace: "Calibri", margin: 0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12 – OUTCOMES & EVIDENCE
// ─────────────────────────────────────────────────────────────────────────────
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  accentBar(s, TEAL);

  sectionLabel(s, "EVIDENCE & OUTCOMES", TEAL);
  slideTitle(s, "Impact of Bundle Compliance on Mortality", 0.28, DARK_NAVY);
  divider(s, 0.88, TEAL);

  const stats = [
    { value: "20–30%", label: "Hospital mortality\n(Robbins Basic Pathology)", color: TEAL },
    { value: "40%", label: "Mortality in septic\nshock (Robbins Cotran)", color: ORANGE },
    { value: "750,000+", label: "Cases per year\nin the USA", color: RED_ALERT },
    { value: "~7%", label: "Absolute mortality\nreduction with bundles", color: GREEN },
  ];

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      x, y: 1.0, w: 2.2, h: 1.5,
      fill: { color: WHITE }, line: { color: stat.color, width: 2 }
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    s.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 2.2, h: 0.12, fill: { color: stat.color } });
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      fontSize: 26, bold: true, color: stat.color, align: "center", fontFace: "Calibri", margin: 0
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    s.addText(stat.label, {
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      fontSize: 8.5, color: DARK_NAVY, align: "center", fontFace: "Calibri", margin: 0
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  });

  const evidence = [
    {
      title: "Hour-1 Bundle (2018)",
      points: [
        "Combining previous 3-hr and 6-hr bundles into a single 1-hr bundle",
        "Faster completion associated with significantly lower in-hospital mortality",
        "ROSEN's Emergency Medicine: Bundle of antibiotics + fluids + cultures within 1 hr reduced mortality (OR significant)"
      ]
    },
    {
      title: "ANDROMEDA-SHOCK Trial",
      points: [
        "Capillary refill time-guided resuscitation vs lactate-guided",
        "CRT group had non-significant lower 28-day mortality (34.9% vs 43.4%)",
        "Informed the NEW 2021 recommendation for CRT as adjunct perfusion marker"
      ]
    },
    {
      title: "Barriers to Implementation",
      points: [
        "Delayed sepsis recognition — qSOFA and NEWS-2 improve screening",
        "Antibiotic overuse concerns — stewardship protocols address this",
        "Fluid overload in elderly and heart failure patients",
        "Resource limitations in low/middle-income countries"
      ]
    }
  ];

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      x, y: 2.65, w: 3.1, h: 2.75,
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    s.addText(ev.title, {
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        fontSize: 8, color: DARK_NAVY, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 13 – QUICK REFERENCE SUMMARY
// ─────────────────────────────────────────────────────────────────────────────
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  accentBar(s, TEAL);

  sectionLabel(s, "QUICK REFERENCE", TEAL);
  slideTitle(s, "Hour-1 Bundle — Bedside Summary Card", 0.28, WHITE);
  divider(s, 0.88, TEAL);

  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 1.0, w: 9.5, h: 0.5,
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  s.addText("⚠  SEPSIS / SEPTIC SHOCK IDENTIFIED?  →  START THE CLOCK — EVERY MINUTE COUNTS", {
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    fontSize: 12, bold: true, color: WHITE, align: "center", fontFace: "Calibri", charSpacing: 1, margin: 0
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    { step: "MEASURE", detail: "Lactate — if >2 mmol/L: repeat in 2h | if >4 mmol/L: septic shock", color: TEAL, t: "⏱ NOW" },
    { step: "OBTAIN", detail: "Blood cultures (≥2 sets) — BEFORE antibiotics", color: ORANGE, t: "⏱ NOW" },
    { step: "GIVE", detail: "IV broad-spectrum antibiotics — within 1h for shock; 3h for possible sepsis", color: RED_ALERT, t: "< 1 HR" },
    { step: "GIVE", detail: "30 mL/kg IV crystalloid (balanced preferred) — within 3h of presentation", color: "5B9BD5", t: "< 3 HR" },
    { step: "APPLY", detail: "Vasopressors (norepinephrine first-line) if MAP <65 mmHg despite fluids — can use peripheral IV", color: GREEN, t: "< 1 HR" },
  ];

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      x: 0.25, y, w: 9.5, h: 0.65,
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    s.addText(item.step, {
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// ─────────────────────────────────────────────────────────────────────────────
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    "Sepsis is a TIME-SENSITIVE emergency — early recognition saves lives",
    "The Hour-1 Bundle: Lactate | Cultures | Antibiotics | 30 mL/kg fluids | Vasopressors",
    "Balanced crystalloids are now preferred over normal saline (SSC 2021)",
    "Norepinephrine is first-line vasopressor; peripheral initiation is now acceptable",
    "Antibiotics: immediately for septic shock; within 3 hrs for possible sepsis",
    "Hydrocortisone 200 mg/day for refractory shock (ongoing vasopressor requirement)",
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