-
Neonatal Assessment
- Fenton 2013 / WHO Classification +Bedside
+ Weight-based pediatric reference. Always verify against institutional protocols.
- ' + name + ' ' + doseText + ' ' + route + ' ' + (notes || '') + '
';
+ }
+ function severityBadge(label, color) { return '' + label + ''; }
+
+ function asthmaManagement(severity) {
+ var wt = parseFloat(document.getElementById('resp-weight').value);
+ var resultDiv = document.getElementById('asthma-result');
+ if (!wt) { resultDiv.innerHTML = '' + phase + ' ' + drug + ' ' + dose + ' ' + route + ' ' + notes + '
';
+ html += '
';
+
+ // Reversal agents
+ html += '
';
+
+ html += '
';
+ },
+ drugRow: function(name, dose, route, notes) {
+ return '' + name + ' ' + dose + ' ' + route + ' ' + (notes || '') + '
• IV/IO: 0.01-0.03 mg/kg (0.1-0.3 mL/kg) — preferred
• ETT: 0.05-0.1 mg/kg (0.5-1 mL/kg) — while IV being placed
Repeat q3-5 min. If hypovolemia: NS 10 mL/kg IV/IO over 5-10 min.'); + html += '';
+ }
+
+ html += '';
+ html += '
';
+
+ // ── Escalation ladder ──
+ html += '';
+ html += '
';
+
+ // ── Mental model summary ──
+ html += '
Gestational age classification, birth weight assessment (AGA/SGA/LGA), and prematurity category.
-
-
+
+
+
-
-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Neonatal Assessment
+GA classification, birth weight assessment (AGA/SGA/LGA), and prematurity category. Fenton 2013 / WHO.
+
+
-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
-
-
-
-
-
-
-
-
-
-
+
+
+
+
-
-
+
+
+
+
+
+
+ NRP Resuscitation Pathway
+AHA Neonatal Resuscitation Program 2020. Static visual pathway — enter weight to calculate drug doses.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Apgar Score
+Assess at 1 and 5 minutes. If <7 at 5 min, repeat every 5 min up to 20 min. Apgar is a description — never delay resuscitation waiting for a score.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Airway Management / RSI
+RSI drugs + equipment sizing + initial ventilator settings.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Cardiac Arrest / PALS
+PALS algorithm medications for arrest and peri-arrest rhythms.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Respiratory Management
+Asthma, croup, bronchiolitis — scores, stepwise management, weight-based drug dosing.
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Select severity to see stepwise management with weight-based dosing.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Westley Croup Score → severity-based treatment.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Bronchiolitis management per AAP 2014/2023 — primarily supportive.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Oxygen & Ventilation
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Status Epilepticus
+Time-based pathway — stabilize → 1st benzo → 2nd benzo → 2nd-line AED → refractory.
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Sepsis & Fever Workup
+Phoenix Sepsis Criteria (2024), age-based approach, first-hour bundle, and validated febrile-infant rules (PECARN / Aronson / Rochester / Step-by-Step).
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Anaphylaxis
+Stepwise management with weight-based dosing.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Procedural Sedation
+Sedation agents + reversal drugs.
+
+
+
+
+
+
+
+
+
+
+ Acute Agitation
+Stepwise: verbal de-escalation → oral → IM/IV.
+
+
+
+
+
+
+
+
+
+
+ Antiemetics
+Common pediatric antiemetic dosing with max doses and key cautions.
+
+
+
+
+
+
+
+
+
+
+ Empiric Antimicrobials
+Empiric regimens by age and infection type. Always tailor to local resistance, cultures, and severity.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Burn Management
+TBSA body-parts calculator (Lund-Browder age-adjusted) + Parkland fluid resuscitation. Count only 2nd-degree or deeper.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ Toxicology
+Approach, decontamination, common ingestions with antidotes, dialyzable drugs reference.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Trauma
+Primary / secondary survey, c-spine, massive transfusion, TXA.
+
+
+
+
+
+
+
+ ![]()
+
diff --git a/public/css/styles.css b/public/css/styles.css
index c2bf4b9..2dffdca 100644
--- a/public/css/styles.css
+++ b/public/css/styles.css
@@ -143,6 +143,7 @@ body{font-family:'Inter',system-ui,sans-serif;background:var(--g50);color:var(--
.btn-generate-green{background:var(--green);box-shadow:0 3px 10px rgba(16,185,129,0.25);}
.btn-sm{display:inline-flex;align-items:center;gap:4px;padding:5px 10px;border:none;border-radius:6px;font-size:12px;font-weight:500;cursor:pointer;font-family:inherit;transition:all 0.15s;}
+.btn-lg{display:inline-flex;align-items:center;gap:6px;padding:9px 18px;border:none;border-radius:8px;font-size:14px;font-weight:600;cursor:pointer;font-family:inherit;transition:all 0.15s;}
.btn-primary{background:var(--blue);color:white;}.btn-primary:hover{background:var(--blue-dark);}
.btn-ghost{background:var(--g200);color:var(--g700);}.btn-ghost:hover{background:var(--g300);}
.btn-success{background:var(--green);color:white;}.btn-success:hover{background:#059669;}
diff --git a/public/img/epilepsy_eiic_pathway.png b/public/img/epilepsy_eiic_pathway.png
new file mode 100644
index 0000000..7623067
Binary files /dev/null and b/public/img/epilepsy_eiic_pathway.png differ
diff --git a/public/img/nrp_pathway.png b/public/img/nrp_pathway.png
new file mode 100644
index 0000000..3dc7dd1
Binary files /dev/null and b/public/img/nrp_pathway.png differ
diff --git a/public/index.html b/public/index.html
index 39a253f..b774db7 100644
--- a/public/index.html
+++ b/public/index.html
@@ -444,6 +444,7 @@
+
diff --git a/public/js/calc-math.js b/public/js/calc-math.js
new file mode 100644
index 0000000..e75842f
--- /dev/null
+++ b/public/js/calc-math.js
@@ -0,0 +1,206 @@
+// ============================================================
+// calc-math.js — Pure, side-effect-free dose / score math.
+// Dual-exported: browser (window._PED_MATH) + Node (module.exports).
+// Keep this file free of DOM references so it can be unit-tested
+// under Node with `node --test test/`.
+// ============================================================
+(function() {
+ function roundTo(v, places) { var m = Math.pow(10, places); return Math.round(v * m) / m; }
+
+ // ── Age → Weight ────────────────────────────────────────────
+ // APLS (Luscombe & Owens 2007 / APLS-UK 2016) and Best Guess
+ // (Tinning & Acworth 2007). For ages ≥13 yr we use Best Guess
+ // as primary; otherwise APLS.
+ function estimateWeightFromAgeMonths(months) {
+ if (months == null || isNaN(months) || months < 0) return null;
+ var years = months / 12;
+ var apls;
+ if (months < 12) apls = 0.5 * months + 4;
+ else if (years <= 5) apls = 2 * years + 8;
+ else apls = 3 * years + 7;
+ var bg;
+ if (months < 12) bg = (months + 9) / 2;
+ else if (years <= 5) bg = 2 * (years + 5);
+ else bg = 4 * years;
+ var primary = years < 13 ? apls : bg;
+ var bandLabel;
+ if (years < 13) {
+ if (months < 12) bandLabel = 'APLS 0-12 mo';
+ else if (years <= 5) bandLabel = 'APLS 1-5 yr';
+ else bandLabel = 'APLS 6-12 yr';
+ } else {
+ bandLabel = 'Best Guess 5-14 yr';
+ }
+ return {
+ weight: Math.max(0.3, roundTo(primary, 1)),
+ formulaLabel: bandLabel,
+ all: { apls: roundTo(apls, 1), bestGuess: roundTo(bg, 1) }
+ };
+ }
+
+ // ── Parkland fluid resuscitation (burn) ─────────────────────
+ // 4 mL × weight(kg) × %TBSA over 24 h; half in first 8 h.
+ function parkland(weightKg, tbsaPct) {
+ if (!weightKg || weightKg <= 0 || !tbsaPct || tbsaPct <= 0) return null;
+ var total = 4 * weightKg * tbsaPct;
+ var first8 = total / 2;
+ var next16 = total - first8;
+ return {
+ totalMl: Math.round(total),
+ first8Ml: Math.round(first8),
+ next16Ml: Math.round(next16),
+ rateFirst8: Math.round(first8 / 8),
+ rateNext16: Math.round(next16 / 16)
+ };
+ }
+
+ // ── Maintenance fluids (Holliday-Segar 4-2-1 rule) ─────────
+ function maintenance421(weightKg) {
+ if (!weightKg || weightKg <= 0) return null;
+ if (weightKg <= 10) return Math.round(weightKg * 4);
+ if (weightKg <= 20) return Math.round(40 + (weightKg - 10) * 2);
+ return Math.round(60 + (weightKg - 20));
+ }
+
+ // ── PRAM score (asthma, 0-12) ───────────────────────────────
+ function pramScore(spo2, retractions, scalene, airEntry, wheeze) {
+ var total = [spo2, retractions, scalene, airEntry, wheeze]
+ .reduce(function(s, v) { return s + (parseInt(v, 10) || 0); }, 0);
+ var severity = total <= 3 ? 'Mild' : total <= 7 ? 'Moderate' : 'Severe';
+ return { total: total, severity: severity };
+ }
+
+ // ── Westley croup score (0-17) ──────────────────────────────
+ function westleyScore(conscious, cyanosis, stridor, airEntry, retractions) {
+ var total = [conscious, cyanosis, stridor, airEntry, retractions]
+ .reduce(function(s, v) { return s + (parseInt(v, 10) || 0); }, 0);
+ var severity;
+ if (total <= 2) severity = 'Mild';
+ else if (total <= 5) severity = 'Moderate';
+ else if (total <= 11) severity = 'Severe';
+ else severity = 'Impending respiratory failure';
+ return { total: total, severity: severity };
+ }
+
+ // ── Epinephrine: anaphylaxis IM vs arrest IV ────────────────
+ // IMPORTANT: different concentrations (1:1,000 vs 1:10,000).
+ function epiAnaphylaxisIM(weightKg) {
+ if (!weightKg || weightKg <= 0) return null;
+ var mg = Math.min(weightKg * 0.01, 0.5);
+ return { doseMg: roundTo(mg, 2), volumeMl_1in1000: roundTo(mg, 2) };
+ }
+ function epiArrestIV(weightKg) {
+ if (!weightKg || weightKg <= 0) return null;
+ var mg = Math.min(weightKg * 0.01, 1);
+ return { doseMg: roundTo(mg, 2), volumeMl_1in10000: roundTo(mg * 10, 2) };
+ }
+
+ // ── NRP epinephrine (neonatal resus) ────────────────────────
+ // IV/IO 0.01-0.03 mg/kg = 0.1-0.3 mL/kg of 1:10,000.
+ function nrpEpiIV(weightKg) {
+ if (!weightKg || weightKg <= 0) return null;
+ return {
+ lowMg: roundTo(weightKg * 0.01, 2),
+ highMg: roundTo(weightKg * 0.03, 2),
+ lowMl: roundTo(weightKg * 0.1, 2),
+ highMl: roundTo(weightKg * 0.3, 2)
+ };
+ }
+
+ // ── RSI drug doses (selected) ───────────────────────────────
+ function rsiKetamine(weightKg) {
+ if (!weightKg) return null;
+ return { lowMg: Math.min(roundTo(weightKg * 1.5, 1), 150), highMg: Math.min(roundTo(weightKg * 2, 1), 200) };
+ }
+ function rsiRocuronium(weightKg) {
+ if (!weightKg) return null;
+ return { mg: Math.min(roundTo(weightKg * 1.2, 1), 100) };
+ }
+ function rsiSuccinylcholine(weightKg) {
+ if (!weightKg) return null;
+ var perKg = weightKg < 10 ? 2 : 1.5;
+ return { mg: Math.min(roundTo(weightKg * perKg, 1), 150), perKg: perKg };
+ }
+
+ // ── Minimum acceptable systolic BP (1-10 yr) ────────────────
+ function minSBP(years) {
+ if (years == null || isNaN(years)) return null;
+ if (years < 1) return 70;
+ if (years > 10) return 90;
+ return 70 + 2 * years;
+ }
+
+ // ── ETT (endotracheal tube) sizing by age ───────────────────
+ function ettSize(ageYears) {
+ if (ageYears == null || ageYears < 0) return null;
+ var uncuffed = ageYears / 4 + 4;
+ var cuffed = ageYears / 4 + 3.5;
+ return {
+ uncuffedMm: roundTo(uncuffed, 1),
+ cuffedMm: roundTo(cuffed, 1),
+ depthCm: roundTo(uncuffed * 3, 1)
+ };
+ }
+
+ // ── Lund-Browder regional TBSA by age bracket ───────────────
+ // Used for burns TBSA calculation. Bracket: 'infant', 'young',
+ // 'child', 'adol', 'adult' — per 0-1, 1-5, 5-10, 10-15, >15 yr.
+ var LB_BRACKETS = ['infant', 'young', 'child', 'adol', 'adult'];
+ var LB = {
+ head: [18, 13, 11, 9, 7],
+ neck: [2, 2, 2, 2, 2],
+ ant_trunk: [13, 13, 13, 13, 13],
+ post_trunk: [13, 13, 13, 13, 13],
+ r_buttock: [2.5, 2.5, 2.5, 2.5, 2.5],
+ l_buttock: [2.5, 2.5, 2.5, 2.5, 2.5],
+ genital: [1, 1, 1, 1, 1],
+ r_uparm: [4, 4, 4, 4, 4],
+ l_uparm: [4, 4, 4, 4, 4],
+ r_forearm: [3, 3, 3, 3, 3],
+ l_forearm: [3, 3, 3, 3, 3],
+ r_hand: [2.5, 2.5, 2.5, 2.5, 2.5],
+ l_hand: [2.5, 2.5, 2.5, 2.5, 2.5],
+ r_thigh: [5.5, 8, 8.5, 9, 9.5],
+ l_thigh: [5.5, 8, 8.5, 9, 9.5],
+ r_leg: [5, 5.5, 6, 6.5, 7],
+ l_leg: [5, 5.5, 6, 6.5, 7],
+ r_foot: [3.5, 3.5, 3.5, 3.5, 3.5],
+ l_foot: [3.5, 3.5, 3.5, 3.5, 3.5]
+ };
+
+ // involvements: { regionKey: percentOfRegionInvolved (0-100), ... }
+ function lundBrowderTBSA(ageBracket, involvements) {
+ var idx = LB_BRACKETS.indexOf(ageBracket);
+ if (idx < 0) return null;
+ var total = 0;
+ Object.keys(LB).forEach(function(key) {
+ var pct = (involvements && involvements[key]) || 0;
+ if (pct < 0) pct = 0; if (pct > 100) pct = 100;
+ total += LB[key][idx] * (pct / 100);
+ });
+ return roundTo(total, 1);
+ }
+
+ var API = {
+ roundTo: roundTo,
+ estimateWeightFromAgeMonths: estimateWeightFromAgeMonths,
+ parkland: parkland,
+ maintenance421: maintenance421,
+ pramScore: pramScore,
+ westleyScore: westleyScore,
+ epiAnaphylaxisIM: epiAnaphylaxisIM,
+ epiArrestIV: epiArrestIV,
+ nrpEpiIV: nrpEpiIV,
+ rsiKetamine: rsiKetamine,
+ rsiRocuronium: rsiRocuronium,
+ rsiSuccinylcholine: rsiSuccinylcholine,
+ minSBP: minSBP,
+ ettSize: ettSize,
+ lundBrowderTBSA: lundBrowderTBSA,
+ LB_BRACKETS: LB_BRACKETS,
+ LB: LB
+ };
+
+ if (typeof window !== 'undefined') window._PED_MATH = API;
+ if (typeof module !== 'undefined' && module.exports) module.exports = API;
+})();
diff --git a/public/js/calculators.js b/public/js/calculators.js
index a6463f9..9edd3f2 100644
--- a/public/js/calculators.js
+++ b/public/js/calculators.js
@@ -2368,3 +2368,1554 @@
resultDiv.innerHTML = html;
}
})();
+
+// ============================================================
+// RESPIRATORY MANAGEMENT (Asthma, Croup, Bronchiolitis)
+// ============================================================
+(function() {
+ // Sub-pill navigation
+ document.addEventListener('click', function(e) {
+ var pill = e.target.closest('[data-resp]');
+ if (pill) {
+ document.querySelectorAll('[data-resp]').forEach(function(p) { p.classList.remove('active'); });
+ pill.classList.add('active');
+ ['asthma','croup','bronchiolitis'].forEach(function(s) {
+ var el = document.getElementById('resp-' + s);
+ if (el) el.style.display = pill.dataset.resp === s ? '' : 'none';
+ });
+ }
+ if (e.target.closest('[data-asthma-severity]')) asthmaManagement(e.target.closest('[data-asthma-severity]').dataset.asthmaSeverity);
+ if (e.target.id === 'btn-pram-calc' || e.target.closest('#btn-pram-calc')) calcPRAM();
+ if (e.target.id === 'btn-croup-calc' || e.target.closest('#btn-croup-calc')) calcCroup();
+ if (e.target.id === 'btn-bronch-calc' || e.target.closest('#btn-bronch-calc')) calcBronchiolitis();
+ });
+
+ function dose(wt, mgPerKg, maxMg) { var d = Math.round(wt * mgPerKg * 10) / 10; return maxMg ? Math.min(d, maxMg) : d; }
+ // Delegates to the shared _EM.dStr so the per-kg math is visible to the prescriber.
+ function doseStr(wt, mgPerKg, maxMg, unit) {
+ return window._EM.dStr(wt, mgPerKg, maxMg, unit);
+ }
+ function drugRow(name, doseText, route, notes) {
+ return '
+
+ Open in new tab
+
+
+ | Drug | Dose | Route | Notes |
|---|
Enter weight (kg).
'; return; } + + var html = ''; + if (severity === 'mild') { + html += severityBadge('Mild Exacerbation', '#10b981'); + html += 'Speaks in sentences, no accessory muscle use, SpO2 ≥94%
'; + html += drugTable( + drugRow('Albuterol (MDI)', '4-8 puffs via spacer', 'Inhaled', 'q20min x 3 doses, then q1-4h') + + drugRow('Albuterol (neb)', doseStr(wt, 0.15, 5, ' mg') + ' (min 2.5 mg)', 'Nebulized', 'q20min x 3 doses') + + drugRow('Dexamethasone', doseStr(wt, 0.6, 16), 'PO/IV', 'Single dose, or 2 days') + + drugRow('Prednisolone', doseStr(wt, 1, 60) + '/day', 'PO', 'Alternative: 3-5 day course') + ); + html += 'Reassess after 1 hour. If improving → discharge with albuterol MDI + spacer + oral steroid course. If not improving → escalate to moderate.
';
+ } else if (severity === 'moderate') {
+ html += severityBadge('Moderate Exacerbation', '#f59e0b');
+ html += 'Speaks in phrases, some accessory muscle use, SpO2 90-93%
'; + html += drugTable( + drugRow('Albuterol (neb)', doseStr(wt, 0.15, 5, ' mg') + ' (min 2.5 mg)', 'Nebulized', 'q20min x 3 doses, then continuous if needed') + + drugRow('Ipratropium', wt < 20 ? '250 mcg' : '500 mcg', 'Nebulized', 'q20min x 3 doses with albuterol') + + drugRow('Dexamethasone', doseStr(wt, 0.6, 16), 'PO/IV/IM', 'Single dose') + + drugRow('O2 supplemental', 'Target SpO2 ≥94%', 'Nasal cannula/mask', 'Titrate to effect') + ); + html += 'Reassess after 1-2 hours. If improving → step down to mild protocol. If worsening or no improvement → escalate to severe.
';
+ } else {
+ html += severityBadge('Severe / Life-Threatening', '#ef4444');
+ html += 'Speaks in words only, significant accessory muscle use, SpO2 <90%. Consider ICU.
'; + html += drugTable( + drugRow('Albuterol continuous', doseStr(wt, 0.5, 20, ' mg') + '/hr', 'Continuous neb', 'Or 0.15-0.3 mg/kg q20min') + + drugRow('Ipratropium', wt < 20 ? '250 mcg' : '500 mcg', 'Nebulized', 'q20min x 3 doses with albuterol') + + drugRow('Dexamethasone', doseStr(wt, 0.6, 16), 'IV', 'Or methylprednisolone 2 mg/kg IV (max 60 mg)') + + drugRow('Magnesium sulfate', doseStr(wt, 50, 2000) + ' IV over 20 min', 'IV', 'Single dose, monitor BP') + + drugRow('Epinephrine (IM)', doseStr(wt, 0.01, 0.5) + ' (1:1000)', 'IM', 'If impending arrest / no IV access') + + drugRow('Terbutaline', doseStr(wt, 0.01, 0.4) + ' SC/IV', 'SC or IV bolus', 'Then 0.1-10 mcg/kg/min infusion') + + drugRow('O2 supplemental', 'Target SpO2 ≥94%', 'High flow / NIPPV', 'Consider BiPAP/CPAP') + ); + html += 'Continuous monitoring. Consider ICU admission. If no response to magnesium → terbutaline infusion. If impending respiratory failure → intubation (ketamine preferred induction agent).
';
+
+ // Clinical decision points specific to severe asthma
+ html += '';
+
+ // ABG
+ html += '
';
+ }
+ html += '' +
+ '
' + + '• Impending respiratory failure — altered mentation, fatigue, silent chest
' + + '• SpO2 <92% despite supplemental O2
' + + '• Suspected CO2 retention (rising PCO2 in a previously tachypneic patient)
' + + 'Interpretation: asthmatics hyperventilate → expect low PCO2. A "normal" or rising PCO2 = impending failure. Don\'t delay treatment for the gas.' + + '
';
+
+ // Intubation
+ html += ' When to obtain a blood gas
' +
+ '• Severe exacerbation not responding after 1-2 h aggressive therapy' + + '• Impending respiratory failure — altered mentation, fatigue, silent chest
' + + '• SpO2 <92% despite supplemental O2
' + + '• Suspected CO2 retention (rising PCO2 in a previously tachypneic patient)
' + + 'Interpretation: asthmatics hyperventilate → expect low PCO2. A "normal" or rising PCO2 = impending failure. Don\'t delay treatment for the gas.' + + '
' +
+ '
' + + '• Progressive fatigue despite maximal therapy (NIV, mag, terbutaline, heliox)
' + + '• Refractory hypoxemia / hypercapnia with acidosis
' + + '• Silent chest + deteriorating consciousness
' + + 'RSI choice: ketamine 1-2 mg/kg (bronchodilator, preserves BP) + rocuronium. Avoid succs if hyperkalemic. Permissive hypercapnia after tube; allow expiration (low rate, I:E 1:3-4).' + + '
';
+
+ // Heliox
+ html += ' When to intubate (mostly clinical)
' +
+ '• Absolute: apnea, cardiac arrest, coma, inability to protect airway' + + '• Progressive fatigue despite maximal therapy (NIV, mag, terbutaline, heliox)
' + + '• Refractory hypoxemia / hypercapnia with acidosis
' + + '• Silent chest + deteriorating consciousness
' + + 'RSI choice: ketamine 1-2 mg/kg (bronchodilator, preserves BP) + rocuronium. Avoid succs if hyperkalemic. Permissive hypercapnia after tube; allow expiration (low rate, I:E 1:3-4).' + + '
' +
+ '
' + + '• Consider in: severe asthma not responding to max therapy (bridge), upper airway obstruction (croup, post-extubation stridor, FB partial).
' + + '• Typical mix: 70:30 He:O2 (or 80:20). Delivered via tight non-rebreather or in-line with neb.
' + + '• Limitation: requires FiO2 ≤ 30-40%. If patient needs higher FiO2, heliox can\'t help.
' + + '• Evidence in asthma is mixed — use as adjunct, not substitute.' + + '
';
+
+ html += ' Heliox (He/O2)
' +
+ '• Lower gas density → less turbulence → reduced work of breathing through narrowed airways.' + + '• Consider in: severe asthma not responding to max therapy (bridge), upper airway obstruction (croup, post-extubation stridor, FB partial).
' + + '• Typical mix: 70:30 He:O2 (or 80:20). Delivered via tight non-rebreather or in-line with neb.
' + + '• Limitation: requires FiO2 ≤ 30-40%. If patient needs higher FiO2, heliox can\'t help.
' + + '• Evidence in asthma is mixed — use as adjunct, not substitute.' + + '
NAEPP/GINA guidelines. Always use clinical judgment. Verify doses against institutional protocols.
'; + resultDiv.innerHTML = html; + } + + function calcPRAM() { + var total = ['pram-spo2','pram-retractions','pram-scalene','pram-air','pram-wheeze'].reduce(function(s, id) { + return s + parseInt(document.getElementById(id).value); + }, 0); + var severity = total <= 3 ? 'Mild' : total <= 7 ? 'Moderate' : 'Severe'; + var color = total <= 3 ? '#10b981' : total <= 7 ? '#f59e0b' : '#ef4444'; + document.getElementById('pram-result').innerHTML = 'PRAM Score: ' + total + '/12 — ' + severity + '
';
+ }
+
+ function calcCroup() {
+ var wt = parseFloat(document.getElementById('resp-weight').value) || 10;
+ var total = ['croup-conscious','croup-cyanosis','croup-stridor','croup-air','croup-retractions'].reduce(function(s, id) {
+ return s + parseInt(document.getElementById(id).value);
+ }, 0);
+ var severity, color, treatment;
+ if (total <= 2) { severity = 'Mild'; color = '#10b981'; treatment = drugTable(drugRow('Dexamethasone', doseStr(wt, 0.6, 16), 'PO (single dose)', 'Preferred corticosteroid') + drugRow('Supportive care', 'Cool mist, comfort measures', '', 'Discharge if tolerating PO')); }
+ else if (total <= 5) { severity = 'Moderate'; color = '#f59e0b'; treatment = drugTable(drugRow('Dexamethasone', doseStr(wt, 0.6, 16), 'PO/IM', 'Single dose') + drugRow('Racemic epinephrine', '0.5 mL of 2.25% solution', 'Nebulized', 'Observe 2-4 hrs after for rebound') + drugRow('Nebulized epinephrine', '0.5 mL/kg of 1:1000 (max 5 mL)', 'Nebulized', 'Alternative to racemic')); }
+ else if (total <= 11) { severity = 'Severe'; color = '#ef4444'; treatment = drugTable(drugRow('Dexamethasone', doseStr(wt, 0.6, 16), 'IV/IM', 'Immediate') + drugRow('Racemic epinephrine', '0.5 mL of 2.25% solution', 'Nebulized', 'May repeat q15-20min, observe 2-4 hrs') + drugRow('Nebulized epinephrine', '0.5 mL/kg of 1:1000 (max 5 mL)', 'Nebulized', 'Alternative') + drugRow('Heliox', '70:30 or 80:20', 'Face mask', 'Consider if not responding') + drugRow('O2 supplemental', 'Target SpO2 ≥94%', 'Blow-by preferred', 'Minimize agitation')); }
+ else { severity = 'Impending Respiratory Failure'; color = '#dc2626'; treatment = 'Mild (0-3): outpatient management. Moderate (4-7): consider oral steroids + frequent bronchodilators. Severe (8-12): aggressive treatment, consider ICU.
Immediate airway management. Prepare for intubation (use ETT 0.5-1 size smaller than predicted). Call anesthesia/ENT. Continue nebulized epinephrine and dexamethasone IV.
'; }
+
+ document.getElementById('croup-result').innerHTML = 'Westley Score: ' + total + '/17 — ' + severity + '
' + treatment + 'Westley WJ et al. Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child 1978. Mild ≤2, Moderate 3-5, Severe 6-11, Impending failure ≥12.
'; + } + + function calcBronchiolitis() { + var wt = parseFloat(document.getElementById('resp-weight').value) || 5; + var age = document.getElementById('bronch-age').value; + var spo2 = document.getElementById('bronch-spo2').value; + var hydration = document.getElementById('bronch-hydration').value; + var distress = document.getElementById('bronch-distress').value; + + var html = 'Bronchiolitis Management
'; + var admit = distress === 'severe' || spo2 === 'low' || hydration === 'poor' || age === '<12w'; + + if (admit) { + html += severityBadge('Admit / Observe', '#ef4444'); + html += '';
+ if (age === '<12w') html += '
';
+ } else {
+ html += severityBadge('Likely Safe for Discharge', '#10b981');
+ }
+
+ html += '⚠ Age <12 weeks — high risk for apnea. Monitor closely.
'; + html += 'Supportive Care (evidence-based):
';
+ html += drugTable(
+ drugRow('Nasal suctioning', 'Bulb suction or NasalClear', 'Nasal', 'Before feeds and as needed') +
+ drugRow('O2 supplemental', 'Target SpO2 ≥90%', 'NC / high flow', spo2 === 'low' ? 'Required' : 'If needed') +
+ drugRow('Hypertonic saline 3%', '4 mL nebulized', 'Nebulized', 'Consider in inpatients (AAP weak recommendation)') +
+ (hydration === 'poor' ? drugRow('IV fluids', 'NS/LR bolus ' + doseStr(wt, 20, null, ' mL'), 'IV', 'Then maintenance D5 0.45NS') + drugRow('NG feeds', 'If unable to feed orally', 'NG tube', 'Preferred over IV if gut functional') : '')
+ );
+
+ html += 'NOT recommended (AAP 2014/2023): Albuterol/salbutamol (no benefit in bronchiolitis), epinephrine (no evidence of benefit), systemic corticosteroids (no benefit), antibiotics (unless secondary bacterial infection), chest physiotherapy.
';
+ html += 'AAP Clinical Practice Guideline: Management of Bronchiolitis in Infants and Children (2014, reaffirmed 2023). RSV is the most common cause (50-80%).
'; + document.getElementById('bronch-result').innerHTML = html; + } +})(); + +// ============================================================ +// SEIZURE MANAGEMENT +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + if (e.target.id === 'btn-seizure-calc' || e.target.closest('#btn-seizure-calc')) calcSeizure(); + }); + + function d(wt, mgPerKg, max) { var v = Math.round(wt * mgPerKg * 100) / 100; return max ? Math.min(v, max) : v; } + function row(phase, drug, dose, route, notes) { + return '' +
+ '
';
+ }
+
+ function calcSeizure() {
+ var wt = parseFloat(document.getElementById('seizure-weight').value);
+ var resultDiv = document.getElementById('seizure-result');
+ if (!wt) { resultDiv.innerHTML = '' +
+ '
' +
+ '' + time + '
' +
+ (isLast ? '' : '') +
+ '' +
+ '
' +
+ '' + title + '
' +
+ '' + bodyHtml + '
' +
+ 'Enter weight (kg).
'; return; } + var S = window._EM; + var d10Low = Math.round(wt * 2 * 10) / 10; + var d10High = Math.round(wt * 5 * 10) / 10; + + var html = ' Status Epilepticus Pathway — ' + wt + ' kg
';
+
+ // 0 min — STABILIZE
+ html += stepRow('0 min', '#3b82f6', 'Stabilize',
+ 'ABCs — position, 100% O2 via NC / NRB, suction. IV or IO × 2. Continuous SpO2, ECG, BP. ' +
+ 'POC glucose — if <60 mg/dL: D10W ' + d10Low + '-' + d10High + ' mL IV (2-5 mL/kg). ' +
+ 'Labs: CBC, CMP, Mg, Ca, Phos, VBG, lactate, AED levels, toxicology if unclear etiology. ' +
+ 'Consider pyridoxine 100 mg IV in infants <18 mo or INH ingestion. Temperature: treat hyperthermia aggressively.'
+ );
+
+ // 5 min — 1ST BENZO
+ html += stepRow('5 min', '#8b5cf6', '1st benzodiazepine (give once, pick by access)',
+ S.drugTable(
+ S.drugRow('Lorazepam (IV preferred)', S.dStr(wt, 0.1, 4), 'IV / IO', 'Slow push over 1-2 min.') +
+ S.drugRow('Midazolam', S.dStr(wt, 0.2, 10), 'IM / IN / buccal', 'Use 5 mg/mL concentrate for IN; split between nares.') +
+ S.drugRow('Diazepam', S.dStr(wt, 0.5, 20), 'PR', 'Only if no IV/IM/IN access.')
+ )
+ );
+
+ // 10 min — 2ND BENZO
+ html += stepRow('10 min', '#a855f7', '2nd benzodiazepine — if still seizing',
+ 'Repeat same agent + dose once. Prepare 2nd-line now (don\'t wait to see if benzo works). If apnea/airway compromise: BVM, consider advanced airway.'
+ );
+
+ // 20 min — 2ND-LINE
+ html += stepRow('20 min', '#f59e0b', '2nd-line anti-epileptic — pick one (ESETT: equivalent efficacy)',
+ S.drugTable(
+ S.drugRow('Levetiracetam (preferred)', S.dStr(wt, 60, 4500), 'IV over 5-15 min', 'Best tolerability. No ECG monitoring needed.') +
+ S.drugRow('Fosphenytoin', S.dStr(wt, 20, 1500, ' mg PE'), 'IV over 10 min', 'Max rate 3 mg PE/kg/min. Monitor ECG, BP. Avoid if cardiac dysrhythmia.') +
+ S.drugRow('Valproic acid', S.dStr(wt, 40, 3000), 'IV over 10 min', 'Avoid <2 yr, hepatic / mitochondrial disease, pregnancy.') +
+ S.drugRow('Phenobarbital', S.dStr(wt, 20, 1000), 'IV over 20 min', 'Last-choice 2nd line. High risk of resp depression + hypotension.')
+ )
+ );
+
+ // 30 min — 2nd of 2nd-line (optional)
+ html += stepRow('30 min', '#ef4444', 'Still seizing? Consider 2nd agent from 2nd-line OR proceed to refractory',
+ 'If the first 2nd-line drug failed, give a different 2nd-line agent OR move directly to refractory therapy. Activate ICU, prepare for intubation. Confirm etiology not reversible (electrolytes, glucose, fever, toxin).'
+ );
+
+ // 40 min — REFRACTORY
+ html += stepRow('40 min', '#dc2626', 'Refractory status — intubate + continuous infusion + continuous EEG',
+ S.drugTable(
+ S.drugRow('Midazolam (1st-line infusion)', 'Bolus ' + d(wt, 0.2, 10) + ' mg → gtt ' + d(wt, 0.05, 2) + '-' + d(wt, 0.5, 18) + ' mg/hr (bolus 0.2 mg/kg, gtt 0.05-0.5 mg/kg/hr)', 'IV', 'Titrate to seizure control / burst suppression.') +
+ S.drugRow('Pentobarbital', 'Bolus ' + d(wt, 5, 200) + ' mg → gtt ' + d(wt, 1, null) + '-' + d(wt, 5, null) + ' mg/hr (bolus 5 mg/kg, gtt 1-5 mg/kg/hr)', 'IV', 'Causes hypotension — often need pressors.') +
+ S.drugRow('Propofol', 'Bolus ' + d(wt, 2, 100) + ' mg → gtt ' + d(wt, 2, null) + '-' + d(wt, 5, null) + ' mg/hr (bolus 2 mg/kg, gtt 2-5 mg/kg/hr)', 'IV', 'PRIS risk in children — limit to <4 mg/kg/hr and duration <48 h.') +
+ S.drugRow('Ketamine', 'Bolus ' + d(wt, 2, 100) + ' mg → gtt ' + d(wt, 1, null) + '-' + d(wt, 5, null) + ' mg/hr (bolus 2 mg/kg, gtt 1-5 mg/kg/hr)', 'IV', 'NMDA antagonist — rescue. Good BP profile; useful if refractory to GABAergics.')
+ ) +
+ 'Time = 0 at seizure onset. Do not pause between steps for benzo to take effect — act on the clock.
Continuous EEG within 1 h — target electrographic seizure suppression × 24-48 h, then wean. Reassess etiology: CNS imaging, LP, expanded workup.
'
+ , true);
+
+ // Key points
+ html += 'Key points
' + + '• Do NOT wait for benzo response before starting the 2nd-line — parallel preparation.
' + + '• Maximum 2 benzo doses total (1 pre-hospital + 1 in ED, or 2 in ED).
' + + '• Respiratory depression is common — have BVM, airway equipment, naloxone, flumazenil accessible (but avoid flumazenil here).
' + + '• ESETT trial: levetiracetam = fosphenytoin = valproate for efficacy. Pick by tolerability / contraindications.
' + + '• Always reassess: ongoing seizure? Non-convulsive status? Pseudo-seizure? → continuous EEG if any doubt.
';
+
+ html += '' + + '• Do NOT wait for benzo response before starting the 2nd-line — parallel preparation.
' + + '• Maximum 2 benzo doses total (1 pre-hospital + 1 in ED, or 2 in ED).
' + + '• Respiratory depression is common — have BVM, airway equipment, naloxone, flumazenil accessible (but avoid flumazenil here).
' + + '• ESETT trial: levetiracetam = fosphenytoin = valproate for efficacy. Pick by tolerability / contraindications.
' + + '• Always reassess: ongoing seizure? Non-convulsive status? Pseudo-seizure? → continuous EEG if any doubt.
Based on AES Guidelines 2016 and ESETT (Kapur et al., NEJM 2019). Verify all doses against institutional protocols.
'; + resultDiv.innerHTML = html; + } +})(); + +// ============================================================ +// ANAPHYLAXIS MANAGEMENT +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + if (e.target.id === 'btn-anaph-calc' || e.target.closest('#btn-anaph-calc')) calcAnaphylaxis(); + }); + + function d(wt, mgPerKg, max) { var v = Math.round(wt * mgPerKg * 100) / 100; return max ? Math.min(v, max) : v; } + + function calcAnaphylaxis() { + var wt = parseFloat(document.getElementById('anaph-weight').value); + var age = document.getElementById('anaph-age').value; + var resultDiv = document.getElementById('anaph-result'); + if (!wt) { resultDiv.innerHTML = 'Enter weight (kg).
'; return; } + var S = window._EM; + + var epiDose = d(wt, 0.01, 0.5); + var epiVol = Math.round(epiDose * 10) / 10; // 1:1000 = 1 mg/mL + var autoInjector = wt < 10 ? 'Draw up manually' : wt <= 25 ? 'EpiPen Jr / Auvi-Q 0.15 mg' : 'EpiPen / Auvi-Q 0.3 mg'; + + var html = '';
+ html += '
';
+
+ html += ' STEP 1: Epinephrine IM — GIVE IMMEDIATELY
';
+ html += 'Epinephrine 1:1000 (1 mg/mL): ' + epiDose + ' mg (' + epiVol + ' mL) IM to lateral thigh
';
+ html += '0.01 mg/kg (max 0.5 mg) | Auto-injector: ' + autoInjector + '
';
+ html += 'May repeat every 5-15 minutes if symptoms persist. No contraindications in anaphylaxis.
';
+ html += '| Step | Drug | Dose | Route | Notes |
|---|---|---|---|---|
| STEP 2 | Position | Supine + legs elevated | — | If dyspneic: sitting position. If vomiting: recovery position |
| STEP 3 | O2 | High flow 10-15 L/min | Face mask | 100% O2. Prepare for airway management |
| STEP 4 | IV fluids | NS ' + S.dStr(wt, 20, null, ' mL') + ' bolus | IV/IO | Repeat up to 60 mL/kg for hypotension |
| STEP 5 | Diphenhydramine | ' + S.dStr(wt, 1.25, 50) + ' | IV/IM/PO | H1 blocker. NOT first-line — adjunct only |
| Ranitidine | ' + S.dStr(wt, 1, 50) + ' | IV over 5 min | H2 blocker. Optional adjunct | |
| STEP 6 | Dexamethasone | ' + S.dStr(wt, 0.6, 16) + ' | IV/IM/PO | Prevents biphasic reaction (4-6 hrs later) |
| Methylprednisolone | ' + S.dStr(wt, 2, 125) + ' | IV | Alternative steroid | |
| IF REFRACTORY | Epinephrine gtt | 0.1-1 mcg/kg/min | IV infusion | For persistent hypotension despite fluids + IM epi |
| Glucagon | ' + S.dStr(wt, 0.02, 1) + ' | IV/IM | For patients on beta-blockers not responding to epi |
Observe minimum 4-6 hours after last dose of epinephrine (biphasic reactions occur in 5-20% of cases). Discharge with EpiPen prescription and anaphylaxis action plan. Refer to allergist.
';
+ html += 'ASCIA Anaphylaxis Guidelines 2021. WAO Anaphylaxis Guidance 2020. AAP/ACAAI Practice Parameters.
'; + resultDiv.innerHTML = html; + } +})(); + +// ============================================================ +// PROCEDURAL SEDATION +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + if (e.target.id === 'btn-sed-calc' || e.target.closest('#btn-sed-calc')) calcSedation(); + }); + + function d(wt, mgPerKg, max) { var v = Math.round(wt * mgPerKg * 100) / 100; return max ? Math.min(v, max) : v; } + + function calcSedation() { + var wt = parseFloat(document.getElementById('sed-weight').value); + var resultDiv = document.getElementById('sed-result'); + if (!wt) { resultDiv.innerHTML = 'Enter weight (kg).
'; return; } + + var html = 'Procedural Sedation — ' + wt + ' kg patient
';
+
+ // Sedation agents
+ html += 'Sedation Agents
'; + html += '| Drug | Dose | Route | Onset | Duration | Notes |
|---|---|---|---|---|---|
| Ketamine | ' + d(wt, 1.5, 100) + '-' + d(wt, 2, 150) + ' mg' + perKg(1.5, 2) + ' | IV | 1 min | 15-30 min | Dissociative. Preserves airway reflexes. |
| ' + d(wt, 4, 300) + '-' + d(wt, 5, 400) + ' mg' + perKg(4, 5) + ' | IM | 3-5 min | 30-60 min | Give atropine 0.01 mg/kg to reduce secretions. | |
| Midazolam | ' + d(wt, 0.05, 2) + '-' + d(wt, 0.1, 5) + ' mg' + perKg(0.05, 0.1) + ' | IV | 2-3 min | 30-60 min | Anxiolysis. Titrate q3-5 min. |
| ' + d(wt, 0.5, 20) + ' mg' + perKg(0.5, null) + ' | IN/PO | 10-15 min | 30-60 min | IN (max 10 mg / naris) or PO (max 20 mg). | |
| Propofol | ' + d(wt, 1, 40) + ' mg' + perKg(1, null) + ' | IV | 30 sec | 5-10 min | Short procedures. Causes apnea — manage airway. |
| Fentanyl | ' + d(wt, 1, 100) + ' mcg' + perKg(1, null, 'mcg') + ' | IV | 2-3 min | 30-60 min | Analgesic. Often combined with midazolam. |
| ' + d(wt, 2, 100) + ' mcg' + perKg(2, null, 'mcg') + ' | IN | 5-10 min | 30-60 min | Intranasal. | |
| Nitrous oxide | 50:50 or 70:30 mix | Inhaled | 2-5 min | 5 min off | Self-administered via demand valve. Anxiolysis + mild analgesia. |
| Dexmedetomidine | ' + d(wt, 2, 100) + ' mcg' + perKg(2, 3, 'mcg') + ' | IN | 15-30 min | 60-90 min | Intranasal. No respiratory depression. Good for imaging. |
Reversal Agents
'; + html += '| Drug | Dose | Route | Reverses | Notes |
|---|---|---|---|---|
| Naloxone | ' + d(wt, 0.1, 2) + ' mg' + perKg(0.1, null) + ' | IV/IM/IN | Opioids (fentanyl, morphine) | Max 2 mg. Repeat q2-3 min. Duration shorter than opioids — monitor for re-sedation. |
| Flumazenil | ' + d(wt, 0.01, 0.2) + ' mg' + perKg(0.01, null) + ' | IV | Benzodiazepines (midazolam) | Max 0.2 mg single dose. Repeat q1 min to max 1 mg total. Risk of seizures — use cautiously. |
Pre-sedation checklist: NPO status (2h clear liquids, 6h solids), consent, monitoring equipment (pulse ox, capnography, BP), resuscitation equipment at bedside, suction ready, IV access. Minimum monitoring: continuous SpO2, HR, capnography. Provider capable of managing airway must be present.
';
+ html += 'AAP Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation. ASA Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.
'; + resultDiv.innerHTML = html; + } +})(); + +// ============================================================ +// IMAGE LIGHTBOX — any element with data-img-src opens fullscreen +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + var opener = e.target.closest && e.target.closest('[data-img-src]'); + if (opener) { + e.preventDefault(); + var lb = document.getElementById('img-lightbox'); + if (!lb) return; + var src = opener.dataset.imgSrc; + var title = opener.dataset.imgTitle || ''; + document.getElementById('img-lightbox-img').src = src; + document.getElementById('img-lightbox-img').alt = title; + document.getElementById('img-lightbox-title').textContent = title; + document.getElementById('img-lightbox-open').href = src; + lb.style.display = 'flex'; + return; + } + // Close on close button, on backdrop click (not on image), and on Escape (below) + var closeBtn = e.target.closest && e.target.closest('#img-lightbox-close'); + var lb2 = document.getElementById('img-lightbox'); + if (!lb2 || lb2.style.display !== 'flex') return; + if (closeBtn || e.target === lb2) { + lb2.style.display = 'none'; + document.getElementById('img-lightbox-img').src = ''; + } + }); + document.addEventListener('keydown', function(e) { + if (e.key === 'Escape') { + var lb = document.getElementById('img-lightbox'); + if (lb && lb.style.display === 'flex') { + lb.style.display = 'none'; + document.getElementById('img-lightbox-img').src = ''; + } + } + }); +})(); + +// ============================================================ +// EMERGENCIES SUB-NAV + SHARED HELPERS +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + var pill = e.target.closest('[data-em]'); + if (!pill) return; + document.querySelectorAll('[data-em]').forEach(function(p) { p.classList.remove('active'); }); + pill.classList.add('active'); + var sections = ['neonatal','airway','cardiac','respiratory','ventilation','seizure','sepsis','anaphylaxis','sedation','agitation','antiemetics','antimicrobials','burns','toxicology','trauma']; + sections.forEach(function(s) { + var el = document.getElementById('em-' + s); + if (el) el.style.display = pill.dataset.em === s ? '' : 'none'; + }); + }); +})(); + +// Shared helpers (attached to window for reuse across sections) +window._EM = { + d: function(wt, perKg, max) { var v = Math.round(wt * perKg * 100) / 100; return max ? Math.min(v, max) : v; }, + // Dose string — always shows the per-kg used (and max when capped), so the + // prescriber can verify the math without opening a drug ref. + // S.dStr(30, 0.1, 4) → "3 mg (0.1 mg/kg, max 4 mg)" + // S.dStr(60, 0.1, 4) → "4 mg (0.1 mg/kg, max 4 mg · capped)" + // S.dStr(20, 2, 150, ' mcg') → "40 mcg (2 mcg/kg, max 150 mcg)" + dStr: function(wt, perKg, max, unit) { + unit = unit || ' mg'; + var uTrim = unit.trim() || 'mg'; + var raw = wt * perKg; + var v = Math.round(raw * 100) / 100; + var capped = max != null && v > max; + var val = capped ? max : v; + var perKgStr = '(' + perKg + ' ' + uTrim + '/kg'; + if (max != null) perKgStr += ', max ' + max + ' ' + uTrim; + if (capped) perKgStr += ' · capped'; + perKgStr += ')'; + return val + unit + ' ' + perKgStr + ''; + }, + drugTable: function(rows) { + return '| Drug | Dose | Route | Notes |
|---|
' +
+ '
';
+ },
+ arrow: '' + title + '
' +
+ '' + body + '
↓
',
+ badge: function(label, color) { return '' + label + ''; },
+ ref: function(text) { return '' + text + '
'; } +}; + +// ============================================================ +// BEDSIDE — AGE → WEIGHT (single source for all sub-sections) +// ============================================================ +(function() { + document.addEventListener('input', function(e) { + if (e.target && e.target.id === 'bedside-age') recomputeFromAge(); + if (e.target && e.target.id === 'bedside-weight') { + e.target.dataset.userTyped = '1'; + } + }); + document.addEventListener('change', function(e) { + if (e.target && e.target.id === 'bedside-formula') recomputeFromAge(true); + }); + document.addEventListener('click', function(e) { + if (e.target.closest && e.target.closest('#btn-bedside-clear')) { + document.getElementById('bedside-age').value = ''; + var wtField = document.getElementById('bedside-weight'); + wtField.value = ''; + delete wtField.dataset.userTyped; + var note = document.getElementById('bedside-estimate-note'); + if (note) note.innerHTML = ''; + } + }); + + // Recompute weight from age using the currently selected formula. + // If forceFromFormula is true (formula dropdown changed), overwrite even user-typed weight. + function recomputeFromAge(forceFromFormula) { + var raw = document.getElementById('bedside-age').value; + var note = document.getElementById('bedside-estimate-note'); + if (!raw || !raw.trim()) { if (note) note.innerHTML = ''; return; } + var months = window._parseAgeMonths ? window._parseAgeMonths(raw) : null; + if (months == null || isNaN(months) || months < 0) { + if (note) note.innerHTML = 'Could not parse age. Try "3y", "18 months", "15 days".'; + return; + } + var formula = document.getElementById('bedside-formula').value; + var est = window._PED_MATH.estimateWeightFromAgeMonths(months); + var pickedWeight = formula === 'bestguess' ? est.all.bestGuess : est.all.apls; + var pickedLabel = formula === 'bestguess' ? bestGuessBand(months) : aplsBand(months); + + var wtField = document.getElementById('bedside-weight'); + if (forceFromFormula || !wtField.dataset.userTyped) { + wtField.value = pickedWeight; + delete wtField.dataset.userTyped; // treat as computed again + } + var ageTxt = months < 12 + ? (Math.round(months * 10) / 10) + ' months' + : (Math.round(months / 12 * 10) / 10) + ' years'; + if (note) note.innerHTML = '' + pickedWeight + ' kg ' + + '(' + ageTxt + ', ' + pickedLabel + ') · ' + + 'APLS: ' + est.all.apls + ' kg · Best Guess: ' + est.all.bestGuess + ' kg. You can override the weight field.'; + } + + function aplsBand(m) { + if (m < 12) return 'APLS 0-12 mo'; + var y = m / 12; + if (y <= 5) return 'APLS 1-5 yr'; + return 'APLS 6-12 yr'; + } + function bestGuessBand(m) { + if (m < 12) return 'Best Guess 1-11 mo'; + var y = m / 12; + if (y <= 5) return 'Best Guess 1-4 yr'; + return 'Best Guess 5-14 yr'; + } + + // Top bedside weight is estimator-only. Sections have their own weight fields and + // read them directly (no auto-propagation). No window globals needed here. + + function flash(id) { + var el = document.getElementById(id); + if (!el) return; + var prev = el.style.background; + el.style.background = 'var(--green)'; + setTimeout(function() { el.style.background = prev; }, 400); + } +})(); + +// PED_MATH pure functions now live in /js/calc-math.js (loaded before this file) +// and are available as window._PED_MATH. Sharing the math with Node unit tests. + +// ============================================================ +// SEPSIS +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + if (e.target.id === 'btn-sepsis-show' || e.target.closest('#btn-sepsis-show')) showSepsis(); + }); + + function showSepsis() { + var wt = parseFloat(document.getElementById('sepsis-weight').value); + var age = document.getElementById('sepsis-age').value; + var el = document.getElementById('sepsis-result'); + var S = window._EM; + var html = ''; + + var ageLbl = { neonate: 'Neonate (0-28 d)', infant: 'Young infant (29 d - 3 mo)', child: 'Older child / adolescent' }[age]; + html += 'Sepsis approach — ' + ageLbl + (wt ? ', ' + wt + ' kg' : '') + '
';
+
+ // Definition (Phoenix 2024)
+ html += 'Definition — Phoenix Sepsis Criteria (JAMA 2024)
'; + html += '';
+ html += 'Sepsis = suspected or confirmed infection + Phoenix Score ≥2 (organ dysfunction across respiratory, cardiovascular, coagulation, neurological).
'; + html += 'Septic shock = sepsis + cardiovascular dysfunction (vasoactive support, or ↑lactate ≥5, or ↓MAP for age).
'; + html += 'Previous SIRS-based criteria (Goldstein 2005) are now superseded. Still useful for quick clinical screening.'; + html += '
';
+
+ // Quick red flags
+ html += ''; + html += 'Septic shock = sepsis + cardiovascular dysfunction (vasoactive support, or ↑lactate ≥5, or ↓MAP for age).
'; + html += 'Previous SIRS-based criteria (Goldstein 2005) are now superseded. Still useful for quick clinical screening.'; + html += '
Red flags (recognize early)
'; + html += 'Abnormal behavior / mentation • Fever + ill-appearance • Tachycardia out of proportion to fever • Prolonged cap refill (>3 s) • Cold/mottled extremities • Weak pulses or wide pulse pressure ("warm shock") • Hypotension is a LATE sign in children • Any immune compromise / indwelling line.
';
+
+ // Age-specific approach
+ html += 'Evaluation & empiric therapy — ' + ageLbl + '
'; + if (age === 'neonate') { + html += '';
+ html += 'Workup (full sepsis eval): CBC + diff, CRP, blood culture, UA + urine culture (cath), lumbar puncture (CSF + HSV PCR), CXR if respiratory sx. Consider procalcitonin. Rapid viral panel if available.
'; + html += 'Early-onset (<72 h): GBS, E. coli, Listeria. Late-onset (>72 h): coag-neg staph, S. aureus, gram-negs, Candida.
';
+ html += S.drugTable(
+ S.drugRow('Ampicillin', wt ? S.dStr(wt, 100, 2000) : '50-100 mg/kg/dose', 'IV', 'q8-12h depending on age/weight. Covers GBS, Listeria, Enterococcus.') +
+ S.drugRow('Gentamicin', wt ? S.dStr(wt, 4, 120) : '4-5 mg/kg/dose', 'IV', 'q24-48h. Monitor levels. Peak 5-12, trough <1.') +
+ S.drugRow('Cefotaxime (add)', wt ? S.dStr(wt, 50, 2000) : '50 mg/kg/dose', 'IV', 'If meningitis suspected or gram-neg concern. Ceftriaxone avoided in hyperbilirubinemia.') +
+ S.drugRow('Acyclovir', wt ? S.dStr(wt, 20, 1200) : '20 mg/kg/dose', 'IV q8h', 'If HSV risk: maternal genital lesions, vesicles, seizures, CSF pleocytosis, hypothermia, hepatitis.')
+ );
+ } else if (age === 'infant') {
+ html += ''; + html += 'Early-onset (<72 h): GBS, E. coli, Listeria. Late-onset (>72 h): coag-neg staph, S. aureus, gram-negs, Candida.
';
+ html += 'Workup: Use validated rules — PECARN, Aronson, Rochester, Step-by-Step (see below). Most warrant CBC + ANC, procalcitonin and/or CRP, blood culture, UA + urine culture. Many warrant LP + admission + empiric abx.
'; + html += 'Coverage: GBS, E. coli, Listeria (up to ~6 wk), S. pneumoniae, N. meningitidis, H. influenzae, Salmonella.
';
+
+ // Febrile-infant rules — collapsible details
+ html += ''; + html += 'Coverage: GBS, E. coli, Listeria (up to ~6 wk), S. pneumoniae, N. meningitidis, H. influenzae, Salmonella.
Validated febrile-infant rules (click to expand)
'; + html += '';
+
+ // PECARN 2019
+ html += '
';
+ html += '
'; + html += ' • Normal UA (no LE, no nitrite, <5 WBC/hpf)
'; + html += ' • ANC ≤4,090 /μL
'; + html += ' • Procalcitonin ≤0.5 ng/mL (if procal unavailable: use CRP ≤20 mg/L as proxy)
'; + html += 'Low-risk → may defer LP/abx, observe, close follow-up. Not low-risk → full workup + empiric abx.'; + html += '
';
+
+ // Aronson 2019
+ html += 'PECARN febrile infant rule (Kuppermann et al., JAMA Pediatrics 2019)
';
+ html += 'Age: 29-60 days, well-appearing, febrile. Low-risk if ALL:'; + html += ' • Normal UA (no LE, no nitrite, <5 WBC/hpf)
'; + html += ' • ANC ≤4,090 /μL
'; + html += ' • Procalcitonin ≤0.5 ng/mL (if procal unavailable: use CRP ≤20 mg/L as proxy)
'; + html += 'Low-risk → may defer LP/abx, observe, close follow-up. Not low-risk → full workup + empiric abx.'; + html += '
';
+ html += '
'; + html += ' • Age 22-28 days: +1
'; + html += ' • Max temperature ≥38.5°C: +2
'; + html += ' • ANC ≥5,185 /μL: +2
'; + html += ' • Abnormal UA: +3
'; + html += 'Score 0-1 → low risk. ≥2 → consider full workup + abx. Higher scores → higher IBI risk.'; + html += '
';
+
+ // Rochester
+ html += 'Aronson rule (Aronson et al., PEDIATRICS 2019)
';
+ html += 'Age: 8-60 days, febrile ≥38°C. Point-based score for invasive bacterial infection (IBI):'; + html += ' • Age 22-28 days: +1
'; + html += ' • Max temperature ≥38.5°C: +2
'; + html += ' • ANC ≥5,185 /μL: +2
'; + html += ' • Abnormal UA: +3
'; + html += 'Score 0-1 → low risk. ≥2 → consider full workup + abx. Higher scores → higher IBI risk.'; + html += '
';
+ html += '
'; + html += ' • Previously healthy (term, no perinatal complications, no prior abx/hospitalization)
'; + html += ' • Well-appearing, no focal infection (not skin/bone/joint/soft tissue)
'; + html += ' • WBC 5,000-15,000 /μL and absolute band count ≤1,500 /μL
'; + html += ' • UA ≤10 WBC/hpf
'; + html += ' • If diarrhea: stool ≤5 WBC/hpf
'; + html += 'Low-risk → observation without abx possible (NPV >98%). Does not include procal.'; + html += '
';
+
+ // Step-by-Step
+ html += 'Rochester criteria (Jaskiewicz et al., Pediatrics 1994)
';
+ html += 'Age: 0-60 days, febrile. Low-risk if ALL:'; + html += ' • Previously healthy (term, no perinatal complications, no prior abx/hospitalization)
'; + html += ' • Well-appearing, no focal infection (not skin/bone/joint/soft tissue)
'; + html += ' • WBC 5,000-15,000 /μL and absolute band count ≤1,500 /μL
'; + html += ' • UA ≤10 WBC/hpf
'; + html += ' • If diarrhea: stool ≤5 WBC/hpf
'; + html += 'Low-risk → observation without abx possible (NPV >98%). Does not include procal.'; + html += '
';
+ html += '
'; + html += ' 1. Ill-appearing? → high risk
'; + html += ' 2. Age ≤21 days? → high risk
'; + html += ' 3. Leukocyturia (UA abnormal)? → high risk
'; + html += ' 4. Procalcitonin ≥0.5 ng/mL? → high risk
'; + html += ' 5. CRP >20 mg/L AND/OR ANC >10,000 /μL? → intermediate
'; + html += ' 6. Otherwise → low risk'; + html += '
';
+
+ html += 'Step-by-Step (Gomez et al., Pediatrics 2016 — European)
';
+ html += 'Age: ≤90 days, febrile. Sequential triage; stop at first positive:'; + html += ' 1. Ill-appearing? → high risk
'; + html += ' 2. Age ≤21 days? → high risk
'; + html += ' 3. Leukocyturia (UA abnormal)? → high risk
'; + html += ' 4. Procalcitonin ≥0.5 ng/mL? → high risk
'; + html += ' 5. CRP >20 mg/L AND/OR ANC >10,000 /μL? → intermediate
'; + html += ' 6. Otherwise → low risk'; + html += '
Highest sensitivity for IBI among these rules when procal available.
';
+ html += 'Practical note: AAP 2021 Clinical Practice Guideline on the well-appearing febrile infant 8-60 days synthesizes these — ages 8-21 d full workup regardless, 22-28 d inflammatory markers guide LP, 29-60 d UA + markers guide LP/abx. Defer to your local institutional pathway if available.
';
+ html += '';
+ html += 'Recognition: Phoenix score or clinical concern + suspected infection. Workup: CBC, CRP, procalcitonin, blood cx (+ site-specific cx), lactate, blood gas, glucose, electrolytes, coags, LP if CNS concern. Source-directed imaging.
'; + html += 'Common sources: respiratory, UTI, CNS, skin/soft tissue, intra-abdominal, bone/joint, indwelling device.
';
+ html += S.drugTable(
+ S.drugRow('Ceftriaxone', wt ? S.dStr(wt, 50, 2000) : '50 mg/kg/dose', 'IV', 'q24h (or 100 mg/kg/day divided for meningitis).') +
+ S.drugRow('Vancomycin', wt ? S.dStr(wt, 15, 1000) : '15 mg/kg/dose', 'IV', 'q6h. If severe, indwelling line, or MRSA prevalence >10%.') +
+ S.drugRow('Piperacillin-tazobactam', wt ? S.dStr(wt, 100, 4500) : '80-100 mg/kg/dose', 'IV', 'If intra-abdominal / neutropenic.') +
+ S.drugRow('Clindamycin', wt ? S.dStr(wt, 10, 900) : '10-13 mg/kg/dose', 'IV', 'Adjunct for toxic shock syndrome (toxin suppression).') +
+ S.drugRow('Acyclovir', wt ? S.dStr(wt, 20, 1200) : '10-20 mg/kg/dose', 'IV q8h', 'If HSV CNS concern.')
+ );
+ }
+
+ // First-hour bundle
+ html += ''; + html += 'Common sources: respiratory, UTI, CNS, skin/soft tissue, intra-abdominal, bone/joint, indwelling device.
First-hour bundle (SSC Peds 2020)
'; + html += S.stepBox('#3b82f6', '0-5 min — Recognize', 'Screen for sepsis; sepsis huddle / activation. Assess ABCs. O2 to SpO2 >94%. Warm patient.'); + html += S.stepBox('#8b5cf6', '5-15 min — Access & labs', 'Two IVs or IO. Draw: blood cx (ideally before abx), lactate, CBC, CMP, coags, blood gas, glucose. UA + culture. Source-specific cultures.'); + html += S.stepBox('#f59e0b', '15-30 min — Fluids', (wt ? 'NS or LR ' + S.d(wt, 20) + ' mL bolus over 5-10 min (20 mL/kg). ' : 'NS/LR 10-20 mL/kg bolus over 5-10 min. ') + 'Reassess after each bolus: HR, perfusion, lung sounds, liver size. Repeat up to 40-60 mL/kg; stop if crackles or hepatomegaly.'); + html += S.stepBox('#10b981', '30-60 min — Antibiotics + reassess', 'Broad-spectrum empiric abx within 1 hour (ideally 3 hr in sepsis, ≤1 hr in septic shock). Recheck lactate, perfusion.'); + html += S.stepBox('#ef4444', '>60 min — Fluid-refractory shock', 'Start vasoactive (epinephrine 0.05-0.3 mcg/kg/min for cold shock or norepinephrine 0.05-0.3 mcg/kg/min for warm shock). Consider central/IO access. Stress-dose hydrocortisone ' + (wt ? '' + S.d(wt, 2, 100) + ' mg IV (2 mg/kg, max 100 mg)' : '2 mg/kg IV (max 100 mg)') + ' if catecholamine-resistant. Consider ICU transfer.'); + + // Key targets + html += 'Resuscitation targets
'; + html += 'Normal mentation • Cap refill ≤2 s • Warm extremities • Strong peripheral pulses • UOP ≥1 mL/kg/hr • MAP ≥5th %ile for age (>65 mmHg adolescent) • SpO2 ≥94% • Lactate trending down.
';
+ html += S.ref('Phoenix Sepsis Criteria (Schlapbach et al., JAMA 2024). Surviving Sepsis Campaign Pediatric 2020. AAP pediatric sepsis guidance.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// NEONATAL RESUSCITATION (NRP) — pathway + drug calc
+// ============================================================
+(function() {
+ document.addEventListener('DOMContentLoaded', renderPathway);
+ document.addEventListener('tabChanged', function() { setTimeout(renderPathway, 100); });
+ if (document.readyState !== 'loading') setTimeout(renderPathway, 0);
+
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-nrp-calc' || e.target.closest('#btn-nrp-calc')) calcNRP();
+ // Render NRP pathway when Neonatal sub-pill is clicked (in case component loaded late)
+ var np = e.target.closest && e.target.closest('[data-em="neonatal"]');
+ if (np) setTimeout(renderPathway, 0);
+ var nav = e.target.closest && e.target.closest('[data-calc="bedside"]');
+ if (nav) setTimeout(renderPathway, 50);
+ });
+
+ function renderPathway() {
+ var el = document.getElementById('nrp-pathway-static');
+ if (!el || el.dataset.rendered) return;
+ var S = window._EM;
+ var html = '';
+ html += S.stepBox('#3b82f6', 'BIRTH — ASSESS (first 30 sec)', 'Term? Tone? Breathing/crying? If all yes → routine care with mother. If any no → warm, dry, stimulate, position airway, clear airway PRN, evaluate HR & respirations.');
+ html += S.arrow;
+ html += S.stepBox('#8b5cf6', 'HR < 100 OR apneic/gasping (60 sec)', 'Start PPV 40-60 breaths/min, room air for term / 21-30% for preterm. Attach SpO2 (right hand) ± ECG. MR SOPA if ineffective: Mask adjust, Reposition, Suction, Open mouth, Pressure increase, Alternative airway.');
+ html += S.arrow;
+ html += S.stepBox('#f59e0b', 'HR < 100 after 30 sec effective PPV', 'Reassess ventilation — ensure chest rise. Consider increasing FiO2, intubation, or LMA. Continue PPV.');
+ html += S.arrow;
+ html += S.stepBox('#ef4444', 'HR < 60 after 30 sec of effective PPV', 'Intubate + Chest compressions — 3:1 ratio (90 compressions + 30 breaths per minute), FiO2 100%, lower 1/3 sternum, depth 1/3 AP chest.');
+ html += S.arrow;
+ html += S.stepBox('#dc2626', 'HR < 60 despite compressions + PPV x 60 sec', 'Epinephrine 1:10,000 (0.1 mg/mL): • IV/IO: 0.01-0.03 mg/kg (0.1-0.3 mL/kg) — preferred
• ETT: 0.05-0.1 mg/kg (0.5-1 mL/kg) — while IV being placed
Repeat q3-5 min. If hypovolemia: NS 10 mL/kg IV/IO over 5-10 min.'); + html += '
';
+ html += '
';
+ el.innerHTML = html;
+ el.dataset.rendered = '1';
+ }
+
+ function calcNRP() {
+ var wt = parseFloat(document.getElementById('nrp-weight').value);
+ var el = document.getElementById('nrp-result');
+ if (!wt) { el.innerHTML = 'Target SpO2 (preductal):
1 min: 60-65%
2 min: 65-70%
3 min: 70-75%
4 min: 75-80%
5 min: 80-85%
10 min: 85-95%
';
+ html += '1 min: 60-65%
2 min: 65-70%
3 min: 70-75%
4 min: 75-80%
5 min: 80-85%
10 min: 85-95%
Initial ETT size:
<1 kg / <28 wk: 2.5
1-2 kg / 28-34 wk: 3.0
2-3 kg / 34-38 wk: 3.5
>3 kg / >38 wk: 3.5-4.0
';
+ html += '<1 kg / <28 wk: 2.5
1-2 kg / 28-34 wk: 3.0
2-3 kg / 34-38 wk: 3.5
>3 kg / >38 wk: 3.5-4.0
ETT depth (lip):
~ 6 + weight(kg) cm
';
+ html += '~ 6 + weight(kg) cm
Enter weight (kg).
'; return; } + var S = window._EM; + var epiIvLow = Math.round(wt * 0.01 * 100) / 100; + var epiIvHigh = Math.round(wt * 0.03 * 100) / 100; + var epiEtLow = Math.round(wt * 0.05 * 100) / 100; + var epiEtHigh = Math.round(wt * 0.1 * 100) / 100; + var ns = Math.round(wt * 10); + var d10 = Math.round(wt * 2 * 10) / 10; + var html = 'NRP doses — ' + wt + ' kg
';
+ var pk = function(txt) { return ' (' + txt + ')'; };
+ html += S.drugTable(
+ S.drugRow('Epinephrine 1:10,000', epiIvLow + '-' + epiIvHigh + ' mg, ' + (Math.round(epiIvLow*10)/10) + '-' + (Math.round(epiIvHigh*10)/10) + ' mL' + pk('0.01-0.03 mg/kg = 0.1-0.3 mL/kg'), 'IV / IO', 'Preferred route. Repeat q3-5 min.') +
+ S.drugRow('Epinephrine 1:10,000', epiEtLow + '-' + epiEtHigh + ' mg, ' + (Math.round(epiEtLow*10)/10) + '-' + (Math.round(epiEtHigh*10)/10) + ' mL' + pk('0.05-0.1 mg/kg = 0.5-1 mL/kg'), 'ETT', 'While IV being placed.') +
+ S.drugRow('Normal saline', ns + ' mL' + pk('10 mL/kg'), 'IV / IO', 'Over 5-10 min for volume. Repeat PRN.') +
+ S.drugRow('Dextrose 10%', d10 + ' mL' + pk('2 mL/kg = 0.2 g/kg'), 'IV slow push', 'For documented hypoglycemia. Then D10 infusion 4-6 mg/kg/min.')
+ );
+ html += 'Concentration note: NRP uses epinephrine 1:10,000 (0.1 mg/mL). NOT 1:1000 (1 mg/mL) — that is IM for anaphylaxis / older patients.
';
+ html += S.ref('AHA/AAP Neonatal Resuscitation Program (NRP) 8th edition, 2020.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// AIRWAY / RSI
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-airway-calc' || e.target.closest('#btn-airway-calc')) calcAirway();
+ });
+
+ function calcAirway() {
+ var wt = parseFloat(document.getElementById('airway-weight').value);
+ var age = parseFloat(document.getElementById('airway-age').value);
+ var el = document.getElementById('airway-result');
+ if (!wt) { el.innerHTML = 'Enter weight (kg).
'; return; } + var S = window._EM; + + // Equipment sizing + var ettUncuff = age ? Math.round(((age/4) + 4) * 2) / 2 : null; + var ettCuff = age ? Math.round(((age/4) + 3.5) * 2) / 2 : null; + var ettDepth = ettUncuff ? Math.round(ettUncuff * 3 * 10) / 10 : null; + var bladeSize = age != null ? (age < 1 ? 'Miller 0-1' : age < 2 ? 'Miller 1 / Mac 1' : age < 8 ? 'Miller 2 / Mac 2' : 'Miller/Mac 3') : '—'; + var lmaSize = wt < 5 ? '1' : wt < 10 ? '1.5' : wt < 20 ? '2' : wt < 30 ? '2.5' : wt < 50 ? '3' : wt < 70 ? '4' : '5'; + + var html = 'RSI doses & equipment — ' + wt + ' kg' + (age ? ', ~' + age + ' yr' : '') + '
';
+
+ // Pre-medication
+ html += 'Pre-medication (optional)
'; + html += S.drugTable( + S.drugRow('Atropine', S.dStr(wt, 0.02, 1, ' mg') + ' (min 0.1 mg)', 'IV', 'Consider <1 yr or if using succinylcholine, or bradycardia risk') + + S.drugRow('Lidocaine 2%', S.dStr(wt, 1.5, 100, ' mg'), 'IV over 1 min', 'For ↑ICP, asthma; give 2-3 min pre-induction') + + S.drugRow('Fentanyl', S.dStr(wt, 2, 150, ' mcg') + ' (2-3 mcg/kg)', 'IV over 1 min', 'Blunts sympathetic response; avoid if hypotensive') + ); + + // Induction + html += 'Induction
'; + html += S.drugTable( + S.drugRow('Ketamine', S.dStr(wt, 1.5, 150, ' mg') + ' (1-2 mg/kg)', 'IV', 'Preserves BP. First-line for shock, asthma, sepsis') + + S.drugRow('Etomidate', S.dStr(wt, 0.3, 30, ' mg'), 'IV', 'Hemodynamically neutral. Avoid in septic shock (adrenal suppression)') + + S.drugRow('Propofol', S.dStr(wt, 2, 200, ' mg') + ' (1-2 mg/kg)', 'IV', 'Causes hypotension. Avoid in shock') + + S.drugRow('Midazolam', S.dStr(wt, 0.2, 10, ' mg'), 'IV', 'Less optimal induction — slower onset') + ); + + // Paralytics + html += 'Paralytics
'; + html += S.drugTable( + S.drugRow('Rocuronium', S.dStr(wt, 1.2, 100, ' mg') + ' (1-1.2 mg/kg)', 'IV', '30-60 sec onset; 30-45 min duration. First-line non-depolarizing.') + + S.drugRow('Succinylcholine', S.dStr(wt, (wt < 10 ? 2 : 1.5), 150, ' mg'), 'IV', '<10kg: 2 mg/kg; ≥10kg: 1.5 mg/kg. Avoid in burns/crush/hyperK/MH/NM dz. IM option: 4 mg/kg.') + + S.drugRow('Vecuronium', S.dStr(wt, 0.1, 10, ' mg'), 'IV', '2-3 min onset; longer duration than roc') + ); + + // Post-intubation sedation + html += 'Maintenance sedation / analgesia
'; + html += S.drugTable( + S.drugRow('Midazolam gtt', S.dStr(wt, 0.05, 2, ' mg') + '-' + S.dStr(wt, 0.2, 10, ' mg') + '/hr', 'IV infusion', '0.05-0.2 mg/kg/hr') + + S.drugRow('Fentanyl gtt', S.dStr(wt, 1, 100, ' mcg') + '-' + S.dStr(wt, 4, 200, ' mcg') + '/hr', 'IV infusion', '1-4 mcg/kg/hr') + + S.drugRow('Ketamine gtt', S.dStr(wt, 0.5, 30, ' mg') + '-' + S.dStr(wt, 2, 100, ' mg') + '/hr', 'IV infusion', '0.5-2 mg/kg/hr. Good for asthma') + + S.drugRow('Dexmedetomidine gtt', '0.2-1.4 mcg/kg/hr', 'IV infusion', 'No resp depression; causes bradycardia + hypotension') + + S.drugRow('Rocuronium gtt', '10-12 mcg/kg/min', 'IV infusion', 'If continued paralysis needed — only with adequate sedation') + ); + + // Equipment + html += 'Equipment sizing
'; + html += '';
+ if (age != null) {
+ html += '
';
+
+ // Ventilator starting settings
+ html += 'ETT (uncuffed): ' + ettUncuff + ' mm
ETT (cuffed): ' + ettCuff + ' mm
Depth at lip: ~' + ettDepth + ' cm
';
+ html += 'ETT (cuffed): ' + ettCuff + ' mm
Depth at lip: ~' + ettDepth + ' cm
Laryngoscope blade:
' + bladeSize + '
';
+ } else {
+ html += '' + bladeSize + '
Enter age for ETT/blade sizing.
ETT (uncuffed) = (age/4) + 4
ETT (cuffed) = (age/4) + 3.5
Depth = ETT size × 3
';
+ }
+ html += 'ETT (uncuffed) = (age/4) + 4
ETT (cuffed) = (age/4) + 3.5
Depth = ETT size × 3
LMA size: ' + lmaSize + '
OPA = corner mouth → angle mandible
NPA = tip nose → tragus
';
+ html += 'OPA = corner mouth → angle mandible
NPA = tip nose → tragus
Suction catheter (Fr): ETT size × 2
NG tube: ETT × 2
Chest tube: 4 × ETT
';
+ html += 'NG tube: ETT × 2
Chest tube: 4 × ETT
Ventilator — starting settings
'; + html += '';
+ html += 'Mode: Volume or pressure control
'; + html += 'Tidal volume: 6-8 mL/kg (= ' + S.d(wt, 6) + '-' + S.d(wt, 8) + ' mL). Use lower (4-6 mL/kg) for ARDS.
'; + html += 'Rate: Infant 25-30, Child 15-25, Adolescent 12-16
'; + html += 'PEEP: 5 cmH2O (↑ for oxygenation problems)
'; + html += 'FiO2: Start 100%, wean to SpO2 92-97%
'; + html += 'I:E ratio: 1:2 (1:3-4 for obstructive disease)'; + html += '
';
+
+ html += S.ref('Harriet Lane Handbook 23rd ed / PALS 2020. Always confirm doses against institutional protocols.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// CARDIAC ARREST / PALS
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ var btn = e.target.closest('[data-cardiac]');
+ if (btn) cardiacShow(btn.dataset.cardiac);
+ });
+
+ function getWt() {
+ return parseFloat(document.getElementById('cardiac-weight').value) || 0;
+ }
+
+ function cardiacShow(kind) {
+ var wt = getWt();
+ var el = document.getElementById('cardiac-result');
+ if (!wt) { el.innerHTML = ''; + html += 'Tidal volume: 6-8 mL/kg (= ' + S.d(wt, 6) + '-' + S.d(wt, 8) + ' mL). Use lower (4-6 mL/kg) for ARDS.
'; + html += 'Rate: Infant 25-30, Child 15-25, Adolescent 12-16
'; + html += 'PEEP: 5 cmH2O (↑ for oxygenation problems)
'; + html += 'FiO2: Start 100%, wean to SpO2 92-97%
'; + html += 'I:E ratio: 1:2 (1:3-4 for obstructive disease)'; + html += '
Enter weight (kg).
'; return; } + var S = window._EM; + var html = '' + title(kind) + ' — ' + wt + ' kg
';
+
+ if (kind === 'general') {
+ html += S.drugTable(
+ S.drugRow('Epinephrine 1:10,000', S.dStr(wt, 0.01, 1, ' mg') + ' (' + S.dStr(wt, 0.1, 10, ' mL') + ')', 'IV / IO', '0.01 mg/kg = 0.1 mL/kg of 1:10,000. Max single dose 1 mg. Repeat q3-5 min.') +
+ S.drugRow('Epinephrine ET', S.dStr(wt, 0.1, 2.5, ' mg'), 'ETT', '0.1 mg/kg (1 mL/kg of 1:10,000) if no IV/IO') +
+ S.drugRow('Amiodarone', S.dStr(wt, 5, 300, ' mg'), 'IV / IO bolus', '5 mg/kg for arrest. Max 300 mg. Repeat up to 2 times (max 15 mg/kg/day).') +
+ S.drugRow('Lidocaine', S.dStr(wt, 1, 100, ' mg'), 'IV / IO bolus', '1 mg/kg. Alternative to amiodarone for VF/VT.') +
+ S.drugRow('Atropine', S.dStr(wt, 0.02, 0.5, ' mg') + ' (min 0.1 mg)', 'IV / IO', '0.02 mg/kg. Bradycardia from ↑vagal tone or AV block.') +
+ S.drugRow('Adenosine (1st)', S.dStr(wt, 0.1, 6, ' mg'), 'IV push + flush', '0.1 mg/kg (max 6 mg). For SVT. Rapid push, double flush.') +
+ S.drugRow('Adenosine (2nd)', S.dStr(wt, 0.2, 12, ' mg'), 'IV push + flush', '0.2 mg/kg (max 12 mg). Second dose if first unsuccessful.') +
+ S.drugRow('Sodium bicarb 8.4%', S.dStr(wt, 1, 50, ' mEq'), 'IV / IO', '1 mEq/kg. ONLY if severe metabolic acidosis, hyperK, or TCA OD. Not routine.') +
+ S.drugRow('Calcium chloride 10%', S.dStr(wt, 20, 1000, ' mg') + ' (' + S.dStr(wt, 0.2, 10, ' mL') + ')', 'IV / IO (central preferred)', 'For hyperK, hypoCa, Mg OD, CCB OD. 20 mg/kg = 0.2 mL/kg.') +
+ S.drugRow('Calcium gluconate 10%', S.dStr(wt, 60, 3000, ' mg') + ' (' + S.dStr(wt, 0.6, 30, ' mL') + ')', 'IV / IO (peripheral OK)', '60 mg/kg = 0.6 mL/kg. Preferred peripherally.') +
+ S.drugRow('Magnesium sulfate', S.dStr(wt, 50, 2000, ' mg'), 'IV over 10-20 min', '25-50 mg/kg. Torsades, severe asthma. Max 2 g.') +
+ S.drugRow('Dextrose 10%', S.dStr(wt, 2, null, ' mL') + ' (0.2 g/kg)', 'IV push', 'For documented hypoglycemia') +
+ S.drugRow('Defibrillation', '2 J/kg → 4 J/kg → 10 J/kg (max 10 J/kg or adult dose)', 'Pad', 'For VF/pulseless VT. Resume CPR immediately after shock.') +
+ S.drugRow('Cardioversion (sync)', '0.5-1 J/kg → 2 J/kg', 'Pad', 'For unstable SVT/VT. Sedate if possible.')
+ );
+ html += 'Concentrations: Epi 1:10,000 (0.1 mg/mL) for IV arrest. 1:1000 (1 mg/mL) for IM anaphylaxis. Atropine <0.1 mg can cause paradoxical bradycardia.
';
+ } else if (kind === 'asystole') {
+ html += S.drugTable(
+ S.drugRow('CPR', '100-120/min, depth 1/3 AP', '—', '15:2 (2 rescuer) or 30:2 (single). Rotate every 2 min.') +
+ S.drugRow('Epinephrine', S.dStr(wt, 0.01, 1, ' mg') + ' IV/IO', 'IV / IO', '0.01 mg/kg 1:10,000 = 0.1 mL/kg. Q3-5 min. Start early.') +
+ S.drugRow('Epinephrine ETT', S.dStr(wt, 0.1, 2.5, ' mg'), 'ETT', '0.1 mg/kg if no IV access')
+ );
+ html += 'Reversible causes (H\'s & T\'s)
'; + html += '';
+ html += '
';
+ } else if (kind === 'brady') {
+ html += S.stepBox('#f59e0b', 'Bradycardia with poor perfusion (HR < 60)', 'Start CPR if HR < 60 with poor perfusion despite oxygenation and ventilation.');
+ html += S.arrow;
+ html += S.drugTable(
+ S.drugRow('Epinephrine', S.dStr(wt, 0.01, 1, ' mg'), 'IV / IO', 'First-line. Q3-5 min.') +
+ S.drugRow('Atropine', S.dStr(wt, 0.02, 0.5, ' mg') + ' (min 0.1 mg)', 'IV / IO', 'If ↑ vagal tone or AV block. Max 1 mg child / 0.5 mg infant.') +
+ S.drugRow('Transcutaneous pacing', '—', 'Pad', 'For refractory bradycardia not responsive to drugs.') +
+ S.drugRow('Consider', '—', '—', 'Hypoxia, tension pneumothorax, ↑ICP, toxic ingestion (organo, CCB, BB), heart block')
+ );
+ } else if (kind === 'svt') {
+ html += S.stepBox('#3b82f6', 'SVT — narrow complex, rate usually >220 infant / >180 child', 'Differentiate from sinus tach: abrupt onset/offset, no P waves or abnormal P axis, HR minimally variable.');
+ html += S.arrow;
+ html += 'H\'s
Hypoxia, Hypovolemia, H+ (acidosis), Hypo/hyperK, Hypoglycemia, Hypothermia
';
+ html += 'Hypoxia, Hypovolemia, H+ (acidosis), Hypo/hyperK, Hypoglycemia, Hypothermia
T\'s
Tension PTX, Tamponade, Toxins, Thrombosis (MI/PE), Trauma
';
+ html += 'Tension PTX, Tamponade, Toxins, Thrombosis (MI/PE), Trauma
If STABLE
'; + html += S.drugTable( + S.drugRow('Vagal maneuvers', 'Ice to face, blow into syringe, Valsalva', '—', 'Try first in stable patient') + + S.drugRow('Adenosine (1st)', S.dStr(wt, 0.1, 6, ' mg'), 'IV push (proximal) + flush', 'Rapid push, 3-way stopcock with NS flush') + + S.drugRow('Adenosine (2nd)', S.dStr(wt, 0.2, 12, ' mg'), 'IV push + flush', 'If first dose unsuccessful') + + S.drugRow('Procainamide', '15 mg/kg over 30-60 min', 'IV', 'Expert consult. Avoid with amiodarone.') + + S.drugRow('Amiodarone', '5 mg/kg over 20-60 min', 'IV', 'Expert consult.') + ); + html += 'If UNSTABLE
'; + html += S.drugTable(S.drugRow('Synchronized cardioversion', '0.5-1 J/kg → 2 J/kg', 'Pad', 'Sedate if possible. Pre-treat with adenosine if IV available.')); + } else if (kind === 'vfib') { + html += S.stepBox('#dc2626', 'VF / Pulseless VT', 'High-quality CPR + defibrillation are key. Minimize interruptions.'); + html += S.arrow; + html += S.drugTable( + S.drugRow('Defibrillation (1st)', '2 J/kg', 'Pad', 'Resume CPR immediately after shock.') + + S.drugRow('Defibrillation (2nd)', '4 J/kg', 'Pad', 'After 2 min CPR.') + + S.drugRow('Defibrillation (3rd+)', '≥4 J/kg (max 10 J/kg or adult dose)', 'Pad', '') + + S.drugRow('Epinephrine', S.dStr(wt, 0.01, 1, ' mg'), 'IV / IO', 'After 2nd shock. Q3-5 min.') + + S.drugRow('Amiodarone', S.dStr(wt, 5, 300, ' mg'), 'IV / IO bolus', 'Refractory VF/VT. Max 15 mg/kg/day.') + + S.drugRow('Lidocaine', S.dStr(wt, 1, 100, ' mg'), 'IV / IO', 'Alternative to amiodarone. Then 20-50 mcg/kg/min gtt.') + + S.drugRow('Mg sulfate', S.dStr(wt, 50, 2000, ' mg'), 'IV over 1-2 min', 'For torsades or hypoMg.') + ); + } else if (kind === 'vt') { + html += S.stepBox('#f59e0b', 'Stable monomorphic VT', 'Expert consult. Avoid combining QT-prolonging agents.'); + html += S.arrow; + html += S.drugTable( + S.drugRow('Amiodarone', '5 mg/kg over 20-60 min', 'IV', '= ' + S.d(wt, 5, 300) + ' mg over 20-60 min') + + S.drugRow('Procainamide', '15 mg/kg over 30-60 min', 'IV', 'Do not combine with amiodarone') + + S.drugRow('Sync cardioversion', '0.5-1 → 2 J/kg', 'Pad', 'If becomes unstable. Sedate.') + ); + } + html += S.ref('AHA PALS Guidelines 2020. Always verify against institutional protocols.'); + el.innerHTML = html; + } + + function title(k) { + return { general: 'PALS General Doses', asystole: 'Asystole / PEA', brady: 'Bradycardia', svt: 'SVT', vfib: 'VF / Pulseless VT', vt: 'Stable VT' }[k] || k; + } +})(); + +// ============================================================ +// AGITATION +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + if (e.target.id === 'btn-agit-calc' || e.target.closest('#btn-agit-calc')) calcAgit(); + }); + + function calcAgit() { + var wt = parseFloat(document.getElementById('agit-weight').value); + var el = document.getElementById('agit-result'); + if (!wt) { el.innerHTML = 'Enter weight (kg).
'; return; } + var S = window._EM; + var html = 'Agitation management — ' + wt + ' kg
';
+ html += S.stepBox('#10b981', 'Step 1 — Non-pharmacologic', 'Dim lights, quiet room, familiar caregiver present, reduce stimulation. Rule out hypoglycemia, hypoxia, pain, ↑ICP, toxic ingestion, infection.');
+ html += S.stepBox('#3b82f6', 'Step 2 — Oral / intranasal (cooperative)', 'First-line for moderate agitation if the patient will accept PO/IN.');
+ html += S.drugTable(
+ S.drugRow('Lorazepam', S.dStr(wt, 0.05, 2, ' mg'), 'PO', '0.05 mg/kg. May repeat in 30 min.') +
+ S.drugRow('Midazolam', S.dStr(wt, 0.5, 10, ' mg'), 'PO', '0.5 mg/kg (max 10 mg)') +
+ S.drugRow('Midazolam', S.dStr(wt, 0.3, 10, ' mg'), 'IN (5 mg/mL)', '0.3 mg/kg split between nares (max 10 mg)') +
+ S.drugRow('Olanzapine (ODT)', wt < 30 ? '2.5-5 mg' : '5-10 mg', 'PO / ODT', 'Age ≥6 yr. Avoid IM + benzo combo (risk of resp depression).') +
+ S.drugRow('Diphenhydramine', S.dStr(wt, 1, 50, ' mg'), 'PO', '1 mg/kg. Adjunct only; sedating.')
+ );
+ html += S.stepBox('#f59e0b', 'Step 3 — IM / IV (severe, uncooperative, or safety risk)', 'Require continuous monitoring. Consider restraints only as last resort.');
+ html += S.drugTable(
+ S.drugRow('Midazolam', S.dStr(wt, 0.1, 5, ' mg'), 'IV / IM', '0.05-0.1 mg/kg IV, 0.1-0.15 mg/kg IM (max 10 mg)') +
+ S.drugRow('Lorazepam', S.dStr(wt, 0.1, 4, ' mg'), 'IV / IM', '0.05-0.1 mg/kg (max 4 mg). May cause resp depression.') +
+ S.drugRow('Haloperidol', wt < 40 ? '0.025-0.075 mg/kg = ' + S.d(wt, 0.05) + ' mg' : '2.5-5 mg', 'IM / IV', 'Avoid <3 yr. Risk: QT, EPS, NMS. ECG if repeated.') +
+ S.drugRow('Olanzapine', wt < 40 ? '2.5-5 mg' : '5-10 mg', 'IM', 'Avoid benzo co-administration (resp depression, hypotension)') +
+ S.drugRow('Ketamine', S.dStr(wt, 4, 500, ' mg'), 'IM', '4-5 mg/kg IM (rescue for severe excited delirium). Monitor airway.') +
+ S.drugRow('Droperidol', '0.03-0.07 mg/kg = ' + S.d(wt, 0.05) + ' mg', 'IM / IV', 'Effective but QT concern — get ECG.')
+ );
+ html += 'Monitoring: Continuous SpO2 + HR after parenteral sedation. Have airway equipment, flumazenil, naloxone, and IV access ready.
';
+ html += S.ref('AAP Clinical Report on Pediatric Agitation. ACEP Guidelines for Acute Agitation.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// ANTIEMETICS
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-emet-calc' || e.target.closest('#btn-emet-calc')) calcEmet();
+ });
+
+ function calcEmet() {
+ var wt = parseFloat(document.getElementById('emet-weight').value);
+ var el = document.getElementById('emet-result');
+ if (!wt) { el.innerHTML = 'Enter weight (kg).
'; return; } + var S = window._EM; + // Ondansetron weight bands + var ondWt = wt < 15 ? '2 mg' : wt < 30 ? '4 mg' : '8 mg'; + var html = 'Antiemetic doses — ' + wt + ' kg
';
+ html += S.drugTable(
+ S.drugRow('Ondansetron', ondWt + ' (weight band) OR ' + S.dStr(wt, 0.15, 8, ' mg') + ' (0.15 mg/kg)', 'PO / ODT / IV', 'First-line. Max single 8 mg. Repeat q8h. QT prolongation — avoid with other QT drugs. <6 mo: limited data.') +
+ S.drugRow('Metoclopramide', S.dStr(wt, 0.15, 10, ' mg'), 'IV / IM / PO', '0.1-0.15 mg/kg (max 10 mg). Give with diphenhydramine to prevent EPS / dystonia.') +
+ S.drugRow('Dimenhydrinate', S.dStr(wt, 1.25, 50, ' mg'), 'PO / IV / IM / PR', '1.25 mg/kg (max 50 mg) q6h. ≥2 yr.') +
+ S.drugRow('Diphenhydramine', S.dStr(wt, 1, 50, ' mg'), 'PO / IV / IM', '1 mg/kg (max 50 mg) q6h. Adjunct, sedating.') +
+ S.drugRow('Promethazine', S.dStr(wt, 0.25, 25, ' mg'), 'PO / IV / IM', '0.25-1 mg/kg. CONTRAINDICATED <2 yr (resp depression). Tissue injury if IV extrav.') +
+ S.drugRow('Dexamethasone', S.dStr(wt, 0.15, 10, ' mg'), 'IV / PO', 'Adjunct, esp. chemo-induced. 0.15 mg/kg (max 10 mg).') +
+ S.drugRow('Scopolamine patch', '1.5 mg patch', 'Transdermal', '≥12 yr. Motion sickness. Apply 4h before exposure.')
+ );
+ html += 'Pearls: Ondansetron is first-line in ED for acute gastroenteritis vomiting — single PO/ODT dose increases oral rehydration success. Avoid anticholinergics + opioid combinations. Check QTc if stacking ondansetron + other QT drugs.
';
+ html += S.ref('AAP gastroenteritis guidance; WHO essential medicines; Lexicomp.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// ANTIMICROBIALS (empiric, by age + infection type)
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-abx-lookup' || e.target.closest('#btn-abx-lookup')) lookupAbx();
+ });
+
+ var REG = {
+ neonate: {
+ sepsis: { first: 'Ampicillin + gentamicin', alt: 'Add cefotaxime if meningitis suspected or gram-neg concern', duration: '7-10 days; 21 days if confirmed meningitis', notes: 'Cover GBS, E. coli, Listeria. Add acyclovir if HSV risk (maternal lesions, vesicles, seizures).' },
+ meningitis: { first: 'Ampicillin + cefotaxime (or gentamicin) + acyclovir', alt: 'Add vancomycin if gram-positive cocci', duration: '14-21 days depending on organism', notes: 'HSV coverage essential. LP + HSV PCR.' },
+ pna: { first: 'Ampicillin + gentamicin', alt: 'Add cefotaxime for gram-neg', duration: '7-10 days', notes: 'Same as sepsis coverage.' },
+ uti: { first: 'Ampicillin + gentamicin', alt: 'Cefotaxime if sensitivities known', duration: '10-14 days', notes: 'Evaluate for sepsis. Renal US and VCUG workup.' },
+ skin: { first: 'Ampicillin + gentamicin', alt: 'Add vancomycin if MRSA risk', duration: '7-10 days', notes: 'Omphalitis, mastitis — broad coverage.' },
+ ent: { first: 'Discuss with infectious diseases', alt: '—', duration: '—', notes: 'Rare in neonates. Any ear/throat infection warrants sepsis eval.' },
+ neutropenic: { first: 'Cefepime or piperacillin-tazobactam', alt: 'Add vancomycin if indwelling line, severe mucositis, or MRSA', duration: 'Until ANC recovery + afebrile ≥48h', notes: 'Oncology/ID consult.' },
+ ic: { first: 'Ampicillin + gentamicin + metronidazole', alt: 'Or piperacillin-tazobactam', duration: '7-14 days', notes: 'NEC: add metronidazole/clindamycin for anaerobes.' },
+ bone: { first: 'Ampicillin + gentamicin', alt: 'Vancomycin if MRSA risk', duration: '3-6 weeks (IV then PO)', notes: 'Usually hematogenous. S. aureus, GBS, E. coli.' }
+ },
+ infant: {
+ sepsis: { first: 'Ampicillin + ceftriaxone (or gentamicin)', alt: '+ vancomycin if MRSA / severe', duration: '7-10 days', notes: 'Add acyclovir if HSV suspected (<6 wks). Fever in <90 days requires workup.' },
+ meningitis: { first: 'Ceftriaxone + vancomycin (± ampicillin if <6 wks for Listeria)', alt: '+ acyclovir if HSV', duration: '10-14 days (longer for Listeria/gram-neg)', notes: 'Dexamethasone if H. influenzae suspected.' },
+ pna: { first: 'Ampicillin (or ceftriaxone)', alt: 'Add azithromycin if atypical', duration: '7-10 days', notes: 'S. pneumoniae most common. RSV/viral often primary.' },
+ uti: { first: 'Ceftriaxone or cefotaxime', alt: 'Ampicillin + gentamicin', duration: '10-14 days', notes: 'US kidney/bladder if first febrile UTI.' },
+ skin: { first: 'Cefazolin or clindamycin', alt: 'Vancomycin if MRSA risk', duration: '7-10 days', notes: 'Consider MRSA if purulent or local resistance >10%.' },
+ ent: { first: 'Amoxicillin (90 mg/kg/day) for AOM', alt: 'Amox-clav if recent abx/treatment failure', duration: 'AOM 10 days <2 yr; 7 days ≥2 yr', notes: 'Observe mild AOM if >6 mo and no severe features.' },
+ neutropenic: { first: 'Cefepime or piperacillin-tazobactam', alt: '+ vancomycin for severe/mucositis/line', duration: 'Until ANC recovery + afebrile', notes: 'Oncology/ID consult.' },
+ ic: { first: 'Ceftriaxone + metronidazole', alt: 'Piperacillin-tazobactam', duration: '5-7 days (uncomplicated), longer for complicated', notes: 'Appendicitis — surgical consult.' },
+ bone: { first: 'Cefazolin ± vancomycin', alt: 'Clindamycin', duration: '3-4 weeks (IV then PO transition)', notes: 'S. aureus most common. Kingella in <4 yr.' }
+ },
+ child: {
+ sepsis: { first: 'Ceftriaxone + vancomycin', alt: 'Piperacillin-tazobactam if intra-abdominal', duration: '7-14 days', notes: 'Expand if specific source. Add antifungal if prolonged neutropenia.' },
+ meningitis: { first: 'Ceftriaxone + vancomycin', alt: '+ dexamethasone (Hib coverage)', duration: '10-14 days', notes: 'Lumbar puncture. Dexamethasone 0.15 mg/kg q6h x 4 days.' },
+ pna: { first: 'Ampicillin OR amoxicillin (high dose)', alt: 'Ceftriaxone if hospitalized; add azithromycin for atypical', duration: '5-7 days (uncomplicated)', notes: 'Mycoplasma if >5 yr. Consider viral causes.' },
+ uti: { first: 'Cephalexin or TMP-SMX (PO)', alt: 'Ceftriaxone if ill', duration: '7-10 days (10-14 if pyelo)', notes: 'Culture-guided de-escalation.' },
+ skin: { first: 'Cephalexin or clindamycin', alt: 'TMP-SMX or doxycycline if MRSA', duration: '5-10 days', notes: 'Abscess — incision & drainage primary tx.' },
+ ent: { first: 'Amoxicillin 90 mg/kg/day (AOM); Penicillin V for strep pharyngitis', alt: 'Amox-clav; cephalexin if non-anaphylactic PCN allergy', duration: 'AOM 5-10 days; strep 10 days', notes: 'Strep pharyngitis dose: PCN V 250 mg BID-TID (<27 kg) or 500 mg BID (≥27 kg).' },
+ neutropenic: { first: 'Cefepime OR piperacillin-tazobactam', alt: '+ vancomycin', duration: 'Until ANC recovery + afebrile', notes: 'Add empiric antifungal if fever >4-7 days.' },
+ ic: { first: 'Ceftriaxone + metronidazole', alt: 'Piperacillin-tazobactam', duration: '5-7 days (uncomplicated appendicitis)', notes: 'Surgical consult.' },
+ bone: { first: 'Cefazolin ± vancomycin', alt: 'Clindamycin', duration: '3-4 weeks total', notes: 'S. aureus, group A strep. Consider MRSA if severe.' }
+ }
+ };
+
+ function lookupAbx() {
+ var age = document.getElementById('abx-age').value;
+ var inf = document.getElementById('abx-infection').value;
+ var el = document.getElementById('abx-result');
+ var r = REG[age] && REG[age][inf];
+ if (!r) { el.innerHTML = 'No regimen found.
'; return; } + var S = window._EM; + var ageLbl = { neonate: 'Neonate (0-28 d)', infant: 'Infant (1-3 mo)', child: 'Child (>3 mo)' }[age]; + var infLbl = document.querySelector('#abx-infection option[value="' + inf + '"]').textContent; + var html = '' + ageLbl + ' — ' + infLbl + '
';
+ html += 'First-line: ' + r.first + '
';
+ html += 'Alternative / add: ' + r.alt + '
';
+ html += 'Duration: ' + r.duration + '
';
+ html += 'Notes: ' + r.notes + '
';
+ html += S.ref('AAP Red Book, IDSA guidelines, Harriet Lane. Always tailor to local resistance patterns and culture results.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// BURNS — Lund-Browder body parts + Parkland
+// ============================================================
+(function() {
+ // Lund-Browder age-adjusted region percentages. Regions marked "*" change with age.
+ // Column order: infant, young (1-5), child (5-10), adol (10-15), adult (>15).
+ var LB = {
+ head: { label: 'Head', vals: [18, 13, 11, 9, 7], ageSensitive: true },
+ neck: { label: 'Neck', vals: [2, 2, 2, 2, 2] },
+ ant_trunk: { label: 'Anterior trunk', vals: [13, 13, 13, 13, 13] },
+ post_trunk:{ label: 'Posterior trunk', vals: [13, 13, 13, 13, 13] },
+ r_buttock: { label: 'Right buttock', vals: [2.5, 2.5, 2.5, 2.5, 2.5] },
+ l_buttock: { label: 'Left buttock', vals: [2.5, 2.5, 2.5, 2.5, 2.5] },
+ genital: { label: 'Genitalia', vals: [1, 1, 1, 1, 1] },
+ r_uparm: { label: 'R upper arm', vals: [4, 4, 4, 4, 4] },
+ l_uparm: { label: 'L upper arm', vals: [4, 4, 4, 4, 4] },
+ r_forearm: { label: 'R forearm', vals: [3, 3, 3, 3, 3] },
+ l_forearm: { label: 'L forearm', vals: [3, 3, 3, 3, 3] },
+ r_hand: { label: 'R hand', vals: [2.5, 2.5, 2.5, 2.5, 2.5] },
+ l_hand: { label: 'L hand', vals: [2.5, 2.5, 2.5, 2.5, 2.5] },
+ r_thigh: { label: 'R thigh', vals: [5.5, 8, 8.5, 9, 9.5], ageSensitive: true },
+ l_thigh: { label: 'L thigh', vals: [5.5, 8, 8.5, 9, 9.5], ageSensitive: true },
+ r_leg: { label: 'R lower leg', vals: [5, 5.5, 6, 6.5, 7], ageSensitive: true },
+ l_leg: { label: 'L lower leg', vals: [5, 5.5, 6, 6.5, 7], ageSensitive: true },
+ r_foot: { label: 'R foot', vals: [3.5, 3.5, 3.5, 3.5, 3.5] },
+ l_foot: { label: 'L foot', vals: [3.5, 3.5, 3.5, 3.5, 3.5] }
+ };
+ var AGE_KEYS = ['infant','young','child','adol','adult'];
+
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-burn-calc' || e.target.closest('#btn-burn-calc')) calcBurn();
+ if (e.target.id === 'btn-burn-reset' || e.target.closest('#btn-burn-reset')) resetParts();
+ // Render body-parts table the first (or any) time the Burns sub-pill is activated
+ var bp = e.target.closest && e.target.closest('[data-em="burns"]');
+ if (bp) setTimeout(renderBodyParts, 0);
+ // Also render if the top-level Bedside tab is clicked (ensures table ready before user navigates)
+ var nav = e.target.closest && e.target.closest('[data-calc="bedside"]');
+ if (nav) setTimeout(renderBodyParts, 50);
+ });
+ document.addEventListener('change', function(e) {
+ if (e.target && e.target.id === 'burn-age') renderBodyParts();
+ });
+ document.addEventListener('input', function(e) {
+ if (e.target && e.target.dataset && e.target.dataset.burnRegion) updateLive();
+ });
+ // Also attempt render on these events in case component mounts later
+ document.addEventListener('DOMContentLoaded', renderBodyParts);
+ document.addEventListener('tabChanged', function() { setTimeout(renderBodyParts, 100); });
+ if (document.readyState !== 'loading') setTimeout(renderBodyParts, 0);
+
+ function ageIdx() { return Math.max(0, AGE_KEYS.indexOf(document.getElementById('burn-age').value)); }
+
+ function renderBodyParts() {
+ var wrap = document.getElementById('burn-bodyparts-wrapper');
+ if (!wrap) return;
+ var idx = ageIdx();
+ var html = '';
+ html += '
';
+ wrap.innerHTML = html;
+ updateLive();
+ }
+
+ function resetParts() {
+ var inputs = document.querySelectorAll('[data-burn-region]');
+ inputs.forEach(function(i) { i.value = 0; });
+ document.getElementById('burn-tbsa').value = '';
+ updateLive();
+ }
+
+ function computeTbsa() {
+ var idx = ageIdx();
+ var total = 0;
+ Object.keys(LB).forEach(function(key) {
+ var el = document.querySelector('[data-burn-region="' + key + '"]');
+ if (!el) return;
+ var pct = parseFloat(el.value) || 0;
+ if (pct < 0) pct = 0; if (pct > 100) pct = 100;
+ total += LB[key].vals[idx] * (pct / 100);
+ });
+ return Math.round(total * 10) / 10;
+ }
+
+ function updateLive() {
+ var t = computeTbsa();
+ var live = document.getElementById('burn-tbsa-live');
+ if (live) live.textContent = t > 0 ? 'Computed TBSA: ' + t + '%' : '';
+ }
+
+ function calcBurn() {
+ var wt = parseFloat(document.getElementById('burn-weight').value);
+ var override = document.getElementById('burn-tbsa').value;
+ var tbsa = override !== '' ? parseFloat(override) : computeTbsa();
+ var el = document.getElementById('burn-result');
+ if (!wt) { el.innerHTML = 'For each involved body region, enter % of that region burned (2° or deeper). Leave 0 if uninvolved. TBSA = sum of (region size × % involvement).
';
+ html += '';
+ Object.keys(LB).forEach(function(key) {
+ var r = LB[key];
+ var max = r.vals[idx];
+ var isAgeDep = r.ageSensitive;
+ html += '
' +
+ '' +
+ ' %' +
+ '
';
+ });
+ html += 'Enter weight (kg).
'; return; } + if (!tbsa || tbsa <= 0) { el.innerHTML = 'Enter % involvement per region, or override TBSA.
'; return; } + var S = window._EM; + var total = Math.round(4 * wt * tbsa); + var first8 = Math.round(total / 2); + var rateFirst = Math.round(first8 / 8); + var next16 = total - first8; + var rateNext = Math.round(next16 / 16); + var maint = wt <= 10 ? wt * 4 : wt <= 20 ? 40 + (wt - 10) * 2 : 60 + (wt - 20); + maint = Math.round(maint); + + var html = 'Burn fluid resuscitation — ' + wt + ' kg, ' + tbsa + '% TBSA (2° or deeper)
';
+ html += 'Parkland formula: 4 mL × kg × %TBSA = ' + total + ' mL LR over 24 hours' +
+ '
First 8 h (from time of burn): ' + first8 + ' mL (~' + rateFirst + ' mL/hr)' + + '
Next 16 h: ' + next16 + ' mL (~' + rateNext + ' mL/hr)
';
+ html += 'First 8 h (from time of burn): ' + first8 + ' mL (~' + rateFirst + ' mL/hr)' + + '
Next 16 h: ' + next16 + ' mL (~' + rateNext + ' mL/hr)
Plus maintenance fluids (4-2-1): ' + maint + ' mL/hr (D5 1/2NS ± 20 mEq KCl/L once UOP established). Consider dextrose in children <30 kg.
';
+ html += 'Titrate to UOP: target 1-2 mL/kg/hr (infants / children), 0.5-1 mL/kg/hr (adolescents). Clinical response trumps formula.
';
+
+ // Breakdown of what regions contributed
+ var idx = ageIdx();
+ var breakdown = '';
+ Object.keys(LB).forEach(function(key) {
+ var el = document.querySelector('[data-burn-region="' + key + '"]');
+ if (!el) return;
+ var pct = parseFloat(el.value) || 0;
+ if (pct > 0) {
+ var contrib = Math.round(LB[key].vals[idx] * pct / 100 * 10) / 10;
+ breakdown += '' + LB[key].label + ': ' + pct + '% of ' + LB[key].vals[idx] + '% = ' + contrib + '%
';
+ }
+ });
+ if (breakdown) {
+ html += 'Region breakdown
' + breakdown + '
Other pearls
'; + html += '';
+ html += 'Rule of palm: Patient\'s palm + fingers ≈ 1% TBSA — good for scattered burns.
'; + html += 'First-degree burns DO NOT count toward TBSA or Parkland.
'; + html += 'Analgesia: Morphine 0.05-0.1 mg/kg IV q2h, or fentanyl 1-2 mcg/kg IV q30-60 min.
'; + html += 'Tetanus prophylaxis if indicated. Tdap/Td ± tetanus immunoglobulin.'; + html += '
';
+
+ html += ''; + html += 'First-degree burns DO NOT count toward TBSA or Parkland.
'; + html += 'Analgesia: Morphine 0.05-0.1 mg/kg IV q2h, or fentanyl 1-2 mcg/kg IV q30-60 min.
'; + html += 'Tetanus prophylaxis if indicated. Tdap/Td ± tetanus immunoglobulin.'; + html += '
Burn center referral (ABA)
'; + html += 'Partial-thickness >10% TBSA; any full-thickness; face/hands/feet/genital/perineum/major joints; electrical/chemical/inhalation; associated trauma; significant comorbidities; pediatric burns in non-pediatric center.
';
+ html += S.ref('ABA Advanced Burn Life Support (ABLS) 2018. Parkland formula: Baxter 1968. Lund-Browder 1944 chart (age-adjusted regions).');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// TOXICOLOGY
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-tox-lookup' || e.target.closest('#btn-tox-lookup')) lookupTox();
+ });
+
+ function lookupTox() {
+ var wt = parseFloat(document.getElementById('tox-weight').value);
+ var topic = document.getElementById('tox-topic').value;
+ var el = document.getElementById('tox-result');
+ var S = window._EM;
+ var html = '';
+
+ if (topic === 'approach') {
+ html += S.stepBox('#3b82f6', '1. Stabilize (ABCDE)', 'Airway, breathing, circulation, disability (glucose, pupils, GCS), exposure. Naloxone if depressed LOC + resp depression. Dextrose if hypoglycemic. Thiamine in select cases.');
+ html += S.stepBox('#8b5cf6', '2. Identify toxidrome', 'Sympathomimetic: HTN, tachy, mydriasis, diaphoresis (cocaine, meth). Anticholinergic: hot/dry, mydriasis, tachy, delirium (antihistamines, TCAs). Cholinergic: SLUDGE-M, miosis (organophosphates). Opioid: miosis, resp depression, ↓LOC. Sedative-hypnotic: ↓LOC, normal/low vitals.');
+ html += S.stepBox('#f59e0b', '3. Decontamination', 'Activated charcoal 1 g/kg PO (max 50 g): within 1h of ingestion, intact airway, ingestion adsorbed (not Li, metals, alcohols). Avoid caustics/hydrocarbons. Whole bowel irrigation: PEG for metals/iron/lithium/sustained release. Gastric lavage: rarely indicated. Ipecac: no longer recommended.');
+ html += S.stepBox('#10b981', '4. Enhance elimination', 'Urinary alkalinization (salicylates, phenobarbital). Hemodialysis (see ISTUMBLE). Lipid emulsion for lipid-soluble drug toxicity (LA, CCB, TCA).');
+ html += S.stepBox('#ef4444', '5. Antidotes', 'See topic list. Contact Poison Center (US: 1-800-222-1222) early for any significant exposure.');
+ } else if (topic === 'acetaminophen') {
+ html += 'Acetaminophen overdose
';
+ html += 'Acute toxic dose: >150 mg/kg (or 7.5 g total) single ingestion. Hepatotoxic after 24h; AST/ALT peak day 3-4.
'; + html += 'Diagnosis: Draw level at 4h post-ingestion (or on arrival if >4h). Plot on Rumack-Matthew nomogram (treatment line at 150 mcg/mL at 4h).
'; + html += S.drugTable( + S.drugRow('N-acetylcysteine (NAC) — IV', '150 mg/kg over 1h → 50 mg/kg over 4h → 100 mg/kg over 16h (21h total)', 'IV', 'Total 300 mg/kg. Most effective if started <8h post-ingestion.') + + S.drugRow('N-acetylcysteine — PO', '140 mg/kg load, then 70 mg/kg q4h × 17 doses', 'PO', 'Alternative to IV. Unpleasant taste — often with juice.') + + S.drugRow('Activated charcoal', '1 g/kg (max 50 g)', 'PO', 'If within 1-2h of ingestion and airway protected.') + ); + if (wt) html += 'For ' + wt + ' kg: IV loading = ' + S.d(wt, 150) + ' mg over 1h (150 mg/kg); 2nd bag = ' + S.d(wt, 50) + ' mg over 4h (50 mg/kg); 3rd bag = ' + S.d(wt, 100) + ' mg over 16h (100 mg/kg). Total 300 mg/kg.
';
+ } else if (topic === 'opioids') {
+ html += 'Opioid overdose
';
+ html += 'Triad: miosis + respiratory depression + ↓ LOC. Fentanyl / synthetics may require repeated/higher doses.
'; + html += S.drugTable( + S.drugRow('Naloxone (initial)', '0.01-0.1 mg/kg' + (wt ? ' = ' + S.d(wt, 0.01) + '-' + S.d(wt, 0.1) + ' mg' : ''), 'IV / IM / IN / IO', 'Start low if chronic opioid use (avoid withdrawal). Titrate to respiratory effort, not consciousness.') + + S.drugRow('Naloxone (full reversal)', '2 mg IV/IM/IN', 'IV / IM / IN', 'If no chronic use and severe resp depression. Repeat q2-3 min.') + + S.drugRow('Naloxone infusion', '2/3 of effective bolus per hour', 'IV', 'For long-acting opioids (methadone, fentanyl patch, sustained release)') + ); + html += 'Observe ≥4h after last dose; longer for long-acting agents. Duration of naloxone (30-90 min) is shorter than most opioids — re-sedation is common.
';
+ } else if (topic === 'iron') {
+ html += 'Iron overdose
';
+ html += 'Toxic dose: elemental Fe ≥20 mg/kg. Severe ≥60 mg/kg. Charcoal does NOT bind iron.
'; + html += 'Stages: 1) GI (0-6h: vomiting, bloody diarrhea); 2) Latent (6-24h: deceptive improvement); 3) Shock/metabolic acidosis (12-24h); 4) Hepatotoxicity (2-5d); 5) Gastric scarring (2-8 wk).
'; + html += S.drugTable( + S.drugRow('Whole bowel irrigation', 'PEG-ES 25-40 mL/kg/hr', 'NG', 'For radiopaque pills on KUB or ingested sustained-release iron.') + + S.drugRow('Deferoxamine', '15 mg/kg/hr IV infusion', 'IV', 'Max 6-8 g/day. Indications: shock, metabolic acidosis, Fe level >500 mcg/dL, or severe symptoms. Urine turns "vin rosé" color.') + ); + html += 'Iron level at 4-6h. <350 usually asymptomatic; 350-500 mild; >500 severe. Consider KUB for radiopaque pills.
';
+ } else if (topic === 'tca') {
+ html += 'TCA overdose
';
+ html += 'Anticholinergic + Na-channel blockade. Risks: seizure, VT/VF, hypotension, coma. ECG: QRS >100 ms or R in aVR >3 mm predicts toxicity.
'; + html += S.drugTable( + S.drugRow('Sodium bicarbonate 8.4%', '1-2 mEq/kg IV bolus → infusion', 'IV', 'Goal pH 7.45-7.55 and narrowing QRS. Repeat bolus for QRS widening, hypotension, or arrhythmia.') + + S.drugRow('Mg sulfate', S.dStr(wt || 30, 50, 2000, ' mg'), 'IV over 10 min', 'For torsades.') + + S.drugRow('IV lipid emulsion 20%', '1.5 mL/kg bolus → 0.25 mL/kg/min × 30-60 min', 'IV', 'If refractory shock/arrest. Consult toxicology.') + ); + html += 'Avoid Class IA/IC antiarrhythmics, beta-blockers, physostigmine (risk of asystole with TCAs).
';
+ } else if (topic === 'bbccb') {
+ html += 'β-blocker / Calcium-channel blocker overdose
';
+ html += 'Bradycardia + hypotension. CCBs (esp. verapamil, diltiazem, amlodipine) can be lethal in small pediatric doses.
'; + html += S.drugTable( + S.drugRow('IV fluids', '20 mL/kg NS bolus', 'IV', 'Cautious — avoid volume overload') + + S.drugRow('Calcium chloride 10% or gluconate', 'CaCl 20 mg/kg / Ca-glu 60 mg/kg', 'IV', 'First-line for CCB. Repeat q15-20 min.') + + S.drugRow('Glucagon', '50 mcg/kg IV bolus → 50-150 mcg/kg/hr', 'IV', 'β-blocker antidote. GI side effects common.') + + S.drugRow('High-dose insulin (HIE)', 'Regular insulin 1 U/kg bolus → 0.5-2 U/kg/hr + D25% infusion', 'IV', 'Hyperinsulinemic euglycemia therapy. Monitor K+ and glucose closely.') + + S.drugRow('Vasopressors', 'Epi / norepi infusion', 'IV', 'Titrate to MAP.') + + S.drugRow('Lipid emulsion 20%', '1.5 mL/kg → 0.25 mL/kg/min', 'IV', 'For lipid-soluble CCBs (verapamil) if refractory.') + + S.drugRow('Methylene blue / ECMO', '—', '—', 'Rescue therapy — toxicology/ICU consult.') + ); + } else if (topic === 'benzo') { + html += 'Benzodiazepine overdose
';
+ html += 'Sedation + resp depression. Usually supportive — intubation rarely needed alone. Flumazenil caution.
'; + html += S.drugTable( + S.drugRow('Flumazenil', '0.01 mg/kg (max 0.2 mg) IV, may repeat q1 min to max 1 mg', 'IV', 'Only for iatrogenic reversal in a benzo-naive patient with no TCAs, seizure disorder, or chronic benzo use. Can precipitate seizures.') + ); + html += 'In real-world ingestion, supportive care (airway, monitoring) is usually safer than flumazenil.
';
+ } else if (topic === 'organo') {
+ html += 'Organophosphate / carbamate poisoning
';
+ html += 'Cholinergic toxidrome: SLUDGE-M (salivation, lacrimation, urination, defecation, GI distress, emesis, miosis) + muscle fasciculation, bradycardia, bronchorrhea. Decontamination critical (PPE for providers).
'; + html += S.drugTable( + S.drugRow('Atropine', '0.05 mg/kg IV, double q3-5 min until bronchial secretions dry', 'IV', 'Endpoint = dry lungs, not dry mouth or heart rate. Can require huge doses.') + + S.drugRow('Pralidoxime (2-PAM)', '25-50 mg/kg IV over 30 min (max 2 g) → 10-20 mg/kg/hr', 'IV', 'Only for organophosphates (not carbamates). Regenerates acetylcholinesterase.') + + S.drugRow('Diazepam / midazolam', 'Standard seizure doses', 'IV', 'For seizures or severe fasciculations.') + ); + } else if (topic === 'salicylate') { + html += 'Salicylate overdose
';
+ html += 'Mixed respiratory alkalosis + anion gap metabolic acidosis. Tinnitus, tachypnea, diaphoresis, hyperthermia. Severe: CNS depression, seizures, pulmonary edema, cerebral edema.
'; + html += S.drugTable( + S.drugRow('Fluids', 'Aggressive resuscitation', 'IV', 'Dehydration common. Avoid fluid overload (risk of pulmonary edema).') + + S.drugRow('Sodium bicarb', '1-2 mEq/kg IV bolus → drip', 'IV', 'Urinary alkalinization (goal urine pH >7.5). Prevents CNS entry.') + + S.drugRow('Glucose', 'Maintain euglycemia even if BG normal', 'IV', 'CNS hypoglycemia despite normal serum glucose.') + + S.drugRow('Hemodialysis', '—', '—', 'For severe: altered MS, pulmonary edema, renal failure, refractory acidosis, or level >100 mg/dL acute / >60 chronic.') + ); + } else if (topic === 'etoh') { + html += 'Toxic alcohols (methanol / ethylene glycol)
';
+ html += 'Anion gap metabolic acidosis + osmolar gap. Methanol → visual changes, blindness. Ethylene glycol → calcium oxalate crystals in urine, renal failure.
'; + html += S.drugTable( + S.drugRow('Fomepizole', '15 mg/kg IV load → 10 mg/kg q12h × 4 → 15 mg/kg q12h', 'IV', 'First-line. Inhibits alcohol dehydrogenase.') + + S.drugRow('Ethanol (alternative)', 'Load 600 mg/kg → maintain level 100-150 mg/dL', 'IV / PO', 'If fomepizole unavailable. Monitor closely.') + + S.drugRow('Hemodialysis', '—', '—', 'For severe acidosis, end-organ damage, or high levels.') + + S.drugRow('Folate / thiamine / pyridoxine', 'Standard doses', 'IV', 'Methanol: folate. EG: thiamine + pyridoxine (divert to non-toxic metabolites).') + ); + } else if (topic === 'dialyzable') { + html += 'Dialyzable drugs (ISTUMBLE)
';
+ html += 'Commonly dialyzable in overdose:
'; + html += '';
+ [['I','Isopropyl alcohol, INH'],['S','Salicylates'],['T','Theophylline, Toxic alcohols'],['U','Uremia-related drugs'],['M','Methanol, Metformin, Methotrexate'],['B','Barbiturates (long-acting)'],['L','Lithium'],['E','Ethylene glycol']].forEach(function(x) {
+ html += '
';
+ html += '' + x[0] + ': ' + x[1] + '
';
+ });
+ html += 'Poor candidates for HD: Large Vd (TCAs, digoxin, BBs), highly protein-bound (benzos, CCBs), lipid-soluble (opioids, phenothiazines). EXTRIP recommendations are evidence-based — consult toxicology.
';
+ }
+ html += S.ref('Call Poison Control early: 1-800-222-1222 (US). Refs: Goldfrank\'s Toxicologic Emergencies, EXTRIP workgroup.');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// TRAUMA
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-trauma-show' || e.target.closest('#btn-trauma-show')) showTrauma();
+ });
+
+ function showTrauma() {
+ var wt = parseFloat(document.getElementById('trauma-weight').value);
+ var el = document.getElementById('trauma-result');
+ var S = window._EM;
+ var html = '';
+
+ html += 'Primary Survey — ABCDE
'; + html += S.stepBox('#ef4444', 'A — Airway + c-spine', 'Maintain airway (jaw thrust, suction). Manual inline stabilization; apply collar. Intubate if GCS ≤8, inadequate airway, or impending compromise. Avoid succinylcholine if burn/crush/prolonged immobilization.'); + html += S.stepBox('#f59e0b', 'B — Breathing', 'SpO2, bilateral breath sounds, chest wall integrity. Identify tension PTX (needle decompression), open PTX (3-sided dressing), flail chest, massive hemothorax.'); + html += S.stepBox('#10b981', 'C — Circulation', 'Two large-bore IVs / IO. Control hemorrhage (direct pressure, tourniquet, pelvic binder). ' + (wt ? 'NS or LR 20 mL/kg = ' + S.d(wt, 20) + ' mL bolus.' : 'NS/LR 20 mL/kg bolus.') + ' Consider blood after 40-60 mL/kg crystalloid or in Class III shock.'); + html += S.stepBox('#3b82f6', 'D — Disability', 'GCS, pupils, glucose, gross motor. Consider ↑ICP (head up 30°, mannitol 0.5-1 g/kg or hypertonic saline 3% 3-5 mL/kg).'); + html += S.stepBox('#8b5cf6', 'E — Exposure + environment', 'Fully expose; prevent hypothermia (warm blankets, fluids).'); + + html += 'Massive Transfusion Protocol (MTP)
'; + html += S.drugTable( + S.drugRow('Ratio', '1:1:1 (pRBC : FFP : platelets)', '—', 'Activate early if ≥40 mL/kg transfused or ongoing hemorrhage. Avoid excessive crystalloid.') + + S.drugRow('Tranexamic acid (TXA)', '15 mg/kg IV (max 1 g) over 10 min → 2 mg/kg/hr × 8h', 'IV', 'Within 3 hr of injury. CRASH-2 / MATIC.') + + S.drugRow('Calcium', '20 mg/kg CaCl or 60 mg/kg Ca-gluconate IV per unit citrated blood', 'IV', 'Citrated blood chelates calcium.') + ); + + html += 'C-spine clearance (NEXUS / CCR)
'; + html += 'Pediatric c-spine decision tools are imperfect. Imaging if any: focal neurologic deficit, altered mental status, neck pain / tenderness, torticollis, substantial torso injury, high-risk mechanism (diving, MVC >55 mph, fall >10 ft). Plain films + CT if positive or equivocal.
';
+
+ html += 'Pediatric shock — signs
'; + html += 'Children compensate well — hypotension is a late finding. Early signs: tachycardia, cool extremities, weak peripheral pulses, prolonged cap refill (>3 sec), narrowed pulse pressure, altered mentation. Minimum SBP = 70 + (2 × age in years) for ages 1-10.
';
+
+ html += 'Secondary survey — AMPLE + head-to-toe
'; + html += 'AMPLE: Allergies, Medications, Past history, Last meal, Events of injury. Head-to-toe exam; log-roll for back; digital rectal; neurovascular checks of all extremities.
';
+
+ html += S.ref('ATLS 10th ed; PALS 2020; PECARN c-spine rule; CRASH-2 trial (TXA).');
+ el.innerHTML = html;
+ }
+})();
+
+// ============================================================
+// APGAR SCORE (inside Neonatal)
+// ============================================================
+(function() {
+ document.addEventListener('click', function(e) {
+ if (e.target.id === 'btn-apgar-calc' || e.target.closest('#btn-apgar-calc')) calcApgar();
+ });
+ function calcApgar() {
+ var keys = ['appearance','pulse','grimace','activity','respiration'];
+ var total = keys.reduce(function(s, k) {
+ return s + (parseInt(document.getElementById('apgar-' + k).value) || 0);
+ }, 0);
+ var el = document.getElementById('apgar-result');
+ var color, severity, guidance;
+ if (total >= 7) {
+ color = '#10b981'; severity = 'Reassuring';
+ guidance = 'Routine newborn care. Continue reassessment. Repeat at 5 min.';
+ } else if (total >= 4) {
+ color = '#f59e0b'; severity = 'Moderately depressed';
+ guidance = 'Stimulate, clear airway, warm. Give O2 if cyanotic. Ventilate with PPV if HR <100 or apneic/gasping. Reassess q30 sec.';
+ } else {
+ color = '#ef4444'; severity = 'Severely depressed';
+ guidance = 'Full NRP pathway — PPV immediately. Intubate if PPV ineffective. Chest compressions if HR <60. Epinephrine and volume per NRP.';
+ }
+ var html = '';
+ html += 'Apgar: ' + total + '/10 — ' + severity + '';
+ html += '
';
+ html += '' + guidance + '
Apgar is a description of status — never delay resuscitation while scoring. Follow NRP algorithm based on HR and breathing. Apgar <7 at 5 min: repeat q5 min up to 20 min.
'; + el.innerHTML = html; + } +})(); + +// ============================================================ +// O2 & VENTILATION (teaching reference) +// ============================================================ +(function() { + document.addEventListener('click', function(e) { + if (e.target.id === 'btn-vent-show' || e.target.closest('#btn-vent-show')) showVent(); + }); + + function showVent() { + var wt = parseFloat(document.getElementById('vent-weight').value); + var age = parseFloat(document.getElementById('vent-age').value); + var el = document.getElementById('vent-result'); + var S = window._EM; + var html = ''; + + // ── Target SpO2 quick reference ── + html += 'Target SpO2
'; + html += '| Patient | Target | Notes |
|---|---|---|
| Most children | 94-98% | Normal |
| Bronchiolitis (AAP 2014/2023) | ≥90% | Don\'t chase higher saturations |
| Chronic lung disease / CF | 90-94% | Avoid hyperoxia in CO2 retainers |
| Preterm neonate | 90-95% | Minimize ROP risk |
| Term neonate (min of life) | Per NRP ladder | 1 min 60-65%, 10 min 85-95% |
Escalation ladder (step up when target not reached / work of breathing)
'; + html += S.stepBox('#10b981', + '1. Nasal cannula (low-flow)', + '0.5-6 L/min · FiO2 ~24-40% (rough: room air 21% + 4% per L/min) · comfortable, no humidification needed. Good for mild hypoxia or baseline support.'); + html += S.stepBox('#3b82f6', + '2. Simple face mask', + '6-10 L/min · FiO2 35-60%. Must keep flow >6 L/min to flush CO2. Tolerated less well than NC.'); + html += S.stepBox('#8b5cf6', + '3. Non-rebreather mask', + '10-15 L/min · FiO2 60-90%. Reservoir bag must stay inflated. For severe hypoxia with intact breathing.'); + html += S.stepBox('#f59e0b', + '4. High-flow nasal cannula (HFNC)', + '' + (wt ? '1-2 L/kg/min = ' + S.d(wt, 1) + '-' + S.d(wt, 2) + ' L/min' : '1-2 L/kg/min') + ' (max ~50-60 L/min adults) · heated + humidified · FiO2 30-100% titratable · generates ~2-5 cmH2O PEEP · works for bronchiolitis, early resp failure. Reassess at 1-2 h — no improvement → step up.'); + html += S.stepBox('#ef4444', + '5. Non-invasive ventilation (CPAP / BiPAP)', + 'CPAP 5-10 cmH2O (pure PEEP) · BiPAP IPAP 10-14 / EPAP 5 (adds pressure support) · FiO2 as needed. Needs cooperative patient, intact airway reflexes, no copious secretions. Contraindicated: coma, apnea, unstable hemodynamics, facial trauma.'); + html += S.stepBox('#dc2626', + '6. Intubate + mechanical ventilation', + 'When NIV fails, airway compromised, apnea, or GCS ≤8. See RSI under the Airway tab for drugs.'); + + // ── BVM how-to ── + html += 'Bag-Valve-Mask (BVM)
'; + html += '';
+ html += 'When: apnea, bradycardia (HR <60 in neonate; inadequate breathing at any age), during resuscitation.
'; + html += 'Rate: Newborn 40-60 /min · Infant-child 20-30 /min · Adolescent 10-12 /min (1 breath q5-6 sec).
'; + html += 'Tidal volume: 6-8 mL/kg — only enough to see gentle chest rise. Avoid over-ventilation (gastric distension, ↓venous return, lung injury).
'; + html += 'Technique: head tilt / jaw thrust, proper mask seal (E-C grip or 2-thumb), squeeze 1 sec, release fully before next breath. Attach O2 at 10-15 L/min + reservoir.
'; + html += 'If not ventilating: MR SOPA — Mask reseal, Reposition airway, Suction mouth+nose, Open mouth, Pressure ↑, Alternative airway (LMA or ETT).'; + html += '
';
+
+ // ── Mechanical vent settings ──
+ html += ''; + html += 'Rate: Newborn 40-60 /min · Infant-child 20-30 /min · Adolescent 10-12 /min (1 breath q5-6 sec).
'; + html += 'Tidal volume: 6-8 mL/kg — only enough to see gentle chest rise. Avoid over-ventilation (gastric distension, ↓venous return, lung injury).
'; + html += 'Technique: head tilt / jaw thrust, proper mask seal (E-C grip or 2-thumb), squeeze 1 sec, release fully before next breath. Attach O2 at 10-15 L/min + reservoir.
'; + html += 'If not ventilating: MR SOPA — Mask reseal, Reposition airway, Suction mouth+nose, Open mouth, Pressure ↑, Alternative airway (LMA or ETT).'; + html += '
Mechanical ventilator — starting settings
'; + var rate = age == null ? '' : (age < 0.1 ? '30-40' : age < 1 ? '25-35' : age < 5 ? '20-25' : age < 12 ? '16-20' : '12-16'); + html += '';
+ html += 'Mode: Volume-control (set TV, get pressure) OR Pressure-control (set pressure, get TV). PRVC / SIMV-PS are hybrids. Pick what your unit uses.
'; + html += 'Tidal volume: ' + (wt ? S.d(wt, 6) + '-' + S.d(wt, 8) + ' mL' : '6-8 mL/kg') + ' (6-8 mL/kg). Use lower (4-6 mL/kg) for ARDS.
'; + html += 'Rate: ' + (rate ? rate + ' /min (for age ' + age + ' yr)' : 'Newborn 30-40 · Infant 25-35 · Child 16-20 · Adolescent 12-16') + '.
'; + html += 'PEEP: start 5 cmH2O (routine). Increase to 8-12+ for refractory hypoxia (ARDS).
'; + html += 'FiO2: start 100%, wean rapidly to lowest that maintains target SpO2 (usually <60%).
'; + html += 'I:E ratio: 1:2 normally. 1:3-4 for obstructive disease (asthma, bronchiolitis) to allow exhalation.
'; + html += 'Inspiratory time: 0.5 s infant · 0.7-1 s child · 1-1.2 s adolescent.
'; + html += 'Pressure limits: keep plateau <30 cmH2O (ideally <28) to avoid barotrauma.'; + html += '
';
+
+ // ── Pressure-time waveform ──
+ html += ''; + html += 'Tidal volume: ' + (wt ? S.d(wt, 6) + '-' + S.d(wt, 8) + ' mL' : '6-8 mL/kg') + ' (6-8 mL/kg). Use lower (4-6 mL/kg) for ARDS.
'; + html += 'Rate: ' + (rate ? rate + ' /min (for age ' + age + ' yr)' : 'Newborn 30-40 · Infant 25-35 · Child 16-20 · Adolescent 12-16') + '.
'; + html += 'PEEP: start 5 cmH2O (routine). Increase to 8-12+ for refractory hypoxia (ARDS).
'; + html += 'FiO2: start 100%, wean rapidly to lowest that maintains target SpO2 (usually <60%).
'; + html += 'I:E ratio: 1:2 normally. 1:3-4 for obstructive disease (asthma, bronchiolitis) to allow exhalation.
'; + html += 'Inspiratory time: 0.5 s infant · 0.7-1 s child · 1-1.2 s adolescent.
'; + html += 'Pressure limits: keep plateau <30 cmH2O (ideally <28) to avoid barotrauma.'; + html += '
Pressure-time waveform (what the monitor shows)
'; + html += '';
+ html += '';
+ html += '
';
+
+ // ── Troubleshooting: "if this, change that" ──
+ html += 'PIP = peak pressure during inspiration (depends on TV, airway resistance, lung compliance). Plateau = static pressure at end-inspiration with brief breath-hold (reflects alveolar pressure — keep <30). PEEP = baseline end-expiratory pressure keeping alveoli open. Ti / Te = inspiratory / expiratory time. Rate × (Ti+Te) = 60 s.
';
+ html += 'Adjusting for gas exchange
'; + html += '| Problem | First lever | Second lever |
|---|---|---|
| Low SpO2 (oxygenation) | ↑ FiO2 | ↑ PEEP (recruits collapsed alveoli) |
| ↑ PCO2 (ventilation) | ↑ Rate | ↑ Tidal volume |
| ↓ PCO2 (over-ventilating) | ↓ Rate | ↓ Tidal volume |
| High peak pressure | Check tube (kink, mucus plug), compliance, bronchospasm | Suction, bronchodilator, lower TV |
| Auto-PEEP (asthma, bronchiolitis) | ↓ Rate, ↑ expiratory time | Disconnect + bag briefly if critical |
Mental model: Oxygenation is mostly FiO2 + PEEP. Ventilation (CO2) is mostly rate + tidal volume. Match mode to disease: obstructive (asthma, bronchiolitis) → long expiratory time, permissive hypercapnia. Restrictive (ARDS) → low TV, high PEEP, permissive hypercapnia + hypoxia.
';
+
+ html += S.ref('Based on AAP / PALS / AARC guidance. Tailor to individual patient and institutional protocols.');
+ el.innerHTML = html;
+ }
+})();
diff --git a/test/calc-math.test.js b/test/calc-math.test.js
new file mode 100644
index 0000000..861b3f3
--- /dev/null
+++ b/test/calc-math.test.js
@@ -0,0 +1,167 @@
+// ============================================================
+// Unit tests for public/js/calc-math.js (pediatric dose math).
+// Run with: npm test (alias for: node --test test/)
+// ============================================================
+const { test } = require('node:test');
+const assert = require('node:assert/strict');
+const M = require('../public/js/calc-math.js');
+
+// ── estimateWeightFromAgeMonths ────────────────────────────────
+test('APLS 0-12 mo: 6 mo -> 7 kg', () => {
+ const r = M.estimateWeightFromAgeMonths(6);
+ assert.equal(r.weight, 7); // 0.5*6 + 4 = 7
+ assert.match(r.formulaLabel, /0-12 mo/);
+});
+
+test('APLS 1-5 yr: 3 yr -> 14 kg', () => {
+ const r = M.estimateWeightFromAgeMonths(36);
+ assert.equal(r.weight, 14); // 2*3 + 8 = 14
+ assert.match(r.formulaLabel, /1-5 yr/);
+});
+
+test('APLS 6-12 yr: 8 yr -> 31 kg', () => {
+ const r = M.estimateWeightFromAgeMonths(96);
+ assert.equal(r.weight, 31); // 3*8 + 7 = 31
+ assert.match(r.formulaLabel, /6-12 yr/);
+});
+
+test('Best Guess 14 yr -> 56 kg (switches away from APLS at >=13 yr)', () => {
+ const r = M.estimateWeightFromAgeMonths(168);
+ assert.equal(r.weight, 56); // 4 * 14 = 56
+ assert.match(r.formulaLabel, /Best Guess/);
+});
+
+test('APLS and Best Guess both reported', () => {
+ const r = M.estimateWeightFromAgeMonths(48);
+ assert.equal(r.all.apls, 16); // 2*4 + 8
+ assert.equal(r.all.bestGuess, 18); // 2*(4+5)
+});
+
+test('Null/negative age returns null', () => {
+ assert.equal(M.estimateWeightFromAgeMonths(null), null);
+ assert.equal(M.estimateWeightFromAgeMonths(-5), null);
+});
+
+// ── Parkland ────────────────────────────────────────────────────
+test('Parkland 20kg, 25% TBSA -> 2000 mL total, 1000 first 8h', () => {
+ const p = M.parkland(20, 25);
+ assert.equal(p.totalMl, 2000); // 4 * 20 * 25
+ assert.equal(p.first8Ml, 1000);
+ assert.equal(p.next16Ml, 1000);
+ assert.equal(p.rateFirst8, 125); // 1000 / 8
+ assert.equal(p.rateNext16, 63); // 1000 / 16 = 62.5 -> 63
+});
+
+test('Parkland invalid inputs return null', () => {
+ assert.equal(M.parkland(0, 25), null);
+ assert.equal(M.parkland(20, 0), null);
+ assert.equal(M.parkland(null, 25), null);
+});
+
+// ── Maintenance 4-2-1 ──────────────────────────────────────────
+test('Maintenance: 8 kg -> 32 mL/hr', () => { assert.equal(M.maintenance421(8), 32); });
+test('Maintenance: 15 kg -> 50 mL/hr', () => { assert.equal(M.maintenance421(15), 50); });
+test('Maintenance: 25 kg -> 65 mL/hr', () => { assert.equal(M.maintenance421(25), 65); });
+test('Maintenance: 70 kg -> 110 mL/hr', () => { assert.equal(M.maintenance421(70), 110); });
+
+// ── PRAM ────────────────────────────────────────────────────────
+test('PRAM all zero -> Mild (0)', () => {
+ const r = M.pramScore(0, 0, 0, 0, 0);
+ assert.equal(r.total, 0); assert.equal(r.severity, 'Mild');
+});
+test('PRAM total 5 -> Moderate', () => {
+ const r = M.pramScore(1, 2, 0, 1, 1);
+ assert.equal(r.total, 5); assert.equal(r.severity, 'Moderate');
+});
+test('PRAM total 10 -> Severe', () => {
+ const r = M.pramScore(2, 2, 2, 2, 2);
+ assert.equal(r.total, 10); assert.equal(r.severity, 'Severe');
+});
+
+// ── Westley ─────────────────────────────────────────────────────
+test('Westley 2 -> Mild', () => { assert.equal(M.westleyScore(0, 0, 1, 0, 1).severity, 'Mild'); });
+test('Westley 4 -> Moderate', () => { assert.equal(M.westleyScore(0, 0, 2, 1, 1).severity, 'Moderate'); });
+test('Westley 8 -> Severe', () => { assert.equal(M.westleyScore(0, 4, 2, 1, 1).severity, 'Severe'); });
+test('Westley 12 -> Impending respiratory failure', () => { assert.equal(M.westleyScore(5, 4, 0, 1, 2).severity, 'Impending respiratory failure'); });
+
+// ── Epinephrine (anaphylaxis vs arrest) ─────────────────────────
+test('Epi anaphylaxis IM: 20 kg -> 0.2 mg (1:1000)', () => {
+ const r = M.epiAnaphylaxisIM(20);
+ assert.equal(r.doseMg, 0.2);
+ assert.equal(r.volumeMl_1in1000, 0.2); // 1 mg/mL concentration
+});
+
+test('Epi anaphylaxis IM: max 0.5 mg for >=50 kg', () => {
+ assert.equal(M.epiAnaphylaxisIM(80).doseMg, 0.5);
+});
+
+test('Epi arrest IV: 10 kg -> 0.1 mg, 1 mL of 1:10,000', () => {
+ const r = M.epiArrestIV(10);
+ assert.equal(r.doseMg, 0.1);
+ assert.equal(r.volumeMl_1in10000, 1); // 0.1 mg/mL concentration
+});
+
+test('Epi arrest IV: max 1 mg for >=100 kg', () => {
+ assert.equal(M.epiArrestIV(120).doseMg, 1);
+});
+
+// ── NRP epi ──────────────────────────────────────────────────────
+test('NRP epi: 3 kg newborn -> 0.03-0.09 mg IV (0.3-0.9 mL of 1:10,000)', () => {
+ const r = M.nrpEpiIV(3);
+ assert.equal(r.lowMg, 0.03);
+ assert.equal(r.highMg, 0.09);
+ assert.equal(r.lowMl, 0.3);
+ assert.equal(r.highMl, 0.9);
+});
+
+// ── RSI drugs ────────────────────────────────────────────────────
+test('Ketamine RSI 20 kg -> 30-40 mg', () => {
+ const r = M.rsiKetamine(20);
+ assert.equal(r.lowMg, 30);
+ assert.equal(r.highMg, 40);
+});
+
+test('Rocuronium 25 kg -> 30 mg (1.2 mg/kg)', () => {
+ assert.equal(M.rsiRocuronium(25).mg, 30);
+});
+
+test('Succinylcholine dose/kg: <10 kg = 2 mg/kg; >=10 kg = 1.5 mg/kg', () => {
+ assert.equal(M.rsiSuccinylcholine(8).perKg, 2);
+ assert.equal(M.rsiSuccinylcholine(20).perKg, 1.5);
+ assert.equal(M.rsiSuccinylcholine(20).mg, 30); // 20*1.5
+});
+
+// ── Min systolic BP ─────────────────────────────────────────────
+test('Min SBP: 5 yr -> 80', () => { assert.equal(M.minSBP(5), 80); });
+test('Min SBP: infant (<1 yr) -> 70', () => { assert.equal(M.minSBP(0.5), 70); });
+test('Min SBP: 12 yr -> 90', () => { assert.equal(M.minSBP(12), 90); });
+
+// ── ETT sizing ──────────────────────────────────────────────────
+test('ETT 4 yr: uncuffed 5.0, cuffed 4.5, depth 15', () => {
+ const r = M.ettSize(4);
+ assert.equal(r.uncuffedMm, 5);
+ assert.equal(r.cuffedMm, 4.5);
+ assert.equal(r.depthCm, 15);
+});
+
+// ── Lund-Browder TBSA ───────────────────────────────────────────
+test('Lund-Browder: full head infant = 18%', () => {
+ assert.equal(M.lundBrowderTBSA('infant', { head: 100 }), 18);
+});
+test('Lund-Browder: full head adult = 7%', () => {
+ assert.equal(M.lundBrowderTBSA('adult', { head: 100 }), 7);
+});
+test('Lund-Browder: full body adds to ~100% (infant) — tolerance for published rounding', () => {
+ const all = {};
+ Object.keys(M.LB).forEach((k) => { all[k] = 100; });
+ const t = M.lundBrowderTBSA('infant', all);
+ // Published charts typically sum to 99-100% depending on head % (18 vs 19 at 0 yr vs 1 yr).
+ assert.ok(t >= 98 && t <= 100.5, 'expected 98-100.5, got ' + t);
+});
+test('Lund-Browder: 50% of both thighs young child = 8%', () => {
+ // young (1-5) thigh = 8% each, so 50% of each = 4% + 4% = 8%
+ assert.equal(M.lundBrowderTBSA('young', { r_thigh: 50, l_thigh: 50 }), 8);
+});
+test('Lund-Browder: invalid bracket returns null', () => {
+ assert.equal(M.lundBrowderTBSA('bogus', { head: 50 }), null);
+});