From ae4c36ff8e53166be1617e21d8f846b960375d37 Mon Sep 17 00:00:00 2001 From: Daniel Date: Fri, 24 Apr 2026 05:46:45 +0200 Subject: [PATCH] chore(verify): drop vanilla-era test + linter; rebuild React bundle MIME-Version: 1.0 Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: 8bit The verify pipeline carried two scripts whose targets no longer exist after the vanilla deletion at commit 25a9c4c: test/calc-math.test.js — required public/js/calc-math.js (gone); every assertion is now covered by shared/clinical/ calculators.test.ts (vitest). scripts/lint-references.js — scans public/js/*.js for DOM id references and checks each target exists in public/components/ *.html. Those trees are gone; TypeScript + knip + vite build cover the equivalent dead-reference class for the React tree. package.json: • `verify` drops `test:node` and `lint:refs`; now runs typecheck + vitest + knip + client vite build. • `test:node` script removed (test/ directory empty). public/app/assets/ — fresh vite build so the bundle hashes match the current source (new chunks for ByVisitAge, Cms, DxPicker, EditableResult, LabsList, Milestones, OutputActions, Recorder, Shadess, SlideEditor, VisitNote — all features landed in the preceding commits). Verified locally on node 20: tsc + 9 test files / 177 tests pass, knip finds nothing, vite builds 35 chunks, client bundle is 343 kB initial / 106 kB gzipped (Cms is the biggest lazy chunk at 402 kB due to Tiptap/ProseMirror). --- package.json | 4 +- .../{Admin-C0fswhTW.js => Admin-DR6X-rgC.js} | 2 +- .../{Auth-BtfAUU3w.js => Auth-B-3rDdHk.js} | 2 +- ...edside-BsBuEI_m.js => Bedside-Da0d6Hsf.js} | 2 +- public/app/assets/ByVisitAge-jMcNy23H.js | 2 + ...rs-hFcuewWL.js => Calculators-BLZD2bUs.js} | 2 +- ...atchup--869idMv.js => Catchup-DCX8L2yV.js} | 2 +- public/app/assets/ChartReview-95oCueTc.js | 1 - public/app/assets/ChartReview-BvAH_gpU.js | 3 + public/app/assets/Cms-BmSRdQI9.js | 143 ++++++++++++++ ...l-zYA0ebt6.js => ConfirmModal-CIfDDoVq.js} | 0 public/app/assets/Dictation-D10JY0ar.js | 1 + public/app/assets/Dictation-Dk3CctmR.js | 1 - public/app/assets/DxPicker-CCeyfxop.js | 4 + public/app/assets/EditableResult-DaHQp1Pv.js | 1 + public/app/assets/Encounter-Br_IbTDu.js | 1 + public/app/assets/Encounter-CbwLX_2x.js | 1 - public/app/assets/HospitalCourse-BeNFIL_Z.js | 1 - public/app/assets/HospitalCourse-CzXNLHTv.js | 3 + public/app/assets/LabsList-CVygta6B.js | 1 + ...rning-BRd1B0-L.js => Learning-CYutu0C6.js} | 2 +- public/app/assets/Milestones-BIwzyW98.js | 1 + public/app/assets/OutputActions-6XZlmtIw.js | 1 + ...eGuide-eWPZEjQC.js => PeGuide-DChX9qua.js} | 2 +- public/app/assets/Recorder-DdXTjnSC.js | 1 + ...-pLQAcaAT.js => ResetPassword-CVgOn7wd.js} | 2 +- ...tings-CnDpQmnm.js => Settings-B_mY7MfB.js} | 2 +- public/app/assets/Shadess-DU9cvMlg.js | 1 + public/app/assets/SickVisit-BHH5UBrw.js | 1 + public/app/assets/SickVisit-vgkhrwdD.js | 1 - public/app/assets/Soap-DyFxx9HE.js | 1 + public/app/assets/Soap-VyU-WHem.js | 1 - ...le-WVnLWGX9.js => VaxSchedule-DSxl1k27.js} | 2 +- public/app/assets/VisitNote-B6TwVraG.js | 5 + public/app/assets/WellVisit-CQEpKEWj.js | 1 - public/app/assets/WellVisit-Dv-oLhFb.js | 2 + ...{fenton-Dvwmge1q.js => fenton-BaYL-F22.js} | 0 public/app/assets/index-BEGt1l85.css | 2 - public/app/assets/index-BuU36CvS.js | 50 ----- public/app/assets/index-C9wKWOAN.js | 50 +++++ public/app/assets/index-D2yFXEFs.css | 2 + public/app/assets/preload-helper-BmrihbwG.js | 1 + public/app/index.html | 5 +- scripts/lint-references.js | 179 ----------------- test/calc-math.test.js | 184 ------------------ 45 files changed, 239 insertions(+), 437 deletions(-) rename public/app/assets/{Admin-C0fswhTW.js => Admin-DR6X-rgC.js} (99%) rename public/app/assets/{Auth-BtfAUU3w.js => Auth-B-3rDdHk.js} (99%) rename public/app/assets/{Bedside-BsBuEI_m.js => Bedside-Da0d6Hsf.js} (99%) create mode 100644 public/app/assets/ByVisitAge-jMcNy23H.js rename public/app/assets/{Calculators-hFcuewWL.js => Calculators-BLZD2bUs.js} (99%) rename public/app/assets/{Catchup--869idMv.js => Catchup-DCX8L2yV.js} (97%) delete mode 100644 public/app/assets/ChartReview-95oCueTc.js create mode 100644 public/app/assets/ChartReview-BvAH_gpU.js create mode 100644 public/app/assets/Cms-BmSRdQI9.js rename public/app/assets/{ConfirmModal-zYA0ebt6.js => ConfirmModal-CIfDDoVq.js} (100%) create mode 100644 public/app/assets/Dictation-D10JY0ar.js delete mode 100644 public/app/assets/Dictation-Dk3CctmR.js create mode 100644 public/app/assets/DxPicker-CCeyfxop.js create mode 100644 public/app/assets/EditableResult-DaHQp1Pv.js create mode 100644 public/app/assets/Encounter-Br_IbTDu.js delete mode 100644 public/app/assets/Encounter-CbwLX_2x.js delete mode 100644 public/app/assets/HospitalCourse-BeNFIL_Z.js create mode 100644 public/app/assets/HospitalCourse-CzXNLHTv.js create mode 100644 public/app/assets/LabsList-CVygta6B.js rename public/app/assets/{Learning-BRd1B0-L.js => Learning-CYutu0C6.js} (99%) create mode 100644 public/app/assets/Milestones-BIwzyW98.js create mode 100644 public/app/assets/OutputActions-6XZlmtIw.js rename public/app/assets/{PeGuide-eWPZEjQC.js => PeGuide-DChX9qua.js} (99%) create mode 100644 public/app/assets/Recorder-DdXTjnSC.js rename public/app/assets/{ResetPassword-pLQAcaAT.js => ResetPassword-CVgOn7wd.js} (97%) rename public/app/assets/{Settings-CnDpQmnm.js => Settings-B_mY7MfB.js} (99%) create mode 100644 public/app/assets/Shadess-DU9cvMlg.js create mode 100644 public/app/assets/SickVisit-BHH5UBrw.js delete mode 100644 public/app/assets/SickVisit-vgkhrwdD.js create mode 100644 public/app/assets/Soap-DyFxx9HE.js delete mode 100644 public/app/assets/Soap-VyU-WHem.js rename public/app/assets/{VaxSchedule-WVnLWGX9.js => VaxSchedule-DSxl1k27.js} (97%) create mode 100644 public/app/assets/VisitNote-B6TwVraG.js delete mode 100644 public/app/assets/WellVisit-CQEpKEWj.js create mode 100644 public/app/assets/WellVisit-Dv-oLhFb.js rename public/app/assets/{fenton-Dvwmge1q.js => fenton-BaYL-F22.js} (100%) delete mode 100644 public/app/assets/index-BEGt1l85.css delete mode 100644 public/app/assets/index-BuU36CvS.js create mode 100644 public/app/assets/index-C9wKWOAN.js create mode 100644 public/app/assets/index-D2yFXEFs.css create mode 100644 public/app/assets/preload-helper-BmrihbwG.js delete mode 100755 scripts/lint-references.js delete mode 100644 test/calc-math.test.js diff --git a/package.json b/package.json index e714306..549fe4e 100644 --- a/package.json +++ b/package.json @@ -11,14 +11,12 @@ "prebuild": "rm -rf dist", "build": "tsc", "typecheck": "tsc --noEmit", - "verify": "npm run typecheck && npm test && npm run test:node && npm run lint:refs && npm run lint:dead && npm --prefix client run build", + "verify": "npm run typecheck && npm test && npm run lint:dead && npm --prefix client run build", "verify:full": "npm run verify && npm run e2e", "dev": "ts-node-dev --respawn --transpile-only server.ts", "test": "vitest run", - "test:node": "node --test test/", "test:coverage": "vitest run --coverage", "e2e": "./scripts/e2e.sh", - "lint:refs": "node scripts/lint-references.js", "lint:dead": "knip --no-config-hints", "maint:check": "node scripts/maintenance.js check", "maint:reindex": "node scripts/maintenance.js reindex", diff --git a/public/app/assets/Admin-C0fswhTW.js b/public/app/assets/Admin-DR6X-rgC.js similarity index 99% rename from public/app/assets/Admin-C0fswhTW.js rename to public/app/assets/Admin-DR6X-rgC.js index 236c0b9..a5ce295 100644 --- a/public/app/assets/Admin-C0fswhTW.js +++ b/public/app/assets/Admin-DR6X-rgC.js @@ -1 +1 @@ -import{i as e,n as t,t as n}from"./jsx-runtime-ByY1xr43.js";import{c as r,i,l as a,u as o}from"./index-BuU36CvS.js";import{t as s}from"./ConfirmModal-zYA0ebt6.js";var c=e(t(),1),l=n(),u=`rounded-lg border border-border bg-card p-5 space-y-3`,d=`w-full rounded-md border border-input bg-background px-3 py-2 text-sm outline-none focus:ring-2 focus:ring-ring`,f=`block text-xs font-medium text-muted-foreground`,p=`rounded-md bg-primary text-primary-foreground px-3 py-2 text-sm font-medium disabled:opacity-50`,m=`rounded-md border border-border bg-background px-3 py-2 text-xs font-medium hover:bg-muted disabled:opacity-50`,h=`rounded-md bg-destructive text-white px-3 py-2 text-xs font-medium disabled:opacity-50`,g=`text-left px-2 py-1.5 border-b border-border font-semibold uppercase tracking-wide text-[10px] text-muted-foreground`,_=`px-2 py-1.5 border-b border-border align-top text-sm`;function v({msg:e}){return e?(0,l.jsx)(`div`,{className:`text-sm `+(e.kind===`ok`?`text-green-600`:e.kind===`err`?`text-destructive`:`text-muted-foreground`),children:e.text}):null}function y(){let e=o(),[t,n]=(0,c.useState)(null),[f,y]=(0,c.useState)(``),[b,x]=(0,c.useState)(null),[S,C]=(0,c.useState)(null),[w,T]=(0,c.useState)(``),{data:E,isLoading:D,error:O}=a({queryKey:[`admin-users`],queryFn:()=>i.get(`/api/admin/users`)}),k=r({mutationFn:e=>i.post(`/api/admin/users/${e}/verify`,{}),onSuccess:t=>{n({text:t.message,kind:`ok`}),e.invalidateQueries({queryKey:[`admin-users`]})},onError:e=>n({text:e.message,kind:`err`})}),A=r({mutationFn:e=>i.post(`/api/admin/users/${e}/disable`,{}),onSuccess:t=>{n({text:t.message,kind:`info`}),e.invalidateQueries({queryKey:[`admin-users`]})},onError:e=>n({text:e.message,kind:`err`})}),j=r({mutationFn:e=>i.post(`/api/admin/users/${e}/enable`,{}),onSuccess:t=>{n({text:t.message,kind:`ok`}),e.invalidateQueries({queryKey:[`admin-users`]})},onError:e=>n({text:e.message,kind:`err`})}),M=r({mutationFn:e=>i.post(`/api/admin/users/${e.id}/role`,{role:e.role}),onSuccess:t=>{n({text:t.message,kind:`ok`}),e.invalidateQueries({queryKey:[`admin-users`]})},onError:e=>n({text:e.message,kind:`err`})}),N=r({mutationFn:e=>i.delete(`/api/admin/users/${e}`),onSuccess:t=>{n({text:t.message,kind:`info`}),e.invalidateQueries({queryKey:[`admin-users`]})},onError:e=>n({text:e.message,kind:`err`})}),P=r({mutationFn:e=>i.post(`/api/admin/users/${e.id}/reset-password`,{newPassword:e.newPassword}),onSuccess:e=>{n({text:e.message,kind:`ok`}),C(null),T(``)},onError:e=>n({text:e.message,kind:`err`})}),F=(E?.users||[]).filter(e=>!f||e.email.toLowerCase().includes(f.toLowerCase())||e.name.toLowerCase().includes(f.toLowerCase()));return(0,l.jsxs)(`section`,{className:u,"data-testid":`admin-users-tab`,children:[(0,l.jsxs)(`div`,{className:`flex items-center justify-between gap-2 flex-wrap`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Users`}),(0,l.jsx)(`input`,{type:`search`,className:d+` max-w-xs`,placeholder:`Search by name or email…`,value:f,onChange:e=>y(e.target.value),"data-testid":`admin-users-search`})]}),D&&(0,l.jsx)(`div`,{className:`text-sm text-muted-foreground`,children:`Loading…`}),O&&(0,l.jsx)(`div`,{className:`text-sm text-destructive`,children:O.message}),(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full 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BMC Pediatr 2013;13:59 · NRP 8th ed (AHA/AAP 2020) · Apgar is a description of status — `,(0,l.jsx)(`strong`,{children:`never`}),` delay resuscitation while scoring.`]})]})}function y(){let[e,t]=(0,c.useState)(`asthma`),[n,r]=(0,c.useState)(``),i=Number.parseFloat(n),a=Number.isFinite(i)&&i>0,o=(e,t,n=`mg`)=>a?s(i,e,t,n):null,[p,m]=(0,c.useState)(null),[v,y]=(0,c.useState)({spo2:0,retractions:0,scalene:0,air:0,wheeze:0}),b=Object.values(v).reduce((e,t)=>e+t,0),x=b<=3?`Mild`:b<=7?`Moderate`:`Severe`,S=b<=3?`text-green-600 bg-green-50`:b<=7?`text-amber-600 bg-amber-50`:`text-destructive bg-red-50`,[C,w]=(0,c.useState)({conscious:0,cyanosis:0,stridor:0,air:0,retractions:0}),T=Object.values(C).reduce((e,t)=>e+t,0),E=T<=2?`Mild`:T<=5?`Moderate`:T<=11?`Severe`:`Impending Respiratory Failure`,D=T<=2?`text-green-600 bg-green-50`:T<=5?`text-amber-600 bg-amber-50`:T<=11?`text-destructive bg-red-50`:`text-red-900 bg-red-100`,[O,k]=(0,c.useState)({age:`gte12w`,spo2:`ok`,hydration:`ok`,distress:`mild`}),A=O.distress===`severe`||O.spo2===`low`||O.hydration===`poor`||O.age===`lt12w`;return(0,l.jsxs)(`section`,{className:u,"data-testid":`bedside-panel-respiratory`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Respiratory`}),(0,l.jsx)(`div`,{className:`flex gap-2 flex-wrap`,children:[`asthma`,`pram`,`croup`,`bronch`].map(n=>(0,l.jsx)(`button`,{type:`button`,onClick:()=>t(n),className:`px-3 py-1 rounded-full text-xs font-medium border `+(e===n?`bg-primary text-primary-foreground border-primary`:`bg-muted border-border`),"data-testid":`resp-mode-`+n,children:n===`asthma`?`Asthma`:n===`pram`?`PRAM`:n===`croup`?`Croup (Westley)`:`Bronchiolitis`},n))}),e!==`pram`&&e!==`bronch`&&(0,l.jsxs)(`div`,{className:`max-w-xs`,children:[(0,l.jsx)(`label`,{className:f,children:`Weight (kg)`}),(0,l.jsx)(`input`,{type:`number`,min:`0.3`,step:`0.1`,className:d,value:n,onChange:e=>r(e.target.value),"data-testid":`resp-weight`})]}),e===`asthma`&&(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`div`,{className:`flex gap-2`,children:[`mild`,`moderate`,`severe`].map(e=>(0,l.jsx)(`button`,{type:`button`,onClick:()=>m(e),className:`px-3 py-1 rounded text-xs font-medium border `+(p===e?e===`mild`?`bg-green-600 text-white`:e===`moderate`?`bg-amber-500 text-white`:`bg-destructive text-white`:`bg-muted`),children:e.charAt(0).toUpperCase()+e.slice(1)},e))}),p&&!a&&(0,l.jsx)(`p`,{className:`text-xs text-destructive`,children:`Enter weight (kg) to see doses.`}),p===`mild`&&a&&(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`p`,{className:`text-xs text-muted-foreground`,children:`Speaks in sentences, no accessory muscle use, SpO₂ ≥94%`}),(0,l.jsxs)(g,{children:[(0,l.jsx)(_,{name:`Albuterol (MDI)`,dose:`4-8 puffs via spacer`,route:`Inhaled`,notes:`q20min × 3 doses, then q1-4h`}),(0,l.jsx)(_,{name:`Albuterol (neb)`,dose:(0,l.jsx)(h,{label:`${o(.15,5,`mg`).label} (min 2.5 mg)`}),route:`Nebulized`,notes:`q20min × 3 doses`}),(0,l.jsx)(_,{name:`Dexamethasone`,dose:(0,l.jsx)(h,{label:o(.6,16).label}),route:`PO/IV`,notes:`Single dose, or 2 days`}),(0,l.jsx)(_,{name:`Prednisolone`,dose:(0,l.jsx)(h,{label:`${o(1,60).label}/day`}),route:`PO`,notes:`Alternative: 3-5 day course`})]})]}),p===`moderate`&&a&&(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`p`,{className:`text-xs text-muted-foreground`,children:`Speaks in phrases, some accessory muscle use, SpO₂ 90-93%`}),(0,l.jsxs)(g,{children:[(0,l.jsx)(_,{name:`Albuterol (neb)`,dose:(0,l.jsx)(h,{label:`${o(.15,5,`mg`).label} (min 2.5 mg)`}),route:`Nebulized`,notes:`q20min × 3 doses, then continuous if needed`}),(0,l.jsx)(_,{name:`Ipratropium`,dose:i<20?`250 mcg`:`500 mcg`,route:`Nebulized`,notes:`q20min × 3 doses with albuterol`}),(0,l.jsx)(_,{name:`Dexamethasone`,dose:(0,l.jsx)(h,{label:o(.6,16).label}),route:`PO/IV/IM`,notes:`Single dose`}),(0,l.jsx)(_,{name:`O₂ supplemental`,dose:`Target SpO₂ ≥94%`,route:`NC/mask`,notes:`Titrate to effect`})]})]}),p===`severe`&&a&&(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`p`,{className:`text-xs text-muted-foreground`,children:`Speaks in words only, significant accessory muscle use, SpO₂ <90%. 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If no response to magnesium → terbutaline infusion. If impending respiratory failure → intubation (ketamine preferred induction agent).`]})]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`NAEPP/GINA guidelines. 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Monitor closely.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`NOT recommended (AAP 2014/2023):`}),` Albuterol/salbutamol (no benefit), epinephrine (no evidence), systemic corticosteroids (no benefit), antibiotics (unless bacterial co-infection), chest physiotherapy.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`AAP Clinical Practice Guideline: Management of Bronchiolitis in Infants and Children (2014, reaffirmed 2023). 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Reservoir bag must stay inflated.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-amber-500 bg-amber-50 dark:bg-amber-950/30 p-3`,children:[(0,l.jsx)(`div`,{className:`font-semibold`,children:`4. High-flow nasal cannula (HFNC)`}),(0,l.jsxs)(`div`,{className:`text-xs text-muted-foreground`,children:[(0,l.jsx)(`strong`,{children:o?`1-2 L/kg/min = ${s}-${p} L/min`:`1-2 L/kg/min`}),` · heated + humidified · FiO₂ 30-100% titratable · generates ~2-5 cmH₂O PEEP. Reassess at 1-2 h.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-red-500 bg-red-50 dark:bg-red-950/30 p-3`,children:[(0,l.jsx)(`div`,{className:`font-semibold`,children:`5. Non-invasive (CPAP / BiPAP)`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground`,children:`CPAP 5-10 cmH₂O · BiPAP IPAP 10-14 / EPAP 5. 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See Airway tab for RSI drugs.`})]})]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-2`,children:`Bag-Valve-Mask (BVM)`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-xs space-y-1`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`When:`}),` apnea, bradycardia (HR <60 neonate; inadequate breathing at any age), during resuscitation.`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Rate:`}),` Newborn 40-60/min · Infant-child 20-30/min · Adolescent 10-12/min (1 breath q5-6 sec).`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Tidal volume:`}),` 6-8 mL/kg — gentle chest rise only. 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NOT first-line — adjunct only`],[``,`Ranitidine`,d.label,`IV over 5 min`,`H2 blocker. 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Refer to allergist.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`ASCIA Anaphylaxis Guidelines 2021 · WAO Anaphylaxis Guidance 2020 · AAP/ACAAI Practice Parameters.`})]})}function P(){let[e,t]=(0,c.useState)(``),[n,r]=(0,c.useState)(`general`),i=Number.parseFloat(e),a=Number.isFinite(i)&&i>0,o=(e,t,n=`mg`)=>a?s(i,e,t,n):null,u=[{id:`general`,label:`PALS General`},{id:`asystole`,label:`Asystole / PEA`},{id:`brady`,label:`Bradycardia`},{id:`svt`,label:`SVT`},{id:`vfib`,label:`VF / Pulseless VT`},{id:`vt`,label:`Stable VT`}];function d({name:e,dose:t,route:n,notes:r}){return(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:e}),(0,l.jsx)(`td`,{className:k,children:(0,l.jsx)(j,{label:t})}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:n}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:r})]})}function f({children:e}){return(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full text-sm`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsx)(`tbody`,{children:e})]})})}function p(){if(!a)return null;let e=o(.01,1,`mg`),t=o(.1,10,`mL`),n=o(.1,2.5,`mg`),r=o(5,300,`mg`),i=o(1,100,`mg`),s=o(.02,.5,`mg`),c=o(.1,6,`mg`),u=o(.2,12,`mg`),p=o(1,50,`mEq`),m=o(20,1e3,`mg`),h=o(.2,10,`mL`),g=o(60,3e3,`mg`),_=o(.6,30,`mL`),v=o(50,2e3,`mg`),y=o(2,null,`mL`);return(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{name:`Epinephrine 1:10,000`,dose:`${e.label} (${t.label})`,route:`IV / IO`,notes:`0.01 mg/kg = 0.1 mL/kg of 1:10,000. 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Sedate.`})]})]})}return(0,l.jsxs)(`section`,{className:T,"data-testid":`bedside-panel-cardiac`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Cardiac Arrest / PALS`}),(0,l.jsx)(A,{id:`cardiac-wt`,value:e,onChange:t,testid:`cardiac-weight`}),(0,l.jsx)(`div`,{className:`flex flex-wrap gap-2`,children:u.map(e=>(0,l.jsx)(`button`,{type:`button`,onClick:()=>r(e.id),className:`px-3 py-1.5 rounded-full text-xs font-medium border `+(n===e.id?`bg-primary text-primary-foreground border-primary`:`bg-muted hover:bg-muted/80 border-border`),"data-testid":`cardiac-view-`+e.id,children:e.label},e.id))}),a?(0,l.jsxs)(`div`,{className:`space-y-3`,children:[(0,l.jsxs)(`div`,{className:`rounded-md border-2 border-destructive bg-red-50 dark:bg-red-950/30 p-3 text-sm font-semibold text-destructive`,children:[u.find(e=>e.id===n)?.label,` — `,i,` kg`]}),n===`general`&&(0,l.jsx)(p,{}),n===`asystole`&&(0,l.jsx)(m,{}),n===`brady`&&(0,l.jsx)(h,{}),n===`svt`&&(0,l.jsx)(g,{}),n===`vfib`&&(0,l.jsx)(_,{}),n===`vt`&&(0,l.jsx)(v,{}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Concentrations:`}),` Epi 1:10,000 (0.1 mg/mL) for IV arrest. 1:1000 (1 mg/mL) for IM anaphylaxis. 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Do not pause between steps for benzo to take effect — act on the clock.`})]}),(0,l.jsxs)(`div`,{className:`space-y-0`,children:[(0,l.jsxs)(u,{time:`0 min`,color:`bg-blue-500 text-white`,title:`Stabilize`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`ABCs`}),` — position, 100% O₂ via NC / NRB, suction. `,(0,l.jsx)(`strong`,{children:`IV or IO`}),` × 2. Continuous SpO₂, ECG, BP.`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`POC glucose`}),` — if <60 mg/dL: `,(0,l.jsxs)(`strong`,{children:[`D10W `,a,`-`,o,` mL IV`]}),` (2-5 mL/kg).`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Labs`}),`: CBC, CMP, Mg, Ca, Phos, VBG, lactate, AED levels, toxicology if unclear etiology.`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Consider pyridoxine`}),` 100 mg IV in infants <18 mo or INH ingestion. Temperature: treat hyperthermia aggressively.`]})]}),(0,l.jsx)(u,{time:`5 min`,color:`bg-purple-500 text-white`,title:`1st benzodiazepine (give once, pick by access)`,children:(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsxs)(`tbody`,{children:[(0,l.jsx)(d,{name:`Lorazepam`,f:i(F.lorazepam.perKg,F.lorazepam.max),route:`IV / IO`,notes:`Slow push over 1-2 min.`,suffix:` (IV preferred)`}),(0,l.jsx)(d,{name:`Midazolam`,f:i(F.midazolam.perKg,F.midazolam.max),route:`IM / IN / buccal`,notes:`Use 5 mg/mL concentrate for IN; split between nares.`}),(0,l.jsx)(d,{name:`Diazepam`,f:i(F.diazepam.perKg,F.diazepam.max),route:`PR`,notes:`Only if no IV/IM/IN access.`})]})]})})}),(0,l.jsxs)(u,{time:`10 min`,color:`bg-violet-500 text-white`,title:`2nd benzodiazepine — if still seizing`,children:[`Repeat same agent + dose `,(0,l.jsx)(`strong`,{children:`once`}),`. Prepare 2nd-line now (don't wait to see if benzo works). If apnea/airway compromise: BVM, consider advanced airway.`]}),(0,l.jsx)(u,{time:`20 min`,color:`bg-amber-500 text-white`,title:`2nd-line anti-epileptic — pick one (ESETT: equivalent efficacy)`,children:(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsxs)(`tbody`,{children:[(0,l.jsx)(d,{name:`Levetiracetam`,f:i(F.levetiracetam.perKg,F.levetiracetam.max),route:`IV over 5-15 min`,notes:`Best tolerability. No ECG monitoring needed.`,suffix:` (preferred)`}),(0,l.jsx)(d,{name:`Fosphenytoin`,f:i(F.fosphenytoin.perKg,F.fosphenytoin.max,`mg PE`),route:`IV over 10 min`,notes:`Max rate 3 mg PE/kg/min. Monitor ECG, BP. Avoid if cardiac dysrhythmia.`}),(0,l.jsx)(d,{name:`Valproic acid`,f:i(F.valproate.perKg,F.valproate.max),route:`IV over 10 min`,notes:`Avoid <2 yr, hepatic / mitochondrial disease, pregnancy.`}),(0,l.jsx)(d,{name:`Phenobarbital`,f:i(F.phenobarb.perKg,F.phenobarb.max),route:`IV over 20 min`,notes:`Last-choice 2nd line. High risk of resp depression + hypotension.`})]})]})})}),(0,l.jsxs)(u,{time:`30 min`,color:`bg-red-500 text-white`,title:`Still seizing? Consider 2nd agent from 2nd-line OR proceed to refractory`,children:[`If the first 2nd-line drug failed, give a different 2nd-line agent `,(0,l.jsx)(`strong`,{children:`OR`}),` move directly to refractory therapy. Activate ICU, prepare for intubation. Confirm etiology not reversible (electrolytes, glucose, fever, toxin).`]}),(0,l.jsxs)(u,{time:`40 min`,color:`bg-destructive text-white`,title:`Refractory status — intubate + continuous infusion + continuous EEG`,last:!0,children:[(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsxs)(`tbody`,{children:[(0,l.jsxs)(`tr`,{children:[(0,l.jsxs)(`td`,{className:k+` font-semibold`,children:[`Midazolam `,(0,l.jsx)(`span`,{className:`text-xs text-green-700`,children:`(1st-line infusion)`})]}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.midazGttBolus.perKg,F.midazGttBolus.max).value,` mg → gtt `,i(F.midazGttLow.perKg,F.midazGttLow.max,`mg/hr`).value,`–`,i(F.midazGttHigh.perKg,F.midazGttHigh.max,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 0.2 mg/kg, gtt 0.05-0.5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Titrate to seizure control / burst suppression.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Pentobarbital`}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.pentobarbBolus.perKg,F.pentobarbBolus.max).value,` mg → gtt `,i(F.pentobarbGttLow.perKg,null,`mg/hr`).value,`–`,i(F.pentobarbGttHigh.perKg,null,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 5 mg/kg, gtt 1-5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Causes hypotension — often need pressors.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Propofol`}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.propofolBolus.perKg,F.propofolBolus.max).value,` mg → gtt `,i(F.propofolGttLow.perKg,null,`mg/hr`).value,`–`,i(F.propofolGttHigh.perKg,null,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 2 mg/kg, gtt 2-5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsxs)(`td`,{className:k+` text-xs text-muted-foreground`,children:[(0,l.jsx)(`strong`,{children:`PRIS risk in children`}),` — limit to <4 mg/kg/hr and duration <48 h.`]})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Ketamine`}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.ketamineBolus.perKg,F.ketamineBolus.max).value,` mg → gtt `,i(F.ketamineGttLow.perKg,null,`mg/hr`).value,`–`,i(F.ketamineGttHigh.perKg,null,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 2 mg/kg, gtt 1-5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`NMDA antagonist — rescue. Good BP profile; useful if refractory to GABAergics.`})]})]})]})}),(0,l.jsxs)(`div`,{className:`text-xs text-muted-foreground mt-2`,children:[(0,l.jsx)(`strong`,{children:`Continuous EEG within 1 h`}),` — target electrographic seizure suppression × 24-48 h, then wean. 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Pseudo-seizure? → continuous EEG if any doubt.`})]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`Based on AES Guidelines 2016 and ESETT (Kapur et al., NEJM 2019). 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IM option: 4 mg/kg.`],[`Vecuronium`,u(.1,10,`mg`).label,`IV`,`2-3 min onset; longer duration than roc`]]}),(0,l.jsx)(b,{title:`Maintenance sedation / analgesia`,rows:[[`Midazolam gtt`,`${u(.05,2,`mg`).label}–${u(.2,10,`mg`).label}/hr`,`IV infusion`,`0.05-0.2 mg/kg/hr`],[`Fentanyl gtt`,`${u(1,100,`mcg`).label}–${u(4,200,`mcg`).label}/hr`,`IV infusion`,`1-4 mcg/kg/hr`],[`Ketamine gtt`,`${u(.5,30,`mg`).label}–${u(2,100,`mg`).label}/hr`,`IV infusion`,`0.5-2 mg/kg/hr. Good for asthma`],[`Dexmedetomidine gtt`,`0.2-1.4 mcg/kg/hr`,`IV infusion`,`No resp depression; causes bradycardia + hypotension`],[`Rocuronium gtt`,`10-12 mcg/kg/min`,`IV infusion`,`If continued paralysis needed — only with adequate sedation`]]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Equipment sizing`}),(0,l.jsxs)(`div`,{className:`grid grid-cols-1 md:grid-cols-2 gap-3 text-xs`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-muted/40 p-3`,children:d?(0,l.jsxs)(l.Fragment,{children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`ETT (uncuffed):`}),` `,f,` mm`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`ETT (cuffed):`}),` `,p,` mm`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Depth at lip:`}),` ~`,m,` cm`]})]}):(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`div`,{children:(0,l.jsx)(`em`,{children:`Enter age for ETT / blade sizing.`})}),(0,l.jsx)(`div`,{children:`ETT (uncuffed) = (age/4) + 4`}),(0,l.jsx)(`div`,{children:`ETT (cuffed) = (age/4) + 3.5`}),(0,l.jsx)(`div`,{children:`Depth = ETT size × 3`})]})}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Laryngoscope blade:`}),` `,h]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`LMA size:`}),` `,g]}),(0,l.jsx)(`div`,{children:`OPA = corner mouth → angle mandible`}),(0,l.jsx)(`div`,{children:`NPA = tip nose → tragus`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 md:col-span-2`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Suction catheter (Fr):`}),` ETT size × 2`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`NG tube:`}),` ETT × 2`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Chest tube:`}),` 4 × ETT`]})]})]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Ventilator — starting settings`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-xs space-y-1`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Mode:`}),` Volume or pressure control`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Tidal volume:`}),` 6-8 mL/kg (= `,v.value,`-`,y.value,` mL). 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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.`}}},V={neonate:`Neonate (0-28 d)`,infant:`Infant (1-3 mo)`,child:`Child (>3 mo)`},H=[[`sepsis`,`Sepsis / bacteremia`],[`meningitis`,`Meningitis`],[`pna`,`Pneumonia`],[`uti`,`Urinary tract infection`],[`skin`,`Skin / soft tissue`],[`ent`,`Ear / throat (ENT)`],[`neutropenic`,`Febrile neutropenia`],[`ic`,`Intra-abdominal`],[`bone`,`Bone / joint`]];function U(){let[e,t]=(0,c.useState)(`child`),[n,r]=(0,c.useState)(`sepsis`),i=B[e][n];return(0,l.jsxs)(`section`,{className:T,"data-testid":`bedside-panel-antimicrobials`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Antimicrobials (empirical)`}),(0,l.jsxs)(`div`,{className:`grid grid-cols-1 sm:grid-cols-2 gap-3 max-w-xl`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`label`,{htmlFor:`abx-age`,className:D,children:`Age band`}),(0,l.jsx)(`select`,{id:`abx-age`,className:E,value:e,onChange:e=>t(e.target.value),"data-testid":`abx-age`,children:Object.entries(V).map(([e,t])=>(0,l.jsx)(`option`,{value:e,children:t},e))})]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`label`,{htmlFor:`abx-infection`,className:D,children:`Infection`}),(0,l.jsx)(`select`,{id:`abx-infection`,className:E,value:n,onChange:e=>r(e.target.value),"data-testid":`abx-infection`,children:H.map(([e,t])=>(0,l.jsx)(`option`,{value:e,children:t},e))})]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-2 border-blue-500 bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold text-blue-900 dark:text-blue-100`,children:[V[e],` — `,H.find(([e])=>e===n)?.[1]]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-green-50 dark:bg-green-950/30 p-3 text-sm`,children:[(0,l.jsx)(`strong`,{className:`text-green-800 dark:text-green-200`,children:`First-line:`}),` `,i.first]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-sm`,children:[(0,l.jsx)(`strong`,{children:`Alternative / add:`}),` `,i.alt]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-sm`,children:[(0,l.jsx)(`strong`,{children:`Duration:`}),` `,i.duration]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Notes:`}),` `,i.notes]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`AAP Red Book · IDSA guidelines · Harriet Lane. 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Intubate if GCS ≤8, inadequate airway, or impending compromise. Avoid succinylcholine if burn/crush/prolonged immobilization.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-amber-500 bg-amber-50 dark:bg-amber-950/30 p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold text-amber-800 dark:text-amber-200`,children:`B — Breathing`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground mt-1`,children:`SpO₂, bilateral breath sounds, chest wall integrity. Identify tension PTX (needle decompression), open PTX (3-sided dressing), flail chest, massive hemothorax.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-green-500 bg-green-50 dark:bg-green-950/30 p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold text-green-800 dark:text-green-200`,children:`C — Circulation`}),(0,l.jsxs)(`div`,{className:`text-xs text-muted-foreground mt-1`,children:[`Two large-bore IVs / IO. Control hemorrhage (direct pressure, tourniquet, pelvic binder).`,` `,r?(0,l.jsxs)(l.Fragment,{children:[`NS or LR 20 mL/kg = `,(0,l.jsxs)(`strong`,{children:[i,` mL`]}),` bolus.`]}):(0,l.jsx)(l.Fragment,{children:`NS/LR 20 mL/kg bolus.`}),` `,`Consider blood after 40-60 mL/kg crystalloid or in Class III shock.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-blue-500 bg-blue-50 dark:bg-blue-950/30 p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold text-blue-800 dark:text-blue-200`,children:`D — Disability`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground mt-1`,children:`GCS, pupils, glucose, gross motor. 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Avoid excessive crystalloid.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Tranexamic acid (TXA)`}),(0,l.jsx)(`td`,{className:k,children:`15 mg/kg IV (max 1 g) over 10 min → 2 mg/kg/hr × 8h`}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Within 3 hr of injury. CRASH-2 / MATIC.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Calcium`}),(0,l.jsx)(`td`,{className:k,children:`20 mg/kg CaCl or 60 mg/kg Ca-gluconate IV per unit citrated blood`}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Citrated blood chelates calcium.`})]})]})]})}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`C-spine clearance (NEXUS / CCR)`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-xs`,children:[`Pediatric c-spine decision tools are imperfect. `,(0,l.jsx)(`strong`,{children:`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.`]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Pediatric shock — signs`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-red-50 dark:bg-red-950/30 p-3 text-xs text-red-900 dark:text-red-200`,children:[`Children compensate well — `,(0,l.jsx)(`strong`,{children:`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.`]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Secondary survey — AMPLE + head-to-toe`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-xs`,children:[(0,l.jsx)(`strong`,{children:`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.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`ATLS 10th ed · PALS 2020 · PECARN c-spine rule · CRASH-2 trial (TXA).`})]})}var G=[{name:`Ketamine IV`,display:`Ketamine`,perKgLow:1.5,perKgHigh:2,maxLow:100,maxHigh:150,unit:`mg`,route:`IV`,onset:`1 min`,duration:`15-30 min`,notes:`Dissociative. Preserves airway reflexes.`},{name:`Ketamine IM`,display:null,perKgLow:4,perKgHigh:5,maxLow:300,maxHigh:400,unit:`mg`,route:`IM`,onset:`3-5 min`,duration:`30-60 min`,notes:`Give atropine 0.01 mg/kg to reduce secretions.`},{name:`Midazolam IV`,display:`Midazolam`,perKgLow:.05,perKgHigh:.1,maxLow:2,maxHigh:5,unit:`mg`,route:`IV`,onset:`2-3 min`,duration:`30-60 min`,notes:`Anxiolysis. Titrate q3-5 min.`},{name:`Midazolam IN/PO`,display:null,perKg:.5,max:20,unit:`mg`,route:`IN/PO`,onset:`10-15 min`,duration:`30-60 min`,notes:`IN (max 10 mg / naris) or PO (max 20 mg).`},{name:`Propofol`,display:`Propofol`,perKg:1,max:40,unit:`mg`,route:`IV`,onset:`30 sec`,duration:`5-10 min`,notes:`Short procedures. Causes apnea — manage airway.`},{name:`Fentanyl IV`,display:`Fentanyl`,perKg:1,max:100,unit:`mcg`,route:`IV`,onset:`2-3 min`,duration:`30-60 min`,notes:`Analgesic. Often combined with midazolam.`},{name:`Fentanyl IN`,display:null,perKg:2,max:100,unit:`mcg`,route:`IN`,onset:`5-10 min`,duration:`30-60 min`,notes:`Intranasal.`},{name:`Nitrous oxide`,display:`Nitrous oxide`,doseDisplay:`50:50 or 70:30 mix`,unit:`mix`,route:`Inhaled`,onset:`2-5 min`,duration:`5 min off`,notes:`Self-administered via demand valve. 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Provider capable of managing airway must be present.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`AAP Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation · ASA Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.`})]}):(0,l.jsx)(`p`,{className:`text-xs text-destructive`,children:`Enter weight (kg) to see doses.`})]})}var J=[[`approach`,`General approach (stabilize → toxidrome → decon → antidote)`],[`acetaminophen`,`Acetaminophen overdose`],[`opioids`,`Opioid overdose`],[`iron`,`Iron overdose`],[`tca`,`Tricyclic antidepressant (TCA) overdose`],[`bbccb`,`β-blocker / CCB overdose`],[`benzo`,`Benzodiazepine overdose`],[`organo`,`Organophosphate / carbamate poisoning`],[`salicylate`,`Salicylate overdose`],[`etoh`,`Toxic alcohols (methanol / ethylene glycol)`],[`dialyzable`,`Dialyzable drugs (ISTUMBLE)`]];function Y(){let[e,t]=(0,c.useState)(``),[n,r]=(0,c.useState)(`approach`),i=Number.parseFloat(e),a=Number.isFinite(i)&&i>0,o=(e,t,n=`mg`)=>a?s(i,e,t,n).value:null;function u({color:e,title:t,body:n}){return(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 ${e} p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold mb-1`,children:t}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground`,children:n})]})}function d({drug:e,dose:t,route:n,notes:r}){return(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:e}),(0,l.jsx)(`td`,{className:k,children:t}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:n}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,dangerouslySetInnerHTML:{__html:r}})]})}function f({children:e}){return(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full text-sm`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsx)(`tbody`,{children:e})]})})}return(0,l.jsxs)(`section`,{className:T,"data-testid":`bedside-panel-toxicology`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Toxicology`}),(0,l.jsxs)(`div`,{className:`grid grid-cols-1 sm:grid-cols-2 gap-3 max-w-xl`,children:[(0,l.jsx)(A,{id:`tox-wt`,value:e,onChange:t,testid:`tox-weight`}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`label`,{htmlFor:`tox-topic`,className:D,children:`Topic`}),(0,l.jsx)(`select`,{id:`tox-topic`,className:E,value:n,onChange:e=>r(e.target.value),"data-testid":`tox-topic`,children:J.map(([e,t])=>(0,l.jsx)(`option`,{value:e,children:t},e))})]})]}),n===`approach`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(u,{color:`border-blue-500 bg-blue-50 dark:bg-blue-950/30`,title:`1. Stabilize (ABCDE)`,body:(0,l.jsx)(l.Fragment,{children:`Airway, breathing, circulation, disability (glucose, pupils, GCS), exposure. Naloxone if depressed LOC + resp depression. Dextrose if hypoglycemic. Thiamine in select cases.`})}),(0,l.jsx)(u,{color:`border-purple-500 bg-purple-50 dark:bg-purple-950/30`,title:`2. Identify toxidrome`,body:(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`strong`,{children:`Sympathomimetic:`}),` HTN, tachy, mydriasis, diaphoresis (cocaine, meth). `,(0,l.jsx)(`strong`,{children:`Anticholinergic:`}),` hot/dry, mydriasis, tachy, delirium (antihistamines, TCAs). `,(0,l.jsx)(`strong`,{children:`Cholinergic:`}),` SLUDGE-M, miosis (organophosphates). `,(0,l.jsx)(`strong`,{children:`Opioid:`}),` miosis, resp depression, ↓LOC. `,(0,l.jsx)(`strong`,{children:`Sedative-hypnotic:`}),` ↓LOC, normal/low vitals.`]})}),(0,l.jsx)(u,{color:`border-amber-500 bg-amber-50 dark:bg-amber-950/30`,title:`3. Decontamination`,body:(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`strong`,{children:`Activated charcoal`}),` 1 g/kg PO (max 50 g): within 1h of ingestion, intact airway, ingestion adsorbed (not Li, metals, alcohols). Avoid caustics/hydrocarbons. `,(0,l.jsx)(`strong`,{children:`Whole bowel irrigation:`}),` PEG for metals/iron/lithium/sustained release. `,(0,l.jsx)(`strong`,{children:`Gastric lavage:`}),` rarely indicated. `,(0,l.jsx)(`strong`,{children:`Ipecac:`}),` no longer recommended.`]})}),(0,l.jsx)(u,{color:`border-green-500 bg-green-50 dark:bg-green-950/30`,title:`4. Enhance elimination`,body:(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`strong`,{children:`Urinary alkalinization`}),` (salicylates, phenobarbital). `,(0,l.jsx)(`strong`,{children:`Hemodialysis`}),` (see ISTUMBLE). `,(0,l.jsx)(`strong`,{children:`Lipid emulsion`}),` for lipid-soluble drug toxicity (LA, CCB, TCA).`]})}),(0,l.jsx)(u,{color:`border-destructive bg-red-50 dark:bg-red-950/30`,title:`5. Antidotes`,body:(0,l.jsxs)(l.Fragment,{children:[`See topic list. `,(0,l.jsx)(`strong`,{children:`Contact Poison Center`}),` (US: 1-800-222-1222) early for any significant exposure.`]})})]}),n===`acetaminophen`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Acetaminophen overdose`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Acute toxic dose: >150 mg/kg (or 7.5 g total) single ingestion. Hepatotoxic after 24h; AST/ALT peak day 3-4.`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[(0,l.jsx)(`strong`,{children:`Diagnosis:`}),` Draw level at 4h post-ingestion (or on arrival if >4h). Plot on `,(0,l.jsx)(`strong`,{children:`Rumack-Matthew nomogram`}),` (treatment line at 150 mcg/mL at 4h).`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`N-acetylcysteine (NAC) — IV`,dose:`150 mg/kg over 1h → 50 mg/kg over 4h → 100 mg/kg over 16h (21h total)`,route:`IV`,notes:`Total 300 mg/kg. Most effective if started <8h post-ingestion.`}),(0,l.jsx)(d,{drug:`N-acetylcysteine — PO`,dose:`140 mg/kg load, then 70 mg/kg q4h × 17 doses`,route:`PO`,notes:`Alternative to IV. Unpleasant taste — often with juice.`}),(0,l.jsx)(d,{drug:`Activated charcoal`,dose:`1 g/kg (max 50 g)`,route:`PO`,notes:`If within 1-2h of ingestion and airway protected.`})]}),a&&(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-xs`,children:[(0,l.jsxs)(`strong`,{children:[`For `,i,` kg:`]}),` IV loading = `,o(150,null),` mg over 1h `,(0,l.jsx)(`span`,{className:`text-muted-foreground`,children:`(150 mg/kg)`}),`; 2nd bag = `,o(50,null),` mg over 4h `,(0,l.jsx)(`span`,{className:`text-muted-foreground`,children:`(50 mg/kg)`}),`; 3rd bag = `,o(100,null),` mg over 16h `,(0,l.jsx)(`span`,{className:`text-muted-foreground`,children:`(100 mg/kg)`}),`. `,(0,l.jsx)(`em`,{children:`Total 300 mg/kg.`})]})]}),n===`opioids`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Opioid overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Triad: `,(0,l.jsx)(`strong`,{children:`miosis + respiratory depression + ↓ LOC`}),`. Fentanyl / synthetics may require repeated/higher doses.`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Naloxone (initial)`,dose:a?`0.01-0.1 mg/kg = ${o(.01,null)}-${o(.1,null)} mg`:`0.01-0.1 mg/kg`,route:`IV / IM / IN / IO`,notes:`Start low if chronic opioid use (avoid withdrawal). Titrate to respiratory effort, not consciousness.`}),(0,l.jsx)(d,{drug:`Naloxone (full reversal)`,dose:`2 mg IV/IM/IN`,route:`IV / IM / IN`,notes:`If no chronic use and severe resp depression. Repeat q2-3 min.`}),(0,l.jsx)(d,{drug:`Naloxone infusion`,dose:`2/3 of effective bolus per hour`,route:`IV`,notes:`For long-acting opioids (methadone, fentanyl patch, sustained release)`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[`Observe ≥4h after last dose; longer for long-acting agents. Duration of naloxone (30-90 min) is shorter than most opioids — `,(0,l.jsx)(`strong`,{children:`re-sedation is common`}),`.`]})]}),n===`iron`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Iron overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Toxic dose: elemental Fe ≥20 mg/kg. Severe ≥60 mg/kg. `,(0,l.jsx)(`strong`,{children:`Charcoal does NOT bind iron.`})]}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[(0,l.jsx)(`strong`,{children:`Stages:`}),` 1) GI (0-6h: vomiting, bloody diarrhea); 2) Latent (6-24h); 3) Shock/metabolic acidosis (12-24h); 4) Hepatotoxicity (2-5d); 5) Gastric scarring (2-8 wk).`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Whole bowel irrigation`,dose:`PEG-ES 25-40 mL/kg/hr`,route:`NG`,notes:`For radiopaque pills on KUB or ingested sustained-release iron.`}),(0,l.jsx)(d,{drug:`Deferoxamine`,dose:`15 mg/kg/hr IV infusion`,route:`IV`,notes:`Max 6-8 g/day. Indications: shock, metabolic acidosis, Fe >500 mcg/dL, or severe symptoms. Urine turns 'vin rosé' color.`})]}),(0,l.jsx)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:`Iron level at 4-6h. <350 usually asymptomatic; 350-500 mild; >500 severe. Consider KUB for radiopaque pills.`})]}),n===`tca`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`TCA overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Anticholinergic + Na-channel blockade. `,(0,l.jsx)(`strong`,{children:`Risks:`}),` seizure, VT/VF, hypotension, coma. ECG: QRS >100 ms or R in aVR >3 mm predicts toxicity.`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Sodium bicarbonate 8.4%`,dose:`1-2 mEq/kg IV bolus → infusion`,route:`IV`,notes:`Goal pH 7.45-7.55 and narrowing QRS. Repeat bolus for QRS widening, hypotension, or arrhythmia.`}),(0,l.jsx)(d,{drug:`Mg sulfate`,dose:a?`${o(50,2e3)} mg`:`25-50 mg/kg (max 2 g)`,route:`IV over 10 min`,notes:`For torsades.`}),(0,l.jsx)(d,{drug:`IV lipid emulsion 20%`,dose:`1.5 mL/kg bolus → 0.25 mL/kg/min × 30-60 min`,route:`IV`,notes:`If refractory shock/arrest. Consult toxicology.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Avoid`}),` Class IA/IC antiarrhythmics, beta-blockers, physostigmine (risk of asystole with TCAs).`]})]}),n===`bbccb`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`β-blocker / Calcium-channel blocker overdose`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Bradycardia + hypotension. CCBs (esp. verapamil, diltiazem, amlodipine) can be lethal in small pediatric doses.`}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`IV fluids`,dose:`20 mL/kg NS bolus`,route:`IV`,notes:`Cautious — avoid volume overload`}),(0,l.jsx)(d,{drug:`Calcium chloride 10% or gluconate`,dose:`CaCl 20 mg/kg / Ca-glu 60 mg/kg`,route:`IV`,notes:`First-line for CCB. Repeat q15-20 min.`}),(0,l.jsx)(d,{drug:`Glucagon`,dose:`50 mcg/kg IV bolus → 50-150 mcg/kg/hr`,route:`IV`,notes:`β-blocker antidote. GI side effects common.`}),(0,l.jsx)(d,{drug:`High-dose insulin (HIE)`,dose:`Regular insulin 1 U/kg bolus → 0.5-2 U/kg/hr + D25% infusion`,route:`IV`,notes:`Hyperinsulinemic euglycemia therapy. Monitor K+ and glucose closely.`}),(0,l.jsx)(d,{drug:`Vasopressors`,dose:`Epi / norepi infusion`,route:`IV`,notes:`Titrate to MAP.`}),(0,l.jsx)(d,{drug:`Lipid emulsion 20%`,dose:`1.5 mL/kg → 0.25 mL/kg/min`,route:`IV`,notes:`For lipid-soluble CCBs (verapamil) if refractory.`}),(0,l.jsx)(d,{drug:`Methylene blue / ECMO`,dose:`—`,route:`—`,notes:`Rescue therapy — toxicology/ICU consult.`})]})]}),n===`benzo`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Benzodiazepine overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Sedation + resp depression. Usually supportive — intubation rarely needed alone. `,(0,l.jsx)(`strong`,{children:`Flumazenil caution.`})]}),(0,l.jsx)(f,{children:(0,l.jsx)(d,{drug:`Flumazenil`,dose:`0.01 mg/kg (max 0.2 mg) IV, may repeat q1 min to max 1 mg`,route:`IV`,notes:`Only for iatrogenic reversal in a benzo-naive patient with no TCAs, seizure disorder, or chronic benzo use. Can precipitate seizures.`})}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[`In real-world ingestion, `,(0,l.jsx)(`strong`,{children:`supportive care (airway, monitoring)`}),` is usually safer than flumazenil.`]})]}),n===`organo`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Organophosphate / carbamate poisoning`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Cholinergic toxidrome: `,(0,l.jsx)(`strong`,{children:`SLUDGE-M`}),` (salivation, lacrimation, urination, defecation, GI distress, emesis, miosis) + muscle fasciculation, bradycardia, bronchorrhea. Decontamination critical (PPE for providers).`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Atropine`,dose:`0.05 mg/kg IV, double q3-5 min until bronchial secretions dry`,route:`IV`,notes:`Endpoint = dry lungs, not dry mouth or heart rate. Can require huge doses.`}),(0,l.jsx)(d,{drug:`Pralidoxime (2-PAM)`,dose:`25-50 mg/kg IV over 30 min (max 2 g) → 10-20 mg/kg/hr`,route:`IV`,notes:`Only for organophosphates (not carbamates). Regenerates acetylcholinesterase.`}),(0,l.jsx)(d,{drug:`Diazepam / midazolam`,dose:`Standard seizure doses`,route:`IV`,notes:`For seizures or severe fasciculations.`})]})]}),n===`salicylate`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Salicylate overdose`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Mixed respiratory alkalosis + anion gap metabolic acidosis. Tinnitus, tachypnea, diaphoresis, hyperthermia. Severe: CNS depression, seizures, pulmonary edema, cerebral edema.`}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Fluids`,dose:`Aggressive resuscitation`,route:`IV`,notes:`Dehydration common. Avoid fluid overload (risk of pulmonary edema).`}),(0,l.jsx)(d,{drug:`Sodium bicarb`,dose:`1-2 mEq/kg IV bolus → drip`,route:`IV`,notes:`Urinary alkalinization (goal urine pH >7.5). Prevents CNS entry.`}),(0,l.jsx)(d,{drug:`Glucose`,dose:`Maintain euglycemia even if BG normal`,route:`IV`,notes:`CNS hypoglycemia despite normal serum glucose.`}),(0,l.jsx)(d,{drug:`Hemodialysis`,dose:`—`,route:`—`,notes:`For severe: altered MS, pulmonary edema, renal failure, refractory acidosis, or level >100 mg/dL acute / >60 chronic.`})]})]}),n===`etoh`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Toxic alcohols (methanol / ethylene glycol)`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Anion gap metabolic acidosis + osmolar gap. Methanol → visual changes, blindness. Ethylene glycol → calcium oxalate crystals in urine, renal failure.`}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Fomepizole`,dose:`15 mg/kg IV load → 10 mg/kg q12h × 4 → 15 mg/kg q12h`,route:`IV`,notes:`First-line. 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EG: thiamine + pyridoxine (divert to non-toxic metabolites).`})]})]}),n===`dialyzable`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Dialyzable drugs (ISTUMBLE)`}),(0,l.jsx)(`div`,{className:`grid grid-cols-1 sm:grid-cols-2 gap-2 text-sm`,children:[[`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`]].map(([e,t])=>(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-2`,children:[(0,l.jsxs)(`strong`,{children:[e,`:`]}),` `,t]},e))}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Poor candidates for HD:`}),` Large Vd (TCAs, digoxin, BBs), highly protein-bound (benzos, CCBs), lipid-soluble (opioids, phenothiazines). 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Uses the same APLS and Best Guess formulas as the legacy app.`})]}),(0,l.jsxs)(`div`,{className:`grid gap-3 md:grid-cols-[1.2fr_1fr_1fr_auto] md:items-end`,children:[(0,l.jsxs)(`div`,{className:`space-y-1`,children:[(0,l.jsx)(`label`,{htmlFor:`bedside-react-age`,className:Z,children:`Age`}),(0,l.jsx)(`input`,{id:`bedside-react-age`,value:e,onChange:e=>t(e.target.value),placeholder:`e.g. "18m", "3y", "2y5m"`,className:Q,"data-testid":`bedside-age-input`})]}),(0,l.jsxs)(`div`,{className:`space-y-1`,children:[(0,l.jsx)(`label`,{htmlFor:`bedside-react-formula`,className:Z,children:`Formula`}),(0,l.jsxs)(`select`,{id:`bedside-react-formula`,value:n,onChange:e=>{a(e.target.value),u(``)},className:Q,"data-testid":`bedside-formula-select`,children:[(0,l.jsx)(`option`,{value:`apls`,children:`APLS`}),(0,l.jsx)(`option`,{value:`bestguess`,children:`Best Guess`})]})]}),(0,l.jsxs)(`div`,{className:`space-y-1`,children:[(0,l.jsx)(`label`,{htmlFor:`bedside-react-weight`,className:Z,children:`Weight (kg)`}),(0,l.jsx)(`input`,{id:`bedside-react-weight`,type:`number`,min:`0.3`,step:`0.1`,value:m,onChange:e=>u(e.target.value),className:Q,"data-testid":`bedside-weight-input`})]}),(0,l.jsx)(`button`,{type:`button`,onClick:h,className:re,children:`Clear`})]}),e.trim()&&d==null?(0,l.jsx)(`div`,{className:`rounded-md border border-red-200 bg-red-50 p-3 text-sm text-red-700 dark:bg-red-950/30 dark:text-red-200`,children:`Could not parse age. Try "3y", "18 months", or "15 days".`}):null,f&&p!=null?(0,l.jsxs)(`div`,{className:`rounded-lg border border-border bg-muted/40 p-4 text-sm`,"data-testid":`bedside-estimate-result`,children:[(0,l.jsxs)(`div`,{className:`font-semibold`,children:[p,` kg estimated from `,o(d??0)]}),(0,l.jsxs)(`div`,{className:`text-muted-foreground`,children:[`APLS: `,f.all.apls,` kg · Best Guess: `,f.all.bestGuess,` kg. 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If no response to magnesium → terbutaline infusion. If impending respiratory failure → intubation (ketamine preferred induction agent).`]})]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`NAEPP/GINA guidelines. 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Moderate (4-7): consider oral steroids + frequent bronchodilators. 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Monitor closely.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`NOT recommended (AAP 2014/2023):`}),` Albuterol/salbutamol (no benefit), epinephrine (no evidence), systemic corticosteroids (no benefit), antibiotics (unless bacterial co-infection), chest physiotherapy.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`AAP Clinical Practice Guideline: Management of Bronchiolitis in Infants and Children (2014, reaffirmed 2023). 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Reservoir bag must stay inflated.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-amber-500 bg-amber-50 dark:bg-amber-950/30 p-3`,children:[(0,l.jsx)(`div`,{className:`font-semibold`,children:`4. High-flow nasal cannula (HFNC)`}),(0,l.jsxs)(`div`,{className:`text-xs text-muted-foreground`,children:[(0,l.jsx)(`strong`,{children:o?`1-2 L/kg/min = ${s}-${p} L/min`:`1-2 L/kg/min`}),` · heated + humidified · FiO₂ 30-100% titratable · generates ~2-5 cmH₂O PEEP. Reassess at 1-2 h.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-red-500 bg-red-50 dark:bg-red-950/30 p-3`,children:[(0,l.jsx)(`div`,{className:`font-semibold`,children:`5. Non-invasive (CPAP / BiPAP)`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground`,children:`CPAP 5-10 cmH₂O · BiPAP IPAP 10-14 / EPAP 5. Needs cooperative patient, intact airway reflexes, no copious secretions.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-destructive bg-red-100 dark:bg-red-950/40 p-3`,children:[(0,l.jsx)(`div`,{className:`font-semibold`,children:`6. Intubate + mechanical ventilation`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground`,children:`When NIV fails, airway compromised, apnea, or GCS ≤8. See Airway tab for RSI drugs.`})]})]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-2`,children:`Bag-Valve-Mask (BVM)`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-xs space-y-1`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`When:`}),` apnea, bradycardia (HR <60 neonate; inadequate breathing at any age), during resuscitation.`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Rate:`}),` Newborn 40-60/min · Infant-child 20-30/min · Adolescent 10-12/min (1 breath q5-6 sec).`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Tidal volume:`}),` 6-8 mL/kg — gentle chest rise only. 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NOT first-line — adjunct only`],[``,`Ranitidine`,d.label,`IV over 5 min`,`H2 blocker. 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Refer to allergist.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`ASCIA Anaphylaxis Guidelines 2021 · WAO Anaphylaxis Guidance 2020 · AAP/ACAAI Practice Parameters.`})]})}function P(){let[e,t]=(0,c.useState)(``),[n,r]=(0,c.useState)(`general`),i=Number.parseFloat(e),a=Number.isFinite(i)&&i>0,o=(e,t,n=`mg`)=>a?s(i,e,t,n):null,u=[{id:`general`,label:`PALS General`},{id:`asystole`,label:`Asystole / PEA`},{id:`brady`,label:`Bradycardia`},{id:`svt`,label:`SVT`},{id:`vfib`,label:`VF / Pulseless VT`},{id:`vt`,label:`Stable VT`}];function d({name:e,dose:t,route:n,notes:r}){return(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:e}),(0,l.jsx)(`td`,{className:k,children:(0,l.jsx)(j,{label:t})}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:n}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:r})]})}function f({children:e}){return(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full text-sm`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsx)(`tbody`,{children:e})]})})}function p(){if(!a)return null;let e=o(.01,1,`mg`),t=o(.1,10,`mL`),n=o(.1,2.5,`mg`),r=o(5,300,`mg`),i=o(1,100,`mg`),s=o(.02,.5,`mg`),c=o(.1,6,`mg`),u=o(.2,12,`mg`),p=o(1,50,`mEq`),m=o(20,1e3,`mg`),h=o(.2,10,`mL`),g=o(60,3e3,`mg`),_=o(.6,30,`mL`),v=o(50,2e3,`mg`),y=o(2,null,`mL`);return(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{name:`Epinephrine 1:10,000`,dose:`${e.label} (${t.label})`,route:`IV / IO`,notes:`0.01 mg/kg = 0.1 mL/kg of 1:10,000. 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Sedate.`})]})]})}return(0,l.jsxs)(`section`,{className:T,"data-testid":`bedside-panel-cardiac`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Cardiac Arrest / PALS`}),(0,l.jsx)(A,{id:`cardiac-wt`,value:e,onChange:t,testid:`cardiac-weight`}),(0,l.jsx)(`div`,{className:`flex flex-wrap gap-2`,children:u.map(e=>(0,l.jsx)(`button`,{type:`button`,onClick:()=>r(e.id),className:`px-3 py-1.5 rounded-full text-xs font-medium border `+(n===e.id?`bg-primary text-primary-foreground border-primary`:`bg-muted hover:bg-muted/80 border-border`),"data-testid":`cardiac-view-`+e.id,children:e.label},e.id))}),a?(0,l.jsxs)(`div`,{className:`space-y-3`,children:[(0,l.jsxs)(`div`,{className:`rounded-md border-2 border-destructive bg-red-50 dark:bg-red-950/30 p-3 text-sm font-semibold text-destructive`,children:[u.find(e=>e.id===n)?.label,` — `,i,` kg`]}),n===`general`&&(0,l.jsx)(p,{}),n===`asystole`&&(0,l.jsx)(m,{}),n===`brady`&&(0,l.jsx)(h,{}),n===`svt`&&(0,l.jsx)(g,{}),n===`vfib`&&(0,l.jsx)(_,{}),n===`vt`&&(0,l.jsx)(v,{}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Concentrations:`}),` Epi 1:10,000 (0.1 mg/mL) for IV arrest. 1:1000 (1 mg/mL) for IM anaphylaxis. 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Do not pause between steps for benzo to take effect — act on the clock.`})]}),(0,l.jsxs)(`div`,{className:`space-y-0`,children:[(0,l.jsxs)(u,{time:`0 min`,color:`bg-blue-500 text-white`,title:`Stabilize`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`ABCs`}),` — position, 100% O₂ via NC / NRB, suction. `,(0,l.jsx)(`strong`,{children:`IV or IO`}),` × 2. Continuous SpO₂, ECG, BP.`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`POC glucose`}),` — if <60 mg/dL: `,(0,l.jsxs)(`strong`,{children:[`D10W `,a,`-`,o,` mL IV`]}),` (2-5 mL/kg).`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Labs`}),`: CBC, CMP, Mg, Ca, Phos, VBG, lactate, AED levels, toxicology if unclear etiology.`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Consider pyridoxine`}),` 100 mg IV in infants <18 mo or INH ingestion. Temperature: treat hyperthermia aggressively.`]})]}),(0,l.jsx)(u,{time:`5 min`,color:`bg-purple-500 text-white`,title:`1st benzodiazepine (give once, pick by access)`,children:(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsxs)(`tbody`,{children:[(0,l.jsx)(d,{name:`Lorazepam`,f:i(F.lorazepam.perKg,F.lorazepam.max),route:`IV / IO`,notes:`Slow push over 1-2 min.`,suffix:` (IV preferred)`}),(0,l.jsx)(d,{name:`Midazolam`,f:i(F.midazolam.perKg,F.midazolam.max),route:`IM / IN / buccal`,notes:`Use 5 mg/mL concentrate for IN; split between nares.`}),(0,l.jsx)(d,{name:`Diazepam`,f:i(F.diazepam.perKg,F.diazepam.max),route:`PR`,notes:`Only if no IV/IM/IN access.`})]})]})})}),(0,l.jsxs)(u,{time:`10 min`,color:`bg-violet-500 text-white`,title:`2nd benzodiazepine — if still seizing`,children:[`Repeat same agent + dose `,(0,l.jsx)(`strong`,{children:`once`}),`. Prepare 2nd-line now (don't wait to see if benzo works). If apnea/airway compromise: BVM, consider advanced airway.`]}),(0,l.jsx)(u,{time:`20 min`,color:`bg-amber-500 text-white`,title:`2nd-line anti-epileptic — pick one (ESETT: equivalent efficacy)`,children:(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsxs)(`tbody`,{children:[(0,l.jsx)(d,{name:`Levetiracetam`,f:i(F.levetiracetam.perKg,F.levetiracetam.max),route:`IV over 5-15 min`,notes:`Best tolerability. No ECG monitoring needed.`,suffix:` (preferred)`}),(0,l.jsx)(d,{name:`Fosphenytoin`,f:i(F.fosphenytoin.perKg,F.fosphenytoin.max,`mg PE`),route:`IV over 10 min`,notes:`Max rate 3 mg PE/kg/min. Monitor ECG, BP. Avoid if cardiac dysrhythmia.`}),(0,l.jsx)(d,{name:`Valproic acid`,f:i(F.valproate.perKg,F.valproate.max),route:`IV over 10 min`,notes:`Avoid <2 yr, hepatic / mitochondrial disease, pregnancy.`}),(0,l.jsx)(d,{name:`Phenobarbital`,f:i(F.phenobarb.perKg,F.phenobarb.max),route:`IV over 20 min`,notes:`Last-choice 2nd line. High risk of resp depression + hypotension.`})]})]})})}),(0,l.jsxs)(u,{time:`30 min`,color:`bg-red-500 text-white`,title:`Still seizing? Consider 2nd agent from 2nd-line OR proceed to refractory`,children:[`If the first 2nd-line drug failed, give a different 2nd-line agent `,(0,l.jsx)(`strong`,{children:`OR`}),` move directly to refractory therapy. Activate ICU, prepare for intubation. Confirm etiology not reversible (electrolytes, glucose, fever, toxin).`]}),(0,l.jsxs)(u,{time:`40 min`,color:`bg-destructive text-white`,title:`Refractory status — intubate + continuous infusion + continuous EEG`,last:!0,children:[(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsxs)(`tbody`,{children:[(0,l.jsxs)(`tr`,{children:[(0,l.jsxs)(`td`,{className:k+` font-semibold`,children:[`Midazolam `,(0,l.jsx)(`span`,{className:`text-xs text-green-700`,children:`(1st-line infusion)`})]}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.midazGttBolus.perKg,F.midazGttBolus.max).value,` mg → gtt `,i(F.midazGttLow.perKg,F.midazGttLow.max,`mg/hr`).value,`–`,i(F.midazGttHigh.perKg,F.midazGttHigh.max,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 0.2 mg/kg, gtt 0.05-0.5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Titrate to seizure control / burst suppression.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Pentobarbital`}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.pentobarbBolus.perKg,F.pentobarbBolus.max).value,` mg → gtt `,i(F.pentobarbGttLow.perKg,null,`mg/hr`).value,`–`,i(F.pentobarbGttHigh.perKg,null,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 5 mg/kg, gtt 1-5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Causes hypotension — often need pressors.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Propofol`}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.propofolBolus.perKg,F.propofolBolus.max).value,` mg → gtt `,i(F.propofolGttLow.perKg,null,`mg/hr`).value,`–`,i(F.propofolGttHigh.perKg,null,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 2 mg/kg, gtt 2-5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsxs)(`td`,{className:k+` text-xs text-muted-foreground`,children:[(0,l.jsx)(`strong`,{children:`PRIS risk in children`}),` — limit to <4 mg/kg/hr and duration <48 h.`]})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Ketamine`}),(0,l.jsxs)(`td`,{className:k+` text-sm`,children:[`Bolus `,i(F.ketamineBolus.perKg,F.ketamineBolus.max).value,` mg → gtt `,i(F.ketamineGttLow.perKg,null,`mg/hr`).value,`–`,i(F.ketamineGttHigh.perKg,null,`mg/hr`).value,` mg/hr `,(0,l.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`(bolus 2 mg/kg, gtt 1-5 mg/kg/hr)`})]}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`NMDA antagonist — rescue. Good BP profile; useful if refractory to GABAergics.`})]})]})]})}),(0,l.jsxs)(`div`,{className:`text-xs text-muted-foreground mt-2`,children:[(0,l.jsx)(`strong`,{children:`Continuous EEG within 1 h`}),` — target electrographic seizure suppression × 24-48 h, then wean. 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Pseudo-seizure? → continuous EEG if any doubt.`})]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`Based on AES Guidelines 2016 and ESETT (Kapur et al., NEJM 2019). 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IM option: 4 mg/kg.`],[`Vecuronium`,u(.1,10,`mg`).label,`IV`,`2-3 min onset; longer duration than roc`]]}),(0,l.jsx)(b,{title:`Maintenance sedation / analgesia`,rows:[[`Midazolam gtt`,`${u(.05,2,`mg`).label}–${u(.2,10,`mg`).label}/hr`,`IV infusion`,`0.05-0.2 mg/kg/hr`],[`Fentanyl gtt`,`${u(1,100,`mcg`).label}–${u(4,200,`mcg`).label}/hr`,`IV infusion`,`1-4 mcg/kg/hr`],[`Ketamine gtt`,`${u(.5,30,`mg`).label}–${u(2,100,`mg`).label}/hr`,`IV infusion`,`0.5-2 mg/kg/hr. Good for asthma`],[`Dexmedetomidine gtt`,`0.2-1.4 mcg/kg/hr`,`IV infusion`,`No resp depression; causes bradycardia + hypotension`],[`Rocuronium gtt`,`10-12 mcg/kg/min`,`IV infusion`,`If continued paralysis needed — only with adequate sedation`]]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Equipment sizing`}),(0,l.jsxs)(`div`,{className:`grid grid-cols-1 md:grid-cols-2 gap-3 text-xs`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-muted/40 p-3`,children:d?(0,l.jsxs)(l.Fragment,{children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`ETT (uncuffed):`}),` `,f,` mm`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`ETT (cuffed):`}),` `,p,` mm`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Depth at lip:`}),` ~`,m,` cm`]})]}):(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`div`,{children:(0,l.jsx)(`em`,{children:`Enter age for ETT / blade sizing.`})}),(0,l.jsx)(`div`,{children:`ETT (uncuffed) = (age/4) + 4`}),(0,l.jsx)(`div`,{children:`ETT (cuffed) = (age/4) + 3.5`}),(0,l.jsx)(`div`,{children:`Depth = ETT size × 3`})]})}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Laryngoscope blade:`}),` `,h]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`LMA size:`}),` `,g]}),(0,l.jsx)(`div`,{children:`OPA = corner mouth → angle mandible`}),(0,l.jsx)(`div`,{children:`NPA = tip nose → tragus`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 md:col-span-2`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Suction catheter (Fr):`}),` ETT size × 2`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`NG tube:`}),` ETT × 2`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Chest tube:`}),` 4 × ETT`]})]})]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Ventilator — starting settings`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-xs space-y-1`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Mode:`}),` Volume or pressure control`]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`strong`,{children:`Tidal volume:`}),` 6-8 mL/kg (= `,v.value,`-`,y.value,` mL). 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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.`}}},V={neonate:`Neonate (0-28 d)`,infant:`Infant (1-3 mo)`,child:`Child (>3 mo)`},H=[[`sepsis`,`Sepsis / bacteremia`],[`meningitis`,`Meningitis`],[`pna`,`Pneumonia`],[`uti`,`Urinary tract infection`],[`skin`,`Skin / soft tissue`],[`ent`,`Ear / throat (ENT)`],[`neutropenic`,`Febrile neutropenia`],[`ic`,`Intra-abdominal`],[`bone`,`Bone / joint`]];function U(){let[e,t]=(0,c.useState)(`child`),[n,r]=(0,c.useState)(`sepsis`),i=B[e][n];return(0,l.jsxs)(`section`,{className:T,"data-testid":`bedside-panel-antimicrobials`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Antimicrobials (empirical)`}),(0,l.jsxs)(`div`,{className:`grid grid-cols-1 sm:grid-cols-2 gap-3 max-w-xl`,children:[(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`label`,{htmlFor:`abx-age`,className:D,children:`Age band`}),(0,l.jsx)(`select`,{id:`abx-age`,className:E,value:e,onChange:e=>t(e.target.value),"data-testid":`abx-age`,children:Object.entries(V).map(([e,t])=>(0,l.jsx)(`option`,{value:e,children:t},e))})]}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`label`,{htmlFor:`abx-infection`,className:D,children:`Infection`}),(0,l.jsx)(`select`,{id:`abx-infection`,className:E,value:n,onChange:e=>r(e.target.value),"data-testid":`abx-infection`,children:H.map(([e,t])=>(0,l.jsx)(`option`,{value:e,children:t},e))})]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-2 border-blue-500 bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold text-blue-900 dark:text-blue-100`,children:[V[e],` — `,H.find(([e])=>e===n)?.[1]]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-green-50 dark:bg-green-950/30 p-3 text-sm`,children:[(0,l.jsx)(`strong`,{className:`text-green-800 dark:text-green-200`,children:`First-line:`}),` `,i.first]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-sm`,children:[(0,l.jsx)(`strong`,{children:`Alternative / add:`}),` `,i.alt]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-sm`,children:[(0,l.jsx)(`strong`,{children:`Duration:`}),` `,i.duration]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Notes:`}),` `,i.notes]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`AAP Red Book · IDSA guidelines · Harriet Lane. 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Intubate if GCS ≤8, inadequate airway, or impending compromise. Avoid succinylcholine if burn/crush/prolonged immobilization.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-amber-500 bg-amber-50 dark:bg-amber-950/30 p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold text-amber-800 dark:text-amber-200`,children:`B — Breathing`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground mt-1`,children:`SpO₂, bilateral breath sounds, chest wall integrity. Identify tension PTX (needle decompression), open PTX (3-sided dressing), flail chest, massive hemothorax.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-green-500 bg-green-50 dark:bg-green-950/30 p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold text-green-800 dark:text-green-200`,children:`C — Circulation`}),(0,l.jsxs)(`div`,{className:`text-xs text-muted-foreground mt-1`,children:[`Two large-bore IVs / IO. Control hemorrhage (direct pressure, tourniquet, pelvic binder).`,` `,r?(0,l.jsxs)(l.Fragment,{children:[`NS or LR 20 mL/kg = `,(0,l.jsxs)(`strong`,{children:[i,` mL`]}),` bolus.`]}):(0,l.jsx)(l.Fragment,{children:`NS/LR 20 mL/kg bolus.`}),` `,`Consider blood after 40-60 mL/kg crystalloid or in Class III shock.`]})]}),(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 border-blue-500 bg-blue-50 dark:bg-blue-950/30 p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold text-blue-800 dark:text-blue-200`,children:`D — Disability`}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground mt-1`,children:`GCS, pupils, glucose, gross motor. 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Avoid excessive crystalloid.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Tranexamic acid (TXA)`}),(0,l.jsx)(`td`,{className:k,children:`15 mg/kg IV (max 1 g) over 10 min → 2 mg/kg/hr × 8h`}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Within 3 hr of injury. CRASH-2 / MATIC.`})]}),(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:`Calcium`}),(0,l.jsx)(`td`,{className:k,children:`20 mg/kg CaCl or 60 mg/kg Ca-gluconate IV per unit citrated blood`}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:`IV`}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,children:`Citrated blood chelates calcium.`})]})]})]})}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`C-spine clearance (NEXUS / CCR)`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-xs`,children:[`Pediatric c-spine decision tools are imperfect. `,(0,l.jsx)(`strong`,{children:`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.`]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Pediatric shock — signs`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-red-50 dark:bg-red-950/30 p-3 text-xs text-red-900 dark:text-red-200`,children:[`Children compensate well — `,(0,l.jsx)(`strong`,{children:`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.`]}),(0,l.jsx)(`h3`,{className:`text-sm font-semibold mt-3`,children:`Secondary survey — AMPLE + head-to-toe`}),(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-xs`,children:[(0,l.jsx)(`strong`,{children:`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.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`ATLS 10th ed · PALS 2020 · PECARN c-spine rule · CRASH-2 trial (TXA).`})]})}var G=[{name:`Ketamine IV`,display:`Ketamine`,perKgLow:1.5,perKgHigh:2,maxLow:100,maxHigh:150,unit:`mg`,route:`IV`,onset:`1 min`,duration:`15-30 min`,notes:`Dissociative. Preserves airway reflexes.`},{name:`Ketamine IM`,display:null,perKgLow:4,perKgHigh:5,maxLow:300,maxHigh:400,unit:`mg`,route:`IM`,onset:`3-5 min`,duration:`30-60 min`,notes:`Give atropine 0.01 mg/kg to reduce secretions.`},{name:`Midazolam IV`,display:`Midazolam`,perKgLow:.05,perKgHigh:.1,maxLow:2,maxHigh:5,unit:`mg`,route:`IV`,onset:`2-3 min`,duration:`30-60 min`,notes:`Anxiolysis. Titrate q3-5 min.`},{name:`Midazolam IN/PO`,display:null,perKg:.5,max:20,unit:`mg`,route:`IN/PO`,onset:`10-15 min`,duration:`30-60 min`,notes:`IN (max 10 mg / naris) or PO (max 20 mg).`},{name:`Propofol`,display:`Propofol`,perKg:1,max:40,unit:`mg`,route:`IV`,onset:`30 sec`,duration:`5-10 min`,notes:`Short procedures. Causes apnea — manage airway.`},{name:`Fentanyl IV`,display:`Fentanyl`,perKg:1,max:100,unit:`mcg`,route:`IV`,onset:`2-3 min`,duration:`30-60 min`,notes:`Analgesic. Often combined with midazolam.`},{name:`Fentanyl IN`,display:null,perKg:2,max:100,unit:`mcg`,route:`IN`,onset:`5-10 min`,duration:`30-60 min`,notes:`Intranasal.`},{name:`Nitrous oxide`,display:`Nitrous oxide`,doseDisplay:`50:50 or 70:30 mix`,unit:`mix`,route:`Inhaled`,onset:`2-5 min`,duration:`5 min off`,notes:`Self-administered via demand valve. 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Provider capable of managing airway must be present.`]}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground italic`,children:`AAP Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation · ASA Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.`})]}):(0,l.jsx)(`p`,{className:`text-xs text-destructive`,children:`Enter weight (kg) to see doses.`})]})}var J=[[`approach`,`General approach (stabilize → toxidrome → decon → antidote)`],[`acetaminophen`,`Acetaminophen overdose`],[`opioids`,`Opioid overdose`],[`iron`,`Iron overdose`],[`tca`,`Tricyclic antidepressant (TCA) overdose`],[`bbccb`,`β-blocker / CCB overdose`],[`benzo`,`Benzodiazepine overdose`],[`organo`,`Organophosphate / carbamate poisoning`],[`salicylate`,`Salicylate overdose`],[`etoh`,`Toxic alcohols (methanol / ethylene glycol)`],[`dialyzable`,`Dialyzable drugs (ISTUMBLE)`]];function Y(){let[e,t]=(0,c.useState)(``),[n,r]=(0,c.useState)(`approach`),i=Number.parseFloat(e),a=Number.isFinite(i)&&i>0,o=(e,t,n=`mg`)=>a?s(i,e,t,n).value:null;function u({color:e,title:t,body:n}){return(0,l.jsxs)(`div`,{className:`rounded-md border-l-4 ${e} p-3 text-sm`,children:[(0,l.jsx)(`div`,{className:`font-semibold mb-1`,children:t}),(0,l.jsx)(`div`,{className:`text-xs text-muted-foreground`,children:n})]})}function d({drug:e,dose:t,route:n,notes:r}){return(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`td`,{className:k+` font-semibold`,children:e}),(0,l.jsx)(`td`,{className:k,children:t}),(0,l.jsx)(`td`,{className:k+` text-xs`,children:n}),(0,l.jsx)(`td`,{className:k+` text-xs text-muted-foreground`,dangerouslySetInnerHTML:{__html:r}})]})}function f({children:e}){return(0,l.jsx)(`div`,{className:`overflow-x-auto`,children:(0,l.jsxs)(`table`,{className:`w-full text-sm`,children:[(0,l.jsx)(`thead`,{children:(0,l.jsxs)(`tr`,{children:[(0,l.jsx)(`th`,{className:O,children:`Drug`}),(0,l.jsx)(`th`,{className:O,children:`Dose`}),(0,l.jsx)(`th`,{className:O,children:`Route`}),(0,l.jsx)(`th`,{className:O,children:`Notes`})]})}),(0,l.jsx)(`tbody`,{children:e})]})})}return(0,l.jsxs)(`section`,{className:T,"data-testid":`bedside-panel-toxicology`,children:[(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Toxicology`}),(0,l.jsxs)(`div`,{className:`grid grid-cols-1 sm:grid-cols-2 gap-3 max-w-xl`,children:[(0,l.jsx)(A,{id:`tox-wt`,value:e,onChange:t,testid:`tox-weight`}),(0,l.jsxs)(`div`,{children:[(0,l.jsx)(`label`,{htmlFor:`tox-topic`,className:D,children:`Topic`}),(0,l.jsx)(`select`,{id:`tox-topic`,className:E,value:n,onChange:e=>r(e.target.value),"data-testid":`tox-topic`,children:J.map(([e,t])=>(0,l.jsx)(`option`,{value:e,children:t},e))})]})]}),n===`approach`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(u,{color:`border-blue-500 bg-blue-50 dark:bg-blue-950/30`,title:`1. Stabilize (ABCDE)`,body:(0,l.jsx)(l.Fragment,{children:`Airway, breathing, circulation, disability (glucose, pupils, GCS), exposure. Naloxone if depressed LOC + resp depression. Dextrose if hypoglycemic. Thiamine in select cases.`})}),(0,l.jsx)(u,{color:`border-purple-500 bg-purple-50 dark:bg-purple-950/30`,title:`2. Identify toxidrome`,body:(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`strong`,{children:`Sympathomimetic:`}),` HTN, tachy, mydriasis, diaphoresis (cocaine, meth). `,(0,l.jsx)(`strong`,{children:`Anticholinergic:`}),` hot/dry, mydriasis, tachy, delirium (antihistamines, TCAs). `,(0,l.jsx)(`strong`,{children:`Cholinergic:`}),` SLUDGE-M, miosis (organophosphates). `,(0,l.jsx)(`strong`,{children:`Opioid:`}),` miosis, resp depression, ↓LOC. `,(0,l.jsx)(`strong`,{children:`Sedative-hypnotic:`}),` ↓LOC, normal/low vitals.`]})}),(0,l.jsx)(u,{color:`border-amber-500 bg-amber-50 dark:bg-amber-950/30`,title:`3. Decontamination`,body:(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`strong`,{children:`Activated charcoal`}),` 1 g/kg PO (max 50 g): within 1h of ingestion, intact airway, ingestion adsorbed (not Li, metals, alcohols). Avoid caustics/hydrocarbons. `,(0,l.jsx)(`strong`,{children:`Whole bowel irrigation:`}),` PEG for metals/iron/lithium/sustained release. `,(0,l.jsx)(`strong`,{children:`Gastric lavage:`}),` rarely indicated. `,(0,l.jsx)(`strong`,{children:`Ipecac:`}),` no longer recommended.`]})}),(0,l.jsx)(u,{color:`border-green-500 bg-green-50 dark:bg-green-950/30`,title:`4. Enhance elimination`,body:(0,l.jsxs)(l.Fragment,{children:[(0,l.jsx)(`strong`,{children:`Urinary alkalinization`}),` (salicylates, phenobarbital). `,(0,l.jsx)(`strong`,{children:`Hemodialysis`}),` (see ISTUMBLE). `,(0,l.jsx)(`strong`,{children:`Lipid emulsion`}),` for lipid-soluble drug toxicity (LA, CCB, TCA).`]})}),(0,l.jsx)(u,{color:`border-destructive bg-red-50 dark:bg-red-950/30`,title:`5. Antidotes`,body:(0,l.jsxs)(l.Fragment,{children:[`See topic list. `,(0,l.jsx)(`strong`,{children:`Contact Poison Center`}),` (US: 1-800-222-1222) early for any significant exposure.`]})})]}),n===`acetaminophen`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Acetaminophen overdose`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Acute toxic dose: >150 mg/kg (or 7.5 g total) single ingestion. Hepatotoxic after 24h; AST/ALT peak day 3-4.`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[(0,l.jsx)(`strong`,{children:`Diagnosis:`}),` Draw level at 4h post-ingestion (or on arrival if >4h). Plot on `,(0,l.jsx)(`strong`,{children:`Rumack-Matthew nomogram`}),` (treatment line at 150 mcg/mL at 4h).`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`N-acetylcysteine (NAC) — IV`,dose:`150 mg/kg over 1h → 50 mg/kg over 4h → 100 mg/kg over 16h (21h total)`,route:`IV`,notes:`Total 300 mg/kg. Most effective if started <8h post-ingestion.`}),(0,l.jsx)(d,{drug:`N-acetylcysteine — PO`,dose:`140 mg/kg load, then 70 mg/kg q4h × 17 doses`,route:`PO`,notes:`Alternative to IV. Unpleasant taste — often with juice.`}),(0,l.jsx)(d,{drug:`Activated charcoal`,dose:`1 g/kg (max 50 g)`,route:`PO`,notes:`If within 1-2h of ingestion and airway protected.`})]}),a&&(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-3 text-xs`,children:[(0,l.jsxs)(`strong`,{children:[`For `,i,` kg:`]}),` IV loading = `,o(150,null),` mg over 1h `,(0,l.jsx)(`span`,{className:`text-muted-foreground`,children:`(150 mg/kg)`}),`; 2nd bag = `,o(50,null),` mg over 4h `,(0,l.jsx)(`span`,{className:`text-muted-foreground`,children:`(50 mg/kg)`}),`; 3rd bag = `,o(100,null),` mg over 16h `,(0,l.jsx)(`span`,{className:`text-muted-foreground`,children:`(100 mg/kg)`}),`. `,(0,l.jsx)(`em`,{children:`Total 300 mg/kg.`})]})]}),n===`opioids`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Opioid overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Triad: `,(0,l.jsx)(`strong`,{children:`miosis + respiratory depression + ↓ LOC`}),`. Fentanyl / synthetics may require repeated/higher doses.`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Naloxone (initial)`,dose:a?`0.01-0.1 mg/kg = ${o(.01,null)}-${o(.1,null)} mg`:`0.01-0.1 mg/kg`,route:`IV / IM / IN / IO`,notes:`Start low if chronic opioid use (avoid withdrawal). Titrate to respiratory effort, not consciousness.`}),(0,l.jsx)(d,{drug:`Naloxone (full reversal)`,dose:`2 mg IV/IM/IN`,route:`IV / IM / IN`,notes:`If no chronic use and severe resp depression. Repeat q2-3 min.`}),(0,l.jsx)(d,{drug:`Naloxone infusion`,dose:`2/3 of effective bolus per hour`,route:`IV`,notes:`For long-acting opioids (methadone, fentanyl patch, sustained release)`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[`Observe ≥4h after last dose; longer for long-acting agents. Duration of naloxone (30-90 min) is shorter than most opioids — `,(0,l.jsx)(`strong`,{children:`re-sedation is common`}),`.`]})]}),n===`iron`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Iron overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Toxic dose: elemental Fe ≥20 mg/kg. Severe ≥60 mg/kg. `,(0,l.jsx)(`strong`,{children:`Charcoal does NOT bind iron.`})]}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[(0,l.jsx)(`strong`,{children:`Stages:`}),` 1) GI (0-6h: vomiting, bloody diarrhea); 2) Latent (6-24h); 3) Shock/metabolic acidosis (12-24h); 4) Hepatotoxicity (2-5d); 5) Gastric scarring (2-8 wk).`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Whole bowel irrigation`,dose:`PEG-ES 25-40 mL/kg/hr`,route:`NG`,notes:`For radiopaque pills on KUB or ingested sustained-release iron.`}),(0,l.jsx)(d,{drug:`Deferoxamine`,dose:`15 mg/kg/hr IV infusion`,route:`IV`,notes:`Max 6-8 g/day. Indications: shock, metabolic acidosis, Fe >500 mcg/dL, or severe symptoms. Urine turns 'vin rosé' color.`})]}),(0,l.jsx)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:`Iron level at 4-6h. <350 usually asymptomatic; 350-500 mild; >500 severe. Consider KUB for radiopaque pills.`})]}),n===`tca`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`TCA overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Anticholinergic + Na-channel blockade. `,(0,l.jsx)(`strong`,{children:`Risks:`}),` seizure, VT/VF, hypotension, coma. ECG: QRS >100 ms or R in aVR >3 mm predicts toxicity.`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Sodium bicarbonate 8.4%`,dose:`1-2 mEq/kg IV bolus → infusion`,route:`IV`,notes:`Goal pH 7.45-7.55 and narrowing QRS. Repeat bolus for QRS widening, hypotension, or arrhythmia.`}),(0,l.jsx)(d,{drug:`Mg sulfate`,dose:a?`${o(50,2e3)} mg`:`25-50 mg/kg (max 2 g)`,route:`IV over 10 min`,notes:`For torsades.`}),(0,l.jsx)(d,{drug:`IV lipid emulsion 20%`,dose:`1.5 mL/kg bolus → 0.25 mL/kg/min × 30-60 min`,route:`IV`,notes:`If refractory shock/arrest. Consult toxicology.`})]}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Avoid`}),` Class IA/IC antiarrhythmics, beta-blockers, physostigmine (risk of asystole with TCAs).`]})]}),n===`bbccb`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`β-blocker / Calcium-channel blocker overdose`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Bradycardia + hypotension. CCBs (esp. verapamil, diltiazem, amlodipine) can be lethal in small pediatric doses.`}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`IV fluids`,dose:`20 mL/kg NS bolus`,route:`IV`,notes:`Cautious — avoid volume overload`}),(0,l.jsx)(d,{drug:`Calcium chloride 10% or gluconate`,dose:`CaCl 20 mg/kg / Ca-glu 60 mg/kg`,route:`IV`,notes:`First-line for CCB. Repeat q15-20 min.`}),(0,l.jsx)(d,{drug:`Glucagon`,dose:`50 mcg/kg IV bolus → 50-150 mcg/kg/hr`,route:`IV`,notes:`β-blocker antidote. GI side effects common.`}),(0,l.jsx)(d,{drug:`High-dose insulin (HIE)`,dose:`Regular insulin 1 U/kg bolus → 0.5-2 U/kg/hr + D25% infusion`,route:`IV`,notes:`Hyperinsulinemic euglycemia therapy. Monitor K+ and glucose closely.`}),(0,l.jsx)(d,{drug:`Vasopressors`,dose:`Epi / norepi infusion`,route:`IV`,notes:`Titrate to MAP.`}),(0,l.jsx)(d,{drug:`Lipid emulsion 20%`,dose:`1.5 mL/kg → 0.25 mL/kg/min`,route:`IV`,notes:`For lipid-soluble CCBs (verapamil) if refractory.`}),(0,l.jsx)(d,{drug:`Methylene blue / ECMO`,dose:`—`,route:`—`,notes:`Rescue therapy — toxicology/ICU consult.`})]})]}),n===`benzo`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Benzodiazepine overdose`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Sedation + resp depression. Usually supportive — intubation rarely needed alone. `,(0,l.jsx)(`strong`,{children:`Flumazenil caution.`})]}),(0,l.jsx)(f,{children:(0,l.jsx)(d,{drug:`Flumazenil`,dose:`0.01 mg/kg (max 0.2 mg) IV, may repeat q1 min to max 1 mg`,route:`IV`,notes:`Only for iatrogenic reversal in a benzo-naive patient with no TCAs, seizure disorder, or chronic benzo use. Can precipitate seizures.`})}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[`In real-world ingestion, `,(0,l.jsx)(`strong`,{children:`supportive care (airway, monitoring)`}),` is usually safer than flumazenil.`]})]}),n===`organo`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Organophosphate / carbamate poisoning`}),(0,l.jsxs)(`p`,{className:`text-sm`,children:[`Cholinergic toxidrome: `,(0,l.jsx)(`strong`,{children:`SLUDGE-M`}),` (salivation, lacrimation, urination, defecation, GI distress, emesis, miosis) + muscle fasciculation, bradycardia, bronchorrhea. Decontamination critical (PPE for providers).`]}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Atropine`,dose:`0.05 mg/kg IV, double q3-5 min until bronchial secretions dry`,route:`IV`,notes:`Endpoint = dry lungs, not dry mouth or heart rate. Can require huge doses.`}),(0,l.jsx)(d,{drug:`Pralidoxime (2-PAM)`,dose:`25-50 mg/kg IV over 30 min (max 2 g) → 10-20 mg/kg/hr`,route:`IV`,notes:`Only for organophosphates (not carbamates). Regenerates acetylcholinesterase.`}),(0,l.jsx)(d,{drug:`Diazepam / midazolam`,dose:`Standard seizure doses`,route:`IV`,notes:`For seizures or severe fasciculations.`})]})]}),n===`salicylate`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Salicylate overdose`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Mixed respiratory alkalosis + anion gap metabolic acidosis. Tinnitus, tachypnea, diaphoresis, hyperthermia. Severe: CNS depression, seizures, pulmonary edema, cerebral edema.`}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Fluids`,dose:`Aggressive resuscitation`,route:`IV`,notes:`Dehydration common. Avoid fluid overload (risk of pulmonary edema).`}),(0,l.jsx)(d,{drug:`Sodium bicarb`,dose:`1-2 mEq/kg IV bolus → drip`,route:`IV`,notes:`Urinary alkalinization (goal urine pH >7.5). Prevents CNS entry.`}),(0,l.jsx)(d,{drug:`Glucose`,dose:`Maintain euglycemia even if BG normal`,route:`IV`,notes:`CNS hypoglycemia despite normal serum glucose.`}),(0,l.jsx)(d,{drug:`Hemodialysis`,dose:`—`,route:`—`,notes:`For severe: altered MS, pulmonary edema, renal failure, refractory acidosis, or level >100 mg/dL acute / >60 chronic.`})]})]}),n===`etoh`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Toxic alcohols (methanol / ethylene glycol)`}),(0,l.jsx)(`p`,{className:`text-sm`,children:`Anion gap metabolic acidosis + osmolar gap. Methanol → visual changes, blindness. Ethylene glycol → calcium oxalate crystals in urine, renal failure.`}),(0,l.jsxs)(f,{children:[(0,l.jsx)(d,{drug:`Fomepizole`,dose:`15 mg/kg IV load → 10 mg/kg q12h × 4 → 15 mg/kg q12h`,route:`IV`,notes:`First-line. 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EG: thiamine + pyridoxine (divert to non-toxic metabolites).`})]})]}),n===`dialyzable`&&(0,l.jsxs)(`div`,{className:`space-y-2`,children:[(0,l.jsx)(`div`,{className:`rounded-md bg-blue-50 dark:bg-blue-950/30 p-3 text-sm font-semibold`,children:`Dialyzable drugs (ISTUMBLE)`}),(0,l.jsx)(`div`,{className:`grid grid-cols-1 sm:grid-cols-2 gap-2 text-sm`,children:[[`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`]].map(([e,t])=>(0,l.jsxs)(`div`,{className:`rounded-md bg-muted/40 p-2`,children:[(0,l.jsxs)(`strong`,{children:[e,`:`]}),` `,t]},e))}),(0,l.jsxs)(`div`,{className:`rounded-md bg-amber-50 dark:bg-amber-950/30 p-3 text-xs text-amber-900 dark:text-amber-100`,children:[(0,l.jsx)(`strong`,{children:`Poor candidates for HD:`}),` Large Vd (TCAs, digoxin, BBs), highly protein-bound (benzos, CCBs), lipid-soluble (opioids, phenothiazines). 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Uses the same APLS and Best Guess formulas as the legacy app.`})]}),(0,l.jsxs)(`div`,{className:`grid gap-3 md:grid-cols-[1.2fr_1fr_1fr_auto] md:items-end`,children:[(0,l.jsxs)(`div`,{className:`space-y-1`,children:[(0,l.jsx)(`label`,{htmlFor:`bedside-react-age`,className:Z,children:`Age`}),(0,l.jsx)(`input`,{id:`bedside-react-age`,value:e,onChange:e=>t(e.target.value),placeholder:`e.g. "18m", "3y", "2y5m"`,className:Q,"data-testid":`bedside-age-input`})]}),(0,l.jsxs)(`div`,{className:`space-y-1`,children:[(0,l.jsx)(`label`,{htmlFor:`bedside-react-formula`,className:Z,children:`Formula`}),(0,l.jsxs)(`select`,{id:`bedside-react-formula`,value:n,onChange:e=>{a(e.target.value),u(``)},className:Q,"data-testid":`bedside-formula-select`,children:[(0,l.jsx)(`option`,{value:`apls`,children:`APLS`}),(0,l.jsx)(`option`,{value:`bestguess`,children:`Best Guess`})]})]}),(0,l.jsxs)(`div`,{className:`space-y-1`,children:[(0,l.jsx)(`label`,{htmlFor:`bedside-react-weight`,className:Z,children:`Weight (kg)`}),(0,l.jsx)(`input`,{id:`bedside-react-weight`,type:`number`,min:`0.3`,step:`0.1`,value:m,onChange:e=>u(e.target.value),className:Q,"data-testid":`bedside-weight-input`})]}),(0,l.jsx)(`button`,{type:`button`,onClick:h,className:re,children:`Clear`})]}),e.trim()&&d==null?(0,l.jsx)(`div`,{className:`rounded-md border border-red-200 bg-red-50 p-3 text-sm text-red-700 dark:bg-red-950/30 dark:text-red-200`,children:`Could not parse age. Try "3y", "18 months", or "15 days".`}):null,f&&p!=null?(0,l.jsxs)(`div`,{className:`rounded-lg border border-border bg-muted/40 p-4 text-sm`,"data-testid":`bedside-estimate-result`,children:[(0,l.jsxs)(`div`,{className:`font-semibold`,children:[p,` kg estimated from `,o(d??0)]}),(0,l.jsxs)(`div`,{className:`text-muted-foreground`,children:[`APLS: `,f.all.apls,` kg · Best Guess: `,f.all.bestGuess,` kg. You can override the weight field.`]})]}):null]})}function ae({pill:e}){return(0,l.jsxs)(`section`,{className:X,"data-testid":`bedside-panel-`+e.id,children:[(0,l.jsxs)(`div`,{className:`flex items-center gap-3`,children:[(0,l.jsx)(`span`,{className:`text-2xl`,"aria-hidden":!0,children:e.icon}),(0,l.jsx)(`h2`,{className:`text-lg font-semibold`,children:e.label})]}),(0,l.jsx)(`p`,{className:`text-sm text-muted-foreground`,children:e.summary}),(0,l.jsx)(`div`,{className:`rounded-md border border-amber-300 bg-amber-50 dark:bg-amber-950/30 p-3 text-sm space-y-2`,children:(0,l.jsx)(`p`,{className:`text-amber-900 dark:text-amber-100`,children:`Weight-based calculators for this module run in the legacy viewer while the clinical data is verified for a direct React port. 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i}from"./index-C9wKWOAN.js";var a=e(t(),1);function o(e,t){if(t[e])return e;let n={newborn:`newborn`,"3-5d":`newborn`,"1mo":`1mo`,"2mo":`2mo`,"4mo":`4mo`,"6mo":`6mo`,"9mo":`9mo`,"12mo":`12mo`,"15mo":`15mo`,"18mo":`18mo`,"24mo":`24mo`,"30mo":`30mo`,"3y":`3y`,"4y":`4y`,"5y":`5y`,"6y":`6y_to_10y`,"7y":`6y_to_10y`,"8y":`6y_to_10y`,"9y":`6y_to_10y`,"10y":`6y_to_10y`,"11y":`11y_to_14y`,"12y":`11y_to_14y`,"13y":`11y_to_14y`,"14y":`11y_to_14y`,"15y":`15y_to_21y`,"16y":`15y_to_21y`,"17y":`15y_to_21y`,"18y":`15y_to_21y`,"19y":`15y_to_21y`,"20y":`15y_to_21y`,"21y":`15y_to_21y`}[e];return n&&t[n]?n:null}function s(e,t){if(t[e])return e;let 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w(){let{data:e,isLoading:t,error:n}=i({queryKey:[`schedule-data`],queryFn:()=>r.get(`/api/schedule-data`)}),[_,y]=(0,a.useState)(`newborn`),[w,E]=(0,a.useState)(()=>b()),[D,O]=(0,a.useState)(null);(0,a.useEffect)(()=>{x(w)},[w]),(0,a.useEffect)(()=>{if(!e||!_)return;let t=e.visitAges.find(e=>e.id===_)?.label||_;try{sessionStorage.setItem(`ped_visit_age`,t)}catch{}},[e,_]);let k=(0,a.useMemo)(()=>{if(!e)return{};let t={};return e.visitAges.forEach(e=>{t[e.era]||(t[e.era]=[]),t[e.era].push(e)}),t},[e]);if(t)return(0,u.jsx)(`div`,{className:`text-sm text-muted-foreground`,children:`Loading schedule…`});if(n)return(0,u.jsx)(`div`,{className:`text-sm text-destructive`,children:n.message});if(!e)return null;let A=e.periodicity[_],j=e.wellVisitCodes[_],M=o(_,e.growthReference),N=M?e.growthReference[M]:null,P=s(_,e.reflexesReference),F=P?e.reflexesReference[P]:null;function I(e,t){E(n=>{let r=n[e],i=typeof r==`object`&&r?r.note:``;return{...n,[e]:{status:t,note:i}}})}function L(e,t){E(n=>{let 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May repeat q5 min.`,max:`Max 100 mg/dose, max total 3 mg/kg`}}},{name:`Magnesium Sulfate`,indication:`Torsades de Pointes`,category:`cardiac`,route:`IV/IO`,calc:e=>{let t=+(e*50).toFixed(0);return{dose:`${Math.min(t,2e3)} mg (50 mg/kg)`,extra:`Give over 10-20 min (faster if pulseless).`,max:`Max 2 g (2000 mg)`}}},{name:`Naloxone`,indication:`Opioid overdose`,category:`reversal`,route:`IV/IO/IM/IN/ETT`,calc:e=>{let t=`${+(e*.001).toFixed(4)}-${+(e*.005).toFixed(4)}`,n=+(e*.1).toFixed(3);return{dose:`Partial: ${t} mg (0.001-0.005 mg/kg)`,extra:`Full reversal: ${Math.min(n,2)} mg (0.1 mg/kg)`,max:`Max partial first dose 0.1 mg, max full 2 mg`}}},{name:`Sodium Bicarbonate`,indication:`Metabolic acidosis`,category:`metabolic`,route:`IV/IO`,calc:e=>{let t=+(e*1).toFixed(1);return{dose:`${Math.min(t,50)} mEq (1 mEq/kg)`,extra:e<10?`Dilute to 0.5 mEq/mL (use 4.2% solution) for neonates/small infants.`:`Use 8.4% solution (1 mEq/mL).`,max:`Max 50 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1`,ett:`3.5`,lma:`1.5`,glidescope:`2`,iv:`20-24 ga`,cvl:`4 Fr`,ngt:`8 Fr`,chest:`12-18 Fr`,foley:`8 Fr`},"1yr":{label:`1 year (10 kg)`,bvm:`Small child`,nasal:`14-18 Fr`,oral:`Small 60 mm`,blade:`Miller 1 / MAC 2`,ett:`4.0`,lma:`2`,glidescope:`2`,iv:`20-24 ga`,cvl:`4-5 Fr`,ngt:`10 Fr`,chest:`16-20 Fr`,foley:`8 Fr`},"2-3yr":{label:`2-3 years (12-16 kg)`,bvm:`Small child`,nasal:`14-18 Fr`,oral:`Small 70 mm`,blade:`Miller 1 / MAC 2`,ett:`4.0-4.5`,lma:`2`,glidescope:`2`,iv:`18-22 ga`,cvl:`4-5 Fr`,ngt:`10-12 Fr`,chest:`16-24 Fr`,foley:`8 Fr`},"4-6yr":{label:`4-6 years (20-25 kg)`,bvm:`Child`,nasal:`16-20 Fr`,oral:`Small 70-80 mm`,blade:`Miller 2 / MAC 2`,ett:`4.5-5.0`,lma:`2.5`,glidescope:`3`,iv:`18-22 ga`,cvl:`5 Fr`,ngt:`12-14 Fr`,chest:`20-28 Fr`,foley:`8 Fr`},"7-10yr":{label:`7-10 years (25-35 kg)`,bvm:`Child / Small adult`,nasal:`18-22 Fr`,oral:`Medium 80-90 mm`,blade:`Miller 2 / MAC 2`,ett:`5.5-6.0`,lma:`2.5-3`,glidescope:`3`,iv:`18-22 ga`,cvl:`5 Fr`,ngt:`12-14 Fr`,chest:`20-32 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May repeat q5 min.`,max:`Max 100 mg/dose, max total 3 mg/kg`}}},{name:`Magnesium Sulfate`,indication:`Torsades de Pointes`,category:`cardiac`,route:`IV/IO`,calc:e=>{let t=+(e*50).toFixed(0);return{dose:`${Math.min(t,2e3)} mg (50 mg/kg)`,extra:`Give over 10-20 min (faster if pulseless).`,max:`Max 2 g (2000 mg)`}}},{name:`Naloxone`,indication:`Opioid overdose`,category:`reversal`,route:`IV/IO/IM/IN/ETT`,calc:e=>{let t=`${+(e*.001).toFixed(4)}-${+(e*.005).toFixed(4)}`,n=+(e*.1).toFixed(3);return{dose:`Partial: ${t} mg (0.001-0.005 mg/kg)`,extra:`Full reversal: ${Math.min(n,2)} mg (0.1 mg/kg)`,max:`Max partial first dose 0.1 mg, max full 2 mg`}}},{name:`Sodium Bicarbonate`,indication:`Metabolic acidosis`,category:`metabolic`,route:`IV/IO`,calc:e=>{let t=+(e*1).toFixed(1);return{dose:`${Math.min(t,50)} mEq (1 mEq/kg)`,extra:e<10?`Dilute to 0.5 mEq/mL (use 4.2% solution) for neonates/small infants.`:`Use 8.4% solution (1 mEq/mL).`,max:`Max 50 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1`,ett:`3.5`,lma:`1.5`,glidescope:`2`,iv:`20-24 ga`,cvl:`4 Fr`,ngt:`8 Fr`,chest:`12-18 Fr`,foley:`8 Fr`},"1yr":{label:`1 year (10 kg)`,bvm:`Small child`,nasal:`14-18 Fr`,oral:`Small 60 mm`,blade:`Miller 1 / MAC 2`,ett:`4.0`,lma:`2`,glidescope:`2`,iv:`20-24 ga`,cvl:`4-5 Fr`,ngt:`10 Fr`,chest:`16-20 Fr`,foley:`8 Fr`},"2-3yr":{label:`2-3 years (12-16 kg)`,bvm:`Small child`,nasal:`14-18 Fr`,oral:`Small 70 mm`,blade:`Miller 1 / MAC 2`,ett:`4.0-4.5`,lma:`2`,glidescope:`2`,iv:`18-22 ga`,cvl:`4-5 Fr`,ngt:`10-12 Fr`,chest:`16-24 Fr`,foley:`8 Fr`},"4-6yr":{label:`4-6 years (20-25 kg)`,bvm:`Child`,nasal:`16-20 Fr`,oral:`Small 70-80 mm`,blade:`Miller 2 / MAC 2`,ett:`4.5-5.0`,lma:`2.5`,glidescope:`3`,iv:`18-22 ga`,cvl:`5 Fr`,ngt:`12-14 Fr`,chest:`20-28 Fr`,foley:`8 Fr`},"7-10yr":{label:`7-10 years (25-35 kg)`,bvm:`Child / Small adult`,nasal:`18-22 Fr`,oral:`Medium 80-90 mm`,blade:`Miller 2 / MAC 2`,ett:`5.5-6.0`,lma:`2.5-3`,glidescope:`3`,iv:`18-22 ga`,cvl:`5 Fr`,ngt:`12-14 Fr`,chest:`20-32 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b/public/app/assets/Catchup-DCX8L2yV.js @@ -1 +1 @@ -import{t as e}from"./jsx-runtime-ByY1xr43.js";import{i as t,l as n}from"./index-BuU36CvS.js";var r=e();function i(){let{data:e,isLoading:i,error:a}=n({queryKey:[`schedule-data`],queryFn:()=>t.get(`/api/schedule-data`)});return i?(0,r.jsx)(`div`,{className:`p-6 text-sm text-muted-foreground`,children:`Loading…`}):a?(0,r.jsx)(`div`,{className:`p-6 text-sm text-destructive`,children:a.message}):e?(0,r.jsxs)(`div`,{className:`max-w-4xl mx-auto p-6 space-y-4`,children:[(0,r.jsxs)(`header`,{children:[(0,r.jsx)(`h1`,{className:`text-2xl font-semibold`,children:`Catch-Up Schedule`}),(0,r.jsx)(`p`,{className:`text-sm text-muted-foreground`,children:`CDC 2025 catch-up immunization schedule — minimum ages and intervals per vaccine.`})]}),Object.entries(e.catchUpSchedule).map(([t,n])=>{let i=e.vaccineFullNames[t]||t,a=n.catchUpNotes?Array.isArray(n.catchUpNotes)?n.catchUpNotes:[n.catchUpNotes]:[];return(0,r.jsxs)(`section`,{className:`rounded-lg 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n=Object.create(null);for(let e in this.nodes){if(e in this.marks)throw RangeError(e+` can not be both a node and a mark`);let t=this.nodes[e],r=t.spec.content||``,i=t.spec.marks;if(t.contentMatch=n[r]||(n[r]=Ee.parse(r,this.nodes)),t.inlineContent=t.contentMatch.inlineContent,t.spec.linebreakReplacement){if(this.linebreakReplacement)throw RangeError(`Multiple linebreak nodes defined`);if(!t.isInline||!t.isLeaf)throw RangeError(`Linebreak replacement nodes must be inline leaf nodes`);this.linebreakReplacement=t}t.markSet=i==`_`?null:i?Ye(this,i.split(` `)):i==``||!t.inlineContent?[]:null}for(let e in this.marks){let t=this.marks[e],n=t.spec.excludes;t.excluded=n==null?[t]:n==``?[]:Ye(this,n.split(` `))}this.nodeFromJSON=e=>Ce.fromJSON(this,e),this.markFromJSON=e=>T.fromJSON(this,e),this.topNodeType=this.nodes[this.spec.topNode||`doc`],this.cached.wrappings=Object.create(null)}node(e,t=null,n,r){if(typeof e==`string`)e=this.nodeType(e);else if(!(e instanceof We))throw 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n.contentMatch.matchType(n)})}parse(e,t={}){let n=new st(this,t,!1);return n.addAll(e,T.none,t.from,t.to),n.finish()}parseSlice(e,t={}){let n=new st(this,t,!0);return n.addAll(e,T.none,t.from,t.to),E.maxOpen(n.finish())}matchTag(e,t,n){for(let r=n?this.tags.indexOf(n)+1:0;re.length&&(a.charCodeAt(e.length)!=61||a.slice(e.length+1)!=t))){if(r.getAttrs){let e=r.getAttrs(t);if(e===!1)continue;r.attrs=e||void 0}return r}}}static schemaRules(e){let t=[];function n(e){let n=e.priority==null?50:e.priority,r=0;for(;r{n(e=ut(e)),e.mark||e.ignore||e.clearMark||(e.mark=t)})}for(let t in e.nodes){let r=e.nodes[t].spec.parseDOM;r&&r.forEach(e=>{n(e=ut(e)),e.node||e.ignore||e.mark||(e.node=t)})}return t}static fromSchema(t){return t.cached.domParser||(t.cached.domParser=new 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t}addElementByRule(e,t,n,r){let i,a;if(t.node)if(a=this.parser.schema.nodes[t.node],a.isLeaf)this.insertNode(a.create(t.attrs),n,e.nodeName==`BR`)||this.leafFallback(e,n);else{let e=this.enter(a,t.attrs||null,n,t.preserveWhitespace);e&&(i=!0,n=e)}else{let e=this.parser.schema.marks[t.mark];n=n.concat(e.create(t.attrs))}let o=this.top;if(a&&a.isLeaf)this.findInside(e);else if(r)this.addElement(e,n,r);else if(t.getContent)this.findInside(e),t.getContent(e,this.parser.schema).forEach(e=>this.insertNode(e,n,!1));else{let r=e;typeof t.contentElement==`string`?r=e.querySelector(t.contentElement):typeof t.contentElement==`function`?r=t.contentElement(e):t.contentElement&&(r=t.contentElement),this.findAround(e,r,!0),this.addAll(r,n),this.findAround(e,r,!1)}i&&this.sync(o)&&this.open--}addAll(e,t,n,r){let i=n||0;for(let a=n?e.childNodes[n]:e.firstChild,o=r==null?null:e.childNodes[r];a!=o;a=a.nextSibling,++i)this.findAtPoint(e,i),this.addDOM(a,t);this.findAtPoint(e,i)}findPlace(e,t,n){let r,i;for(let t=this.open,a=0;t>=0;t--){let o=this.nodes[t],s=o.findWrapping(e);if(s&&(!r||r.length>s.length+a)&&(r=s,i=o,!s.length))break;if(o.solid){if(n)break;a+=2}}if(!r)return null;this.sync(i);for(let e=0;e(a.type?a.type.allowsMarkType(t.type):dt(t.type,e))?(s=t.addToSet(s),!1):!0),this.nodes.push(new ot(e,t,s,r,null,o)),this.open++,n}closeExtra(e=!1){let t=this.nodes.length-1;if(t>this.open){for(;t>this.open;t--)this.nodes[t-1].content.push(this.nodes[t].finish(e));this.nodes.length=this.open+1}}finish(){return this.open=0,this.closeExtra(this.isOpen),this.nodes[0].finish(!!(this.isOpen||this.options.topOpen))}sync(e){for(let t=this.open;t>=0;t--)if(this.nodes[t]==e)return this.open=t,!0;else this.localPreserveWS&&(this.nodes[t].options|=nt);return!1}get currentPos(){this.closeExtra();let e=0;for(let t=this.open;t>=0;t--){let n=this.nodes[t].content;for(let t=n.length-1;t>=0;t--)e+=n[t].nodeSize;t&&e++}return e}findAtPoint(e,t){if(this.find)for(let n=0;n-1)return 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c=e.mapping.slice(s),l=c.map(t-n);if(e.step(new Lt(l,c.map(t+n,-1),E.empty,!0)),r===!0){let t=e.doc.resolve(l);Zt(e,t.node(),t.before(),e.steps.length)}return e}function ln(e,t,n){let r=e.resolve(t);if(r.parent.canReplaceWith(r.index(),r.index(),n))return t;if(r.parentOffset==0)for(let e=r.depth-1;e>=0;e--){let t=r.index(e);if(r.node(e).canReplaceWith(t,t,n))return r.before(e+1);if(t>0)return null}if(r.parentOffset==r.parent.content.size)for(let e=r.depth-1;e>=0;e--){let t=r.indexAfter(e);if(r.node(e).canReplaceWith(t,t,n))return r.after(e+1);if(t=0;t--){let n=t==r.depth?0:r.pos<=(r.start(t+1)+r.end(t+1))/2?-1:1,a=r.index(t)+ +(n>0),o=r.node(t),s=!1;if(e==1)s=o.canReplace(a,a,i);else{let e=o.contentMatchAt(a).findWrapping(i.firstChild.type);s=e&&o.canReplaceWith(a,a,e[0])}if(s)return n==0?r.pos:n<0?r.before(t+1):r.after(t+1)}return null}function dn(e,t,n=t,r=E.empty){if(t==n&&!r.size)return null;let i=e.resolve(t),a=e.resolve(n);return fn(i,a,r)?new Lt(t,n,r):new 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e=this.unplaced.openStart;for(let t=this.unplaced.content,n=0,r=this.unplaced.openEnd;n1&&(r=0),i.type.spec.isolating&&r<=n){e=n;break}t=i.content}for(let t=1;t<=2;t++)for(let n=t==1?e:this.unplaced.openStart;n>=0;n--){let e,r=null;n?(r=gn(this.unplaced.content,n-1).firstChild,e=r.content):e=this.unplaced.content;let i=e.firstChild;for(let e=this.depth;e>=0;e--){let{type:a,match:o}=this.frontier[e],s,c=null;if(t==1&&(i?o.matchType(i.type)||(c=o.fillBefore(C.from(i),!1)):r&&a.compatibleContent(r.type)))return{sliceDepth:n,frontierDepth:e,parent:r,inject:c};if(t==2&&i&&(s=o.findWrapping(i.type)))return{sliceDepth:n,frontierDepth:e,parent:r,wrap:s};if(r&&o.matchType(r.type))break}}}openMore(){let{content:e,openStart:t,openEnd:n}=this.unplaced,r=gn(e,t);return!r.childCount||r.firstChild.isLeaf?!1:(this.unplaced=new E(e,t+1,Math.max(n,r.size+t>=e.size-n?t+1:0)),!0)}dropNode(){let{content:e,openStart:t,openEnd:n}=this.unplaced,r=gn(e,t);if(r.childCount<=1&&t>0){let i=e.size-t<=t+r.size;this.unplaced=new E(mn(e,t-1,1),t-1,i?t-1:n)}else this.unplaced=new E(mn(e,t,1),t,n)}placeNodes({sliceDepth:e,frontierDepth:t,parent:n,inject:r,wrap:i}){for(;this.depth>t;)this.closeFrontierNode();if(i)for(let e=0;e1||s==0||e.content.size)&&(u=t,l.push(_n(e.mark(d.allowedMarks(e.marks)),c==1?s:0,c==o.childCount?f:-1)))}let p=c==o.childCount;p||(f=-1),this.placed=hn(this.placed,t,C.from(l)),this.frontier[t].match=u,p&&f<0&&n&&n.type==this.frontier[this.depth].type&&this.frontier.length>1&&this.closeFrontierNode();for(let e=0,t=o;e1&&r==this.$to.end(--n);)++r;return r}findCloseLevel(e){scan:for(let t=Math.min(this.depth,e.depth);t>=0;t--){let{match:n,type:r}=this.frontier[t],i=t=0;n--){let{match:t,type:r}=this.frontier[n],i=vn(e,n,r,t,!0);if(!i||i.childCount)continue scan}return{depth:t,fit:a,move:i?e.doc.resolve(e.after(t+1)):e}}}}close(e){let t=this.findCloseLevel(e);if(!t)return null;for(;this.depth>t.depth;)this.closeFrontierNode();t.fit.childCount&&(this.placed=hn(this.placed,t.depth,t.fit)),e=t.move;for(let n=t.depth+1;n<=e.depth;n++){let t=e.node(n),r=t.type.contentMatch.fillBefore(t.content,!0,e.index(n));this.openFrontierNode(t.type,t.attrs,r)}return e}openFrontierNode(e,t=null,n){let r=this.frontier[this.depth];r.match=r.match.matchType(e),this.placed=hn(this.placed,this.depth,C.from(e.create(t,n))),this.frontier.push({type:e,match:e.contentMatch})}closeFrontierNode(){let e=this.frontier.pop().match.fillBefore(C.empty,!0);e.childCount&&(this.placed=hn(this.placed,this.frontier.length,e))}};function mn(e,t,n){return t==0?e.cutByIndex(n,e.childCount):e.replaceChild(0,e.firstChild.copy(mn(e.firstChild.content,t-1,n)))}function hn(e,t,n){return t==0?e.append(n):e.replaceChild(e.childCount-1,e.lastChild.copy(hn(e.lastChild.content,t-1,n)))}function gn(e,t){for(let n=0;n1&&(r=r.replaceChild(0,_n(r.firstChild,t-1,r.childCount==1?n-1:0))),t>0&&(r=e.type.contentMatch.fillBefore(r).append(r),n<=0&&(r=r.append(e.type.contentMatch.matchFragment(r).fillBefore(C.empty,!0)))),e.copy(r)}function vn(e,t,n,r,i){let a=e.node(t),o=i?e.indexAfter(t):e.index(t);if(o==a.childCount&&!n.compatibleContent(a.type))return null;let s=r.fillBefore(a.content,!0,o);return s&&!yn(n,a.content,o)?s:null}function yn(e,t,n){for(let r=n;r0;e--,t--){let n=i.node(e).type.spec;if(n.defining||n.definingAsContext||n.isolating)break;o.indexOf(e)>-1?s=e:i.before(e)==t&&o.splice(1,0,-e)}let c=o.indexOf(s),l=[],u=r.openStart;for(let e=r.content,t=0;;t++){let n=e.firstChild;if(l.push(n),t==r.openStart)break;e=n.content}for(let e=u-1;e>=0;e--){let t=l[e],n=bn(t.type);if(n&&!t.sameMarkup(i.node(Math.abs(s)-1)))u=e;else if(n||!t.type.isTextblock)break}for(let t=r.openStart;t>=0;t--){let s=(t+u+1)%(r.openStart+1),d=l[s];if(d)for(let t=0;t=0&&(e.replace(t,n,r),!(e.steps.length>d));s--){let 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a=1;a<=r.depth&&a<=i.depth;a++)if(t-r.start(a)==r.depth-a&&n>r.end(a)&&i.end(a)-n!=i.depth-a&&r.start(a-1)==i.start(a-1)&&r.node(a-1).canReplace(r.index(a-1),i.index(a-1)))return e.delete(r.before(a),n);e.delete(t,n)}function Tn(e,t){let n=[],r=Math.min(e.depth,t.depth);for(let i=r;i>=0;i--){let r=e.start(i);if(rt.pos+(t.depth-i)||e.node(i).type.spec.isolating||t.node(i).type.spec.isolating)break;(r==t.start(i)||i==e.depth&&i==t.depth&&e.parent.inlineContent&&t.parent.inlineContent&&i&&t.start(i-1)==r-1)&&n.push(i)}return n}var En=class e extends D{constructor(e,t,n){super(),this.pos=e,this.attr=t,this.value=n}apply(e){let t=e.nodeAt(this.pos);if(!t)return O.fail(`No node at attribute step's position`);let n=Object.create(null);for(let e in t.attrs)n[e]=t.attrs[e];n[this.attr]=this.value;let r=t.type.create(n,null,t.marks);return O.fromReplace(e,this.pos,this.pos+1,new E(C.from(r),0,+!t.isLeaf))}getMap(){return kt.empty}invert(t){return new e(this.pos,this.attr,t.nodeAt(this.pos).attrs[this.attr])}map(t){let n=t.mapResult(this.pos,1);return n.deletedAfter?null:new e(n.pos,this.attr,this.value)}toJSON(){return{stepType:`attr`,pos:this.pos,attr:this.attr,value:this.value}}static fromJSON(t,n){if(typeof n.pos!=`number`||typeof n.attr!=`string`)throw RangeError(`Invalid input for AttrStep.fromJSON`);return new e(n.pos,n.attr,n.value)}};D.jsonID(`attr`,En);var Dn=class e extends D{constructor(e,t){super(),this.attr=e,this.value=t}apply(e){let t=Object.create(null);for(let n in e.attrs)t[n]=e.attrs[n];t[this.attr]=this.value;let n=e.type.create(t,e.content,e.marks);return O.ok(n)}getMap(){return kt.empty}invert(t){return new e(this.attr,t.attrs[this.attr])}map(e){return this}toJSON(){return{stepType:`docAttr`,attr:this.attr,value:this.value}}static fromJSON(t,n){if(typeof n.attr!=`string`)throw RangeError(`Invalid input for DocAttrStep.fromJSON`);return new e(n.attr,n.value)}};D.jsonID(`docAttr`,Dn);var On=class extends 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this.replaceWith(e,e,t)}replaceRange(e,t,n){return xn(this,e,t,n),this}replaceRangeWith(e,t,n){return Cn(this,e,t,n),this}deleteRange(e,t){return wn(this,e,t),this}lift(e,t){return Wt(this,e,t),this}join(e,t=1){return cn(this,e,t),this}wrap(e,t){return Yt(this,e,t),this}setBlockType(e,t=e,n,r=null){return Xt(this,e,t,n,r),this}setNodeMarkup(e,t,n=null,r){return en(this,e,t,n,r),this}setNodeAttribute(e,t,n){return this.step(new En(e,t,n)),this}setDocAttribute(e,t){return this.step(new Dn(e,t)),this}addNodeMark(e,t){return this.step(new Ft(e,t)),this}removeNodeMark(e,t){let n=this.doc.nodeAt(e);if(!n)throw RangeError(`No node at position `+e);if(t instanceof T)t.isInSet(n.marks)&&this.step(new It(e,t));else{let r=n.marks,i,a=[];for(;i=t.isInSet(r);)a.push(new It(e,i)),r=i.removeFromSet(r);for(let e=a.length-1;e>=0;e--)this.step(a[e])}return this}split(e,t=1,n){return nn(this,e,t,n),this}addMark(e,t,n){return zt(this,e,t,n),this}removeMark(e,t,n){return Bt(this,e,t,n),this}clearIncompatible(e,t,n){return Vt(this,e,t,n),this}},An=Object.create(null),A=class{constructor(e,t,n){this.$anchor=e,this.$head=t,this.ranges=n||[new jn(e.min(t),e.max(t))]}get anchor(){return this.$anchor.pos}get head(){return this.$head.pos}get from(){return this.$from.pos}get to(){return this.$to.pos}get $from(){return this.ranges[0].$from}get $to(){return this.ranges[0].$to}get empty(){let e=this.ranges;for(let t=0;t=0;r--){let i=t<0?Rn(e.node(0),e.node(r),e.before(r+1),e.index(r),t,n):Rn(e.node(0),e.node(r),e.after(r+1),e.index(r)+1,t,n);if(i)return i}return null}static near(e,t=1){return this.findFrom(e,t)||this.findFrom(e,-t)||new In(e.node(0))}static atStart(e){return Rn(e,e,0,0,1)||new In(e)}static atEnd(e){return Rn(e,e,e.content.size,e.childCount,-1)||new In(e)}static fromJSON(e,t){if(!t||!t.type)throw RangeError(`Invalid input for Selection.fromJSON`);let n=An[t.type];if(!n)throw RangeError(`No selection type ${t.type} defined`);return n.fromJSON(e,t)}static jsonID(e,t){if(e in An)throw RangeError(`Duplicate use of selection JSON ID `+e);return An[e]=t,t.prototype.jsonID=e,t}getBookmark(){return j.between(this.$anchor,this.$head).getBookmark()}};A.prototype.visible=!0;var jn=class{constructor(e,t){this.$from=e,this.$to=t}},Mn=!1;function Nn(e){!Mn&&!e.parent.inlineContent&&(Mn=!0,console.warn(`TextSelection endpoint not pointing into a node with inline content (`+e.parent.type.name+`)`))}var j=class e extends A{constructor(e,t=e){Nn(e),Nn(t),super(e,t)}get $cursor(){return this.$anchor.pos==this.$head.pos?this.$head:null}map(t,n){let r=t.resolve(n.map(this.head));if(!r.parent.inlineContent)return A.near(r);let i=t.resolve(n.map(this.anchor));return new e(i.parent.inlineContent?i:r,r)}replace(e,t=E.empty){if(super.replace(e,t),t==E.empty){let t=this.$from.marksAcross(this.$to);t&&e.ensureMarks(t)}}eq(t){return t instanceof e&&t.anchor==this.anchor&&t.head==this.head}getBookmark(){return new Pn(this.anchor,this.head)}toJSON(){return{type:`text`,anchor:this.anchor,head:this.head}}static fromJSON(t,n){if(typeof n.anchor!=`number`||typeof n.head!=`number`)throw RangeError(`Invalid input for TextSelection.fromJSON`);return new e(t.resolve(n.anchor),t.resolve(n.head))}static create(e,t,n=t){let r=e.resolve(t);return new this(r,n==t?r:e.resolve(n))}static between(t,n,r){let i=t.pos-n.pos;if((!r||i)&&(r=i>=0?1:-1),!n.parent.inlineContent){let e=A.findFrom(n,r,!0)||A.findFrom(n,-r,!0);if(e)n=e.$head;else return A.near(n,r)}return t.parent.inlineContent||(i==0?t=n:(t=(A.findFrom(t,-r,!0)||A.findFrom(t,r,!0)).$anchor,t.pos0?0:1);i>0?o=0;o+=i){let r=t.child(o);if(!r.isAtom){let t=Rn(e,r,n+i,i<0?r.childCount:0,i,a);if(t)return t}else if(!a&&M.isSelectable(r))return M.create(e,n-(i<0?r.nodeSize:0));n+=r.nodeSize*i}return null}function zn(e,t,n){let r=e.steps.length-1;if(r{o??=r}),e.setSelection(A.near(e.doc.resolve(o),n))}var Bn=1,Vn=2,Hn=4,Un=class extends kn{constructor(e){super(e.doc),this.curSelectionFor=0,this.updated=0,this.meta=Object.create(null),this.time=Date.now(),this.curSelection=e.selection,this.storedMarks=e.storedMarks}get selection(){return this.curSelectionFor0}setStoredMarks(e){return this.storedMarks=e,this.updated|=Vn,this}ensureMarks(e){return T.sameSet(this.storedMarks||this.selection.$from.marks(),e)||this.setStoredMarks(e),this}addStoredMark(e){return this.ensureMarks(e.addToSet(this.storedMarks||this.selection.$head.marks()))}removeStoredMark(e){return this.ensureMarks(e.removeFromSet(this.storedMarks||this.selection.$head.marks()))}get storedMarksSet(){return(this.updated&Vn)>0}addStep(e,t){super.addStep(e,t),this.updated&=~Vn,this.storedMarks=null}setTime(e){return this.time=e,this}replaceSelection(e){return this.selection.replace(this,e),this}replaceSelectionWith(e,t=!0){let n=this.selection;return t&&(e=e.mark(this.storedMarks||(n.empty?n.$from.marks():n.$from.marksAcross(n.$to)||T.none))),n.replaceWith(this,e),this}deleteSelection(){return this.selection.replace(this),this}insertText(e,t,n){let r=this.doc.type.schema;if(t==null)return e?this.replaceSelectionWith(r.text(e),!0):this.deleteSelection();{if(n??=t,!e)return this.deleteRange(t,n);let i=this.storedMarks;if(!i){let e=this.doc.resolve(t);i=n==t?e.marks():e.marksAcross(this.doc.resolve(n))}return this.replaceRangeWith(t,n,r.text(e,i)),!this.selection.empty&&this.selection.to==t+e.length&&this.setSelection(A.near(this.selection.$to)),this}}setMeta(e,t){return this.meta[typeof e==`string`?e:e.key]=t,this}getMeta(e){return this.meta[typeof e==`string`?e:e.key]}get isGeneric(){for(let e in this.meta)return!1;return!0}scrollIntoView(){return this.updated|=Hn,this}get scrolledIntoView(){return(this.updated&Hn)>0}};function Wn(e,t){return!t||!e?e:e.bind(t)}var Gn=class{constructor(e,t,n){this.name=e,this.init=Wn(t.init,n),this.apply=Wn(t.apply,n)}},Kn=[new Gn(`doc`,{init(e){return e.doc||e.schema.topNodeType.createAndFill()},apply(e){return e.doc}}),new Gn(`selection`,{init(e,t){return e.selection||A.atStart(t.doc)},apply(e){return e.selection}}),new Gn(`storedMarks`,{init(e){return e.storedMarks||null},apply(e,t,n,r){return r.selection.$cursor?e.storedMarks:null}}),new Gn(`scrollToSelection`,{init(){return 0},apply(e,t){return e.scrolledIntoView?t+1:t}})],qn=class{constructor(e,t){this.schema=e,this.plugins=[],this.pluginsByKey=Object.create(null),this.fields=Kn.slice(),t&&t.forEach(e=>{if(this.pluginsByKey[e.key])throw RangeError(`Adding different instances of a keyed plugin (`+e.key+`)`);this.plugins.push(e),this.pluginsByKey[e.key]=e,e.spec.state&&this.fields.push(new Gn(e.key,e.spec.state,e))})}},Jn=class e{constructor(e){this.config=e}get schema(){return this.config.schema}get plugins(){return this.config.plugins}apply(e){return this.applyTransaction(e).state}filterTransaction(e,t=-1){for(let n=0;ne.toJSON())),e&&typeof e==`object`)for(let n in e){if(n==`doc`||n==`selection`)throw RangeError("The JSON fields `doc` and `selection` are reserved");let r=e[n],i=r.spec.state;i&&i.toJSON&&(t[n]=i.toJSON.call(r,this[r.key]))}return t}static fromJSON(t,n,r){if(!n)throw RangeError(`Invalid input for EditorState.fromJSON`);if(!t.schema)throw RangeError(`Required config field 'schema' missing`);let i=new qn(t.schema,t.plugins),a=new e(i);return i.fields.forEach(e=>{if(e.name==`doc`)a.doc=Ce.fromJSON(t.schema,n.doc);else if(e.name==`selection`)a.selection=A.fromJSON(a.doc,n.selection);else if(e.name==`storedMarks`)n.storedMarks&&(a.storedMarks=n.storedMarks.map(t.schema.markFromJSON));else{if(r)for(let i in r){let o=r[i],s=o.spec.state;if(o.key==e.name&&s&&s.fromJSON&&Object.prototype.hasOwnProperty.call(n,i)){a[e.name]=s.fromJSON.call(o,t,n[i],a);return}}a[e.name]=e.init(t,a)}}),a}};function Yn(e,t,n){for(let r in e){let 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Ji==t&&Yi==n?Xi:(Ji=t,Yi=n,Xi=n==`up`||n==`down`?Gi(e,t,n):qi(e,t,n))}var Qi=0,$i=1,ea=2,ta=3,na=class{constructor(e,t,n,r){this.parent=e,this.children=t,this.dom=n,this.contentDOM=r,this.dirty=Qi,n.pmViewDesc=this}matchesWidget(e){return!1}matchesMark(e){return!1}matchesNode(e,t,n){return!1}matchesHack(e){return!1}parseRule(){return null}stopEvent(e){return!1}get size(){let e=0;for(let t=0;tF(this.contentDOM);else if(this.contentDOM&&this.contentDOM!=this.dom&&this.dom.contains(this.contentDOM))r=e.compareDocumentPosition(this.contentDOM)&2;else if(this.dom.firstChild){if(t==0)for(let t=e;;t=t.parentNode){if(t==this.dom){r=!1;break}if(t.previousSibling)break}if(r==null&&t==e.childNodes.length)for(let t=e;;t=t.parentNode){if(t==this.dom){r=!0;break}if(t.nextSibling)break}}return r??n>0?this.posAtEnd:this.posAtStart}nearestDesc(e,t=!1){for(let n=!0,r=e;r;r=r.parentNode){let i=this.getDesc(r),a;if(i&&(!t||i.node))if(n&&(a=i.nodeDOM)&&!(a.nodeType==1?a.contains(e.nodeType==1?e:e.parentNode):a==e))n=!1;else return i}}getDesc(e){let t=e.pmViewDesc;for(let e=t;e;e=e.parent)if(e==this)return t}posFromDOM(e,t,n){for(let r=e;r;r=r.parentNode){let i=this.getDesc(r);if(i)return i.localPosFromDOM(e,t,n)}return-1}descAt(e){for(let t=0,n=0;te||i instanceof la){r=e-t;break}t=a}if(r)return this.children[n].domFromPos(r-this.children[n].border,t);for(let e;n&&!(e=this.children[n-1]).size&&e instanceof ra&&e.side>=0;n--);if(t<=0){let e,r=!0;for(;e=n?this.children[n-1]:null,!(!e||e.dom.parentNode==this.contentDOM);n--,r=!1);return e&&t&&r&&!e.border&&!e.domAtom?e.domFromPos(e.size,t):{node:this.contentDOM,offset:e?F(e.dom)+1:0}}else{let e,r=!0;for(;e=n=i&&t<=s-n.border&&n.node&&n.contentDOM&&this.contentDOM.contains(n.contentDOM))return n.parseRange(e,t,i);e=a;for(let t=o;t>0;t--){let n=this.children[t-1];if(n.size&&n.dom.parentNode==this.contentDOM&&!n.emptyChildAt(1)){r=F(n.dom)+1;break}e-=n.size}r==-1&&(r=0)}if(r>-1&&(s>t||o==this.children.length-1)){t=s;for(let e=o+1;es&&at){let e=o;o=s,s=e}let n=document.createRange();n.setEnd(s.node,s.offset),n.setStart(o.node,o.offset),c.removeAllRanges(),c.addRange(n)}}ignoreMutation(e){return!this.contentDOM&&e.type!=`selection`}get contentLost(){return this.contentDOM&&this.contentDOM!=this.dom&&!this.dom.contains(this.contentDOM)}markDirty(e,t){for(let n=0,r=0;r=n:en){let r=n+i.border,o=a-i.border;if(e>=r&&t<=o){this.dirty=e==n||t==a?ea:$i,e==r&&t==o&&(i.contentLost||i.dom.parentNode!=this.contentDOM)?i.dirty=ta:i.markDirty(e-r,t-r);return}else i.dirty=i.dom==i.contentDOM&&i.dom.parentNode==this.contentDOM&&!i.children.length?ea:ta}n=a}this.dirty=ea}markParentsDirty(){let e=1;for(let t=this.parent;t;t=t.parent,e++){let n=e==1?ea:$i;t.dirty{if(!i)return r;if(i.parent)return i.parent.posBeforeChild(i)})),!t.type.spec.raw){if(a.nodeType!=1){let e=document.createElement(`span`);e.appendChild(a),a=e}a.contentEditable=`false`,a.classList.add(`ProseMirror-widget`)}super(e,[],a,null),this.widget=t,this.widget=t,i=this}matchesWidget(e){return this.dirty==Qi&&e.type.eq(this.widget.type)}parseRule(){return{ignore:!0}}stopEvent(e){let t=this.widget.spec.stopEvent;return t?t(e):!1}ignoreMutation(e){return e.type!=`selection`||this.widget.spec.ignoreSelection}destroy(){this.widget.type.destroy(this.dom),super.destroy()}get domAtom(){return!0}get ignoreForSelection(){return!!this.widget.type.spec.relaxedSide}get side(){return this.widget.type.side}},ia=class extends na{constructor(e,t,n,r){super(e,[],t,null),this.textDOM=n,this.text=r}get size(){return this.text.length}localPosFromDOM(e,t){return e==this.textDOM?this.posAtStart+t:this.posAtStart+(t?this.size:0)}domFromPos(e){return{node:this.textDOM,offset:e}}ignoreMutation(e){return e.type===`characterData`&&e.target.nodeValue==e.oldValue}},aa=class e extends na{constructor(e,t,n,r,i){super(e,[],n,r),this.mark=t,this.spec=i}static create(t,n,r,i){let a=i.nodeViews[n.type.name],o=a&&a(n,i,r);return(!o||!o.dom)&&(o=ft.renderSpec(document,n.type.spec.toDOM(n,r),null,n.attrs)),new e(t,n,o.dom,o.contentDOM||o.dom,o)}parseRule(){return this.dirty&ta||this.mark.type.spec.reparseInView?null:{mark:this.mark.type.name,attrs:this.mark.attrs,contentElement:this.contentDOM}}matchesMark(e){return this.dirty!=ta&&this.mark.eq(e)}markDirty(e,t){if(super.markDirty(e,t),this.dirty!=Qi){let e=this.parent;for(;!e.node;)e=e.parent;e.dirty0&&(a=Ea(a,0,t,r));for(let e=0;e{if(!c)return o;if(c.parent)return c.parent.posBeforeChild(c)},r,i),u=l&&l.dom,d=l&&l.contentDOM;if(n.isText){if(!u)u=document.createTextNode(n.text);else if(u.nodeType!=3)throw RangeError(`Text must be rendered as a DOM text node`)}else if(!u){let e=ft.renderSpec(document,n.type.spec.toDOM(n),null,n.attrs);({dom:u,contentDOM:d}=e)}!d&&!n.isText&&u.nodeName!=`BR`&&(u.hasAttribute(`contenteditable`)||(u.contentEditable=`false`),n.type.spec.draggable&&(u.draggable=!0));let f=u;return u=_a(u,r,n),l?c=new ua(t,n,r,i,u,d||null,f,l,a,o+1):n.isText?new ca(t,n,r,i,u,f,a):new e(t,n,r,i,u,d||null,f,a,o+1)}parseRule(){if(this.node.type.spec.reparseInView)return null;let e={node:this.node.type.name,attrs:this.node.attrs};if(this.node.type.whitespace==`pre`&&(e.preserveWhitespace=`full`),!this.contentDOM)e.getContent=()=>this.node.content;else if(!this.contentLost)e.contentElement=this.contentDOM;else{for(let t=this.children.length-1;t>=0;t--){let n=this.children[t];if(this.dom.contains(n.dom.parentNode)){e.contentElement=n.dom.parentNode;break}}e.contentElement||(e.getContent=()=>C.empty)}return e}matchesNode(e,t,n){return this.dirty==Qi&&e.eq(this.node)&&va(t,this.outerDeco)&&n.eq(this.innerDeco)}get size(){return this.node.nodeSize}get border(){return+!this.node.isLeaf}updateChildren(e,t){let n=this.node.inlineContent,r=t,i=e.composing?this.localCompositionInfo(e,t):null,a=i&&i.pos>-1?i:null,o=i&&i.pos<0,s=new ba(this,a&&a.node,e);Ca(this.node,this.innerDeco,(t,i,a)=>{t.spec.marks?s.syncToMarks(t.spec.marks,n,e,i):t.type.side>=0&&!a&&s.syncToMarks(i==this.node.childCount?T.none:this.node.child(i).marks,n,e,i),s.placeWidget(t,e,r)},(t,a,c,l)=>{s.syncToMarks(t.marks,n,e,l);let u;s.findNodeMatch(t,a,c,l)||o&&e.state.selection.from>r&&e.state.selection.to-1&&s.updateNodeAt(t,a,c,u,e)||s.updateNextNode(t,a,c,e,l,r)||s.addNode(t,a,c,e,r),r+=t.nodeSize}),s.syncToMarks([],n,e,0),this.node.isTextblock&&s.addTextblockHacks(),s.destroyRest(),(s.changed||this.dirty==ea)&&(a&&this.protectLocalComposition(e,a),da(this.contentDOM,this.children,e),mi&&wa(this.dom))}localCompositionInfo(e,t){let{from:n,to:r}=e.state.selection;if(!(e.state.selection instanceof j)||nt+this.node.content.size)return null;let i=e.input.compositionNode;if(!i||!this.dom.contains(i.parentNode))return null;if(this.node.inlineContent){let e=i.nodeValue,a=Ta(this.node.content,e,n-t,r-t);return a<0?null:{node:i,pos:a,text:e}}else return{node:i,pos:-1,text:``}}protectLocalComposition(e,{node:t,pos:n,text:r}){if(this.getDesc(t))return;let i=t;for(;i.parentNode!=this.contentDOM;i=i.parentNode){for(;i.previousSibling;)i.parentNode.removeChild(i.previousSibling);for(;i.nextSibling;)i.parentNode.removeChild(i.nextSibling);i.pmViewDesc&&=void 0}let a=new ia(this,i,t,r);e.input.compositionNodes.push(a),this.children=Ea(this.children,n,n+r.length,e,a)}update(e,t,n,r){return this.dirty==ta||!e.sameMarkup(this.node)?!1:(this.updateInner(e,t,n,r),!0)}updateInner(e,t,n,r){this.updateOuterDeco(t),this.node=e,this.innerDeco=n,this.contentDOM&&this.updateChildren(r,this.posAtStart),this.dirty=Qi}updateOuterDeco(e){if(va(e,this.outerDeco))return;let t=this.nodeDOM.nodeType!=1,n=this.dom;this.dom=ha(this.dom,this.nodeDOM,ma(this.outerDeco,this.node,t),ma(e,this.node,t)),this.dom!=n&&(n.pmViewDesc=void 0,this.dom.pmViewDesc=this),this.outerDeco=e}selectNode(){this.nodeDOM.nodeType==1&&(this.nodeDOM.classList.add(`ProseMirror-selectednode`),(this.contentDOM||!this.node.type.spec.draggable)&&(this.nodeDOM.draggable=!0))}deselectNode(){this.nodeDOM.nodeType==1&&(this.nodeDOM.classList.remove(`ProseMirror-selectednode`),(this.contentDOM||!this.node.type.spec.draggable)&&this.nodeDOM.removeAttribute(`draggable`))}get domAtom(){return this.node.isAtom}};function sa(e,t,n,r,i){_a(r,t,e);let a=new oa(void 0,e,t,n,r,r,r,i,0);return a.contentDOM&&a.updateChildren(i,0),a}var ca=class e extends oa{constructor(e,t,n,r,i,a,o){super(e,t,n,r,i,null,a,o,0)}parseRule(){let e=this.nodeDOM.parentNode;for(;e&&e!=this.dom&&!e.pmIsDeco;)e=e.parentNode;return{skip:e||!0}}update(e,t,n,r){return this.dirty==ta||this.dirty!=Qi&&!this.inParent()||!e.sameMarkup(this.node)?!1:(this.updateOuterDeco(t),(this.dirty!=Qi||e.text!=this.node.text)&&e.text!=this.nodeDOM.nodeValue&&(this.nodeDOM.nodeValue=e.text,r.trackWrites==this.nodeDOM&&(r.trackWrites=null)),this.node=e,this.dirty=Qi,!0)}inParent(){let e=this.parent.contentDOM;for(let t=this.nodeDOM;t;t=t.parentNode)if(t==e)return!0;return!1}domFromPos(e){return{node:this.nodeDOM,offset:e}}localPosFromDOM(e,t,n){return e==this.nodeDOM?this.posAtStart+Math.min(t,this.node.text.length):super.localPosFromDOM(e,t,n)}ignoreMutation(e){return e.type!=`characterData`&&e.type!=`selection`}slice(t,n,r){let i=this.node.cut(t,n),a=document.createTextNode(i.text);return new e(this.parent,i,this.outerDeco,this.innerDeco,a,a,r)}markDirty(e,t){super.markDirty(e,t),this.dom!=this.nodeDOM&&(e==0||t==this.nodeDOM.nodeValue.length)&&(this.dirty=ta)}get domAtom(){return!1}isText(e){return this.node.text==e}},la=class extends na{parseRule(){return{ignore:!0}}matchesHack(e){return this.dirty==Qi&&this.dom.nodeName==e}get domAtom(){return!0}get ignoreForCoords(){return this.dom.nodeName==`IMG`}},ua=class extends oa{constructor(e,t,n,r,i,a,o,s,c,l){super(e,t,n,r,i,a,o,c,l),this.spec=s}update(e,t,n,r){if(this.dirty==ta)return!1;if(this.spec.update&&(this.node.type==e.type||this.spec.multiType)){let i=this.spec.update(e,t,n);return i&&this.updateInner(e,t,n,r),i}else if(!this.contentDOM&&!e.isLeaf)return!1;else return super.update(e,t,n,r)}selectNode(){this.spec.selectNode?this.spec.selectNode():super.selectNode()}deselectNode(){this.spec.deselectNode?this.spec.deselectNode():super.deselectNode()}setSelection(e,t,n,r){this.spec.setSelection?this.spec.setSelection(e,t,n.root):super.setSelection(e,t,n,r)}destroy(){this.spec.destroy&&this.spec.destroy(),super.destroy()}stopEvent(e){return this.spec.stopEvent?this.spec.stopEvent(e):!1}ignoreMutation(e){return this.spec.ignoreMutation?this.spec.ignoreMutation(e):super.ignoreMutation(e)}};function da(e,t,n){let r=e.firstChild,i=!1;for(let a=0;a>1,o=Math.min(a,e.length);for(;i-1)i>this.index&&(this.changed=!0,this.destroyBetween(this.index,i)),this.top=this.top.children[this.index];else{let r=aa.create(this.top,e[a],t,n);this.top.children.splice(this.index,0,r),this.top=r,this.changed=!0}this.index=0,a++}}findNodeMatch(e,t,n,r){let i=-1,a;if(r>=this.preMatch.index&&(a=this.preMatch.matches[r-this.preMatch.index]).parent==this.top&&a.matchesNode(e,t,n))i=this.top.children.indexOf(a,this.index);else for(let r=this.index,a=Math.min(this.top.children.length,r+5);r0;){let s;for(;;)if(r){let e=n.children[r-1];if(e instanceof aa)n=e,r=e.children.length;else{s=e,r--;break}}else if(n==t)break outer;else r=n.parent.children.indexOf(n),n=n.parent;let c=s.node;if(c){if(c!=e.child(i-1))break;--i,a.set(s,i),o.push(s)}}return{index:i,matched:a,matches:o.reverse()}}function Sa(e,t){return e.type.side-t.type.side}function Ca(e,t,n,r){let i=t.locals(e),a=0;if(i.length==0){for(let n=0;na;)s.push(i[o++]);let m=a+f.nodeSize;if(f.isText){let e=m;o!e.inline):s.slice();r(f,h,t.forChild(a,f),p),a=m}}function wa(e){if(e.nodeName==`UL`||e.nodeName==`OL`){let t=e.style.cssText;e.style.cssText=t+`; list-style: square !important`,window.getComputedStyle(e).listStyle,e.style.cssText=t}}function Ta(e,t,n,r){for(let i=0,a=0;i=n){if(a>=r&&c.slice(r-t.length-s,r-s)==t)return r-t.length;let e=s=0&&e+t.length+s>=n)return s+e;if(n==r&&c.length>=r+t.length-s&&c.slice(r-s,r-s+t.length)==t)return r}}return-1}function Ea(e,t,n,r,i){let a=[];for(let o=0,s=0;o=n||u<=t?a.push(c):(ln&&a.push(c.slice(n-l,c.size,r)))}return a}function Da(e,t=null){let n=e.domSelectionRange(),r=e.state.doc;if(!n.focusNode)return null;let i=e.docView.nearestDesc(n.focusNode),a=i&&i.size==0,o=e.docView.posFromDOM(n.focusNode,n.focusOffset,1);if(o<0)return null;let s=r.resolve(o),c,l;if(ei(n)){for(c=o;i&&!i.node;)i=i.parent;let e=i.node;if(i&&e.isAtom&&M.isSelectable(e)&&i.parent&&!(e.isInline&&Qr(n.focusNode,n.focusOffset,i.dom))){let e=i.posBefore;l=new M(o==e?s:r.resolve(e))}}else{if(n instanceof e.dom.ownerDocument.defaultView.Selection&&n.rangeCount>1){let t=o,i=o;for(let r=0;r{(n.anchorNode!=r||n.anchorOffset!=i)&&(t.removeEventListener(`selectionchange`,e.input.hideSelectionGuard),setTimeout(()=>{(!Oa(e)||e.state.selection.visible)&&e.dom.classList.remove(`ProseMirror-hideselection`)},20))})}function Fa(e){let t=e.domSelection();if(!t)return;let n=e.cursorWrapper.dom,r=n.nodeName==`IMG`;r?t.collapse(n.parentNode,F(n)+1):t.collapse(n,0),!r&&!e.state.selection.visible&&I&&ui<=11&&(n.disabled=!0,n.disabled=!1)}function Ia(e,t){if(t instanceof M){let n=e.docView.descAt(t.from);n!=e.lastSelectedViewDesc&&(La(e),n&&n.selectNode(),e.lastSelectedViewDesc=n)}else La(e)}function 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Us=/^(a|abbr|acronym|b|bd[io]|big|br|button|cite|code|data(list)?|del|dfn|em|i|img|ins|kbd|label|map|mark|meter|output|q|ruby|s|samp|small|span|strong|su[bp]|time|u|tt|var)$/i;function Ws(e,t,n,r,i){let a=e.input.compositionPendingChanges||(e.composing?e.input.compositionID:0);if(e.input.compositionPendingChanges=0,t<0){let t=e.input.lastSelectionTime>Date.now()-50?e.input.lastSelectionOrigin:null,n=Da(e,t);if(n&&!e.state.selection.eq(n)){if(L&&_i&&e.input.lastKeyCode===13&&Date.now()-100t(e,ti(13,`Enter`))))return;let r=e.state.tr.setSelection(n);t==`pointer`?r.setMeta(`pointer`,!0):t==`key`&&r.scrollIntoView(),a&&r.setMeta(`composition`,a),e.dispatch(r)}return}let o=e.state.doc.resolve(t),s=o.sharedDepth(n);t=o.before(s+1),n=e.state.doc.resolve(n).after(s+1);let c=e.state.selection,l=Vs(e,t,n),u=e.state.doc,d=u.slice(l.from,l.to),f,p;e.input.lastKeyCode===8&&Date.now()-100Date.now()-225||_i)&&i.some(e=>e.nodeType==1&&!Us.test(e.nodeName))&&(!m||m.endA>=m.endB)&&e.someProp(`handleKeyDown`,t=>t(e,ti(13,`Enter`)))){e.input.lastIOSEnter=0;return}if(!m)if(r&&c instanceof j&&!c.empty&&c.$head.sameParent(c.$anchor)&&!e.composing&&!(l.sel&&l.sel.anchor!=l.sel.head))m={start:c.from,endA:c.to,endB:c.to};else{if(l.sel){let t=Gs(e,e.state.doc,l.sel);if(t&&!t.eq(e.state.selection)){let n=e.state.tr.setSelection(t);a&&n.setMeta(`composition`,a),e.dispatch(n)}}return}e.state.selection.frome.state.selection.from&&m.start<=e.state.selection.from+2&&e.state.selection.from>=l.from?m.start=e.state.selection.from:m.endA=e.state.selection.to-2&&e.state.selection.to<=l.to&&(m.endB+=e.state.selection.to-m.endA,m.endA=e.state.selection.to)),I&&ui<=11&&m.endB==m.start+1&&m.endA==m.start&&m.start>l.from&&l.doc.textBetween(m.start-l.from-1,m.start-l.from+1)==` 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t=Gs(e,n.doc,l.sel);t&&!(L&&e.composing&&t.empty&&(m.start!=m.endB||e.input.lastChromeDeleteka(e),20));let t=x(e.state.tr.delete(y,b)),n=u.resolve(m.start).marksAcross(u.resolve(m.endA));n&&t.ensureMarks(n),e.dispatch(t)}else if(m.endA==m.endB&&(S=Ks(h.parent.content.cut(h.parentOffset,g.parentOffset),_.parent.content.cut(_.parentOffset,m.endA-_.start())))){let t=x(e.state.tr);S.type==`add`?t.addMark(y,b,S.mark):t.removeMark(y,b,S.mark),e.dispatch(t)}else if(h.parent.child(h.index()).isText&&h.index()==g.index()-+!g.textOffset){let t=h.parent.textBetween(h.parentOffset,g.parentOffset),n=()=>x(e.state.tr.insertText(t,y,b));e.someProp(`handleTextInput`,r=>r(e,y,b,t,n))||e.dispatch(n())}else e.dispatch(x());else e.dispatch(x())}function Gs(e,t,n){return Math.max(n.anchor,n.head)>t.content.size?null:Ra(e,t.resolve(n.anchor),t.resolve(n.head))}function Ks(e,t){let n=e.firstChild.marks,r=t.firstChild.marks,i=n,a=r,o,s,c;for(let e=0;ee.mark(s.addToSet(e.marks));else 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u=c==`preserve`&&i&&this.dom.style.overflowAnchor==null&&wi(this);if(i){this.domObserver.stop();let t=l&&(I||L)&&!this.composing&&!n.selection.empty&&!e.selection.empty&&tc(n.selection,e.selection);if(l){let n=L?this.trackWrites=this.domSelectionRange().focusNode:null;this.composing&&(this.input.compositionNode=Qo(this)),(r||!this.docView.update(e.doc,s,o,this))&&(this.docView.updateOuterDeco(s),this.docView.destroy(),this.docView=sa(e.doc,s,o,this.dom,this)),n&&(!this.trackWrites||!this.dom.contains(this.trackWrites))&&(t=!0)}t||!(this.input.mouseDown&&this.domObserver.currentSelection.eq(this.domSelectionRange())&&Va(this))?ka(this,t):(Ia(this,e.selection),this.domObserver.setCurSelection()),this.domObserver.start()}this.updatePluginViews(n),this.dragging?.node&&!n.doc.eq(e.doc)&&this.updateDraggedNode(this.dragging,n),c==`reset`?this.dom.scrollTop=0:c==`to selection`?this.scrollToSelection():u&&Ei(u)}scrollToSelection(){let 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t=this._props.dispatchTransaction;t?t.call(this,e):this.updateState(this.state.apply(e))};function Qs(e){let t=Object.create(null);return t.class=`ProseMirror`,t.contenteditable=String(e.editable),e.someProp(`attributes`,n=>{if(typeof n==`function`&&(n=n(e.state)),n)for(let e in n)e==`class`?t.class+=` `+n[e]:e==`style`?t.style=(t.style?t.style+`;`:``)+n[e]:!t[e]&&e!=`contenteditable`&&e!=`nodeName`&&(t[e]=String(n[e]))}),t.translate||=`no`,[gs.node(0,e.state.doc.content.size,t)]}function $s(e){if(e.markCursor){let t=document.createElement(`img`);t.className=`ProseMirror-separator`,t.setAttribute(`mark-placeholder`,`true`),t.setAttribute(`alt`,``),e.cursorWrapper={dom:t,deco:gs.widget(e.state.selection.from,t,{raw:!0,marks:e.markCursor})}}else e.cursorWrapper=null}function ec(e){return!e.someProp(`editable`,t=>t(e.state)===!1)}function tc(e,t){let n=Math.min(e.$anchor.sharedDepth(e.head),t.$anchor.sharedDepth(t.head));return e.$anchor.start(n)!=t.$anchor.start(n)}function nc(e){let 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uc(e){var t=!(sc&&e.metaKey&&e.shiftKey&&!e.ctrlKey&&!e.altKey||cc&&e.shiftKey&&e.key&&e.key.length==1||e.key==`Unidentified`)&&e.key||(e.shiftKey?oc:ac)[e.keyCode]||e.key||`Unidentified`;return t==`Esc`&&(t=`Escape`),t==`Del`&&(t=`Delete`),t==`Left`&&(t=`ArrowLeft`),t==`Up`&&(t=`ArrowUp`),t==`Right`&&(t=`ArrowRight`),t==`Down`&&(t=`ArrowDown`),t}var dc=typeof navigator<`u`&&/Mac|iP(hone|[oa]d)/.test(navigator.platform),fc=typeof navigator<`u`&&/Win/.test(navigator.platform);function pc(e){let t=e.split(/-(?!$)/),n=t[t.length-1];n==`Space`&&(n=` `);let r,i,a,o;for(let e=0;e{for(var n in t)bc(e,n,{get:t[n],enumerable:!0})};function Sc(e){let{state:t,transaction:n}=e,{selection:r}=n,{doc:i}=n,{storedMarks:a}=n;return{...t,apply:t.apply.bind(t),applyTransaction:t.applyTransaction.bind(t),plugins:t.plugins,schema:t.schema,reconfigure:t.reconfigure.bind(t),toJSON:t.toJSON.bind(t),get storedMarks(){return a},get selection(){return r},get doc(){return i},get tr(){return 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Tc=()=>({editor:e,view:t})=>(requestAnimationFrame(()=>{var n;e.isDestroyed||(t.dom.blur(),(n=window==null?void 0:window.getSelection())==null||n.removeAllRanges())}),!0),Ec=(e=!0)=>({commands:t})=>t.setContent(``,{emitUpdate:e}),Dc=()=>({state:e,tr:t,dispatch:n})=>{let{selection:r}=t,{ranges:i}=r;return n&&i.forEach(({$from:n,$to:r})=>{e.doc.nodesBetween(n.pos,r.pos,(e,n)=>{if(e.type.isText)return;let{doc:r,mapping:i}=t,a=r.resolve(i.map(n)),o=r.resolve(i.map(n+e.nodeSize)),s=a.blockRange(o);if(!s)return;let c=Ut(s);if(e.type.isTextblock){let{defaultType:e}=a.parent.contentMatchAt(a.index());t.setNodeMarkup(s.start,e)}(c||c===0)&&t.lift(s,c)})}),!0},Oc=e=>t=>e(t),kc=()=>({state:e,dispatch:t})=>_r(e,t),Ac=(e,t)=>({editor:n,tr:r})=>{let{state:i}=n,a=i.doc.slice(e.from,e.to);r.deleteRange(e.from,e.to);let o=r.mapping.map(t);return r.insert(o,a.content),r.setSelection(new j(r.doc.resolve(Math.max(o-1,0)))),!0},jc=()=>({tr:e,dispatch:t})=>{let{selection:n}=e,r=n.$anchor.node();if(r.content.size>0)return!1;let i=e.selection.$anchor;for(let n=i.depth;n>0;--n)if(i.node(n).type===r.type){if(t){let t=i.before(n),r=i.after(n);e.delete(t,r).scrollIntoView()}return!0}return!1};function W(e,t){if(typeof e==`string`){if(!t.nodes[e])throw Error(`There is no node type named '${e}'. 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od=class{constructor(e={}){this.type=`extendable`,this.parent=null,this.child=null,this.name=``,this.config={name:this.name},this.config={...this.config,...e},this.name=this.config.name}get options(){return{...K(G(this,`addOptions`,{name:this.name}))||{}}}get storage(){return{...K(G(this,`addStorage`,{name:this.name,options:this.options}))||{}}}configure(e={}){let t=this.extend({...this.config,addOptions:()=>ad(this.options,e)});return t.name=this.name,t.parent=this.parent,t}extend(e={}){let t=new this.constructor({...this.config,...e});return t.parent=this,this.child=t,t.name=`name`in e?e.name:t.parent.name,t}},sd=class e extends od{constructor(){super(...arguments),this.type=`mark`}static create(t={}){return new e(typeof t==`function`?t():t)}static handleExit({editor:e,mark:t}){let{tr:n}=e.state,r=e.state.selection.$from;if(r.pos===r.end()){let i=r.marks();if(!i.find(e=>e?.type.name===t.name))return!1;let a=i.find(e=>e?.type.name===t.name);return 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0,``),a.find,o).forEach(e=>{if(e.index===void 0)return;let t=p+e.index+1,r=t+e[0].length,i={from:n.tr.mapping.map(t),to:n.tr.mapping.map(r)},f=a.handler({state:n,range:i,match:e,commands:c,chain:l,can:u,pasteEvent:o,dropEvent:s});d.push(f)})}),d.every(e=>e!==null)}var fd=null,pd=e=>{var t;let n=new ClipboardEvent(`paste`,{clipboardData:new DataTransfer});return(t=n.clipboardData)==null||t.setData(`text/html`,e),n};function md(e){let{editor:t,rules:n}=e,r=null,i=!1,a=!1,o=typeof ClipboardEvent<`u`?new ClipboardEvent(`paste`):null,s;try{s=typeof DragEvent<`u`?new DragEvent(`drop`):null}catch{s=null}let c=({state:e,from:n,to:r,rule:i,pasteEvt:a})=>{let c=e.tr;if(!(!dd({editor:t,state:Sc({state:e,transaction:c}),from:Math.max(n-1,0),to:r.b-1,rule:i,pasteEvent:a,dropEvent:s})||!c.steps.length)){try{s=typeof DragEvent<`u`?new DragEvent(`drop`):null}catch{s=null}return o=typeof ClipboardEvent<`u`?new ClipboardEvent(`paste`):null,c}};return n.map(e=>new N({view(e){let n=n=>{r=e.dom.parentElement?.contains(n.target)?e.dom.parentElement:null,r&&(fd=t)},i=()=>{fd&&=null};return window.addEventListener(`dragstart`,n),window.addEventListener(`dragend`,i),{destroy(){window.removeEventListener(`dragstart`,n),window.removeEventListener(`dragend`,i)}}},props:{handleDOMEvents:{drop:(e,t)=>{if(a=r===e.dom.parentElement,s=t,!a){let e=fd;e?.isEditable&&setTimeout(()=>{let t=e.state.selection;t&&e.commands.deleteRange({from:t.from,to:t.to})},10)}return!1},paste:(e,t)=>{let n=t.clipboardData?.getData(`text/html`);return o=t,i=!!n?.includes(`data-pm-slice`),!1}}},appendTransaction:(t,n,r)=>{let s=t[0],l=s.getMeta(`uiEvent`)===`paste`&&!i,u=s.getMeta(`uiEvent`)===`drop`&&!a,d=s.getMeta(`applyPasteRules`),f=!!d;if(!l&&!u&&!f)return;if(f){let{text:t}=d;t=typeof t==`string`?t:Vl(C.from(t),r.schema);let{from:n}=d,i=n+t.length,a=pd(t);return c({rule:e,state:r,from:n,to:{b:i},pasteEvt:a})}let p=n.doc.content.findDiffStart(r.doc.content),m=n.doc.content.findDiffEnd(r.doc.content);if(!(!cd(p)||!m||p===m.b))return c({rule:e,state:r,from:p,to:m,pasteEvt:o})}}))}var hd=class{constructor(e,t){this.splittableMarks=[],this.editor=t,this.baseExtensions=e,this.extensions=nu(e),this.schema=$l(this.extensions,t),this.setupExtensions()}get commands(){return this.extensions.reduce((e,t)=>{let n=G(t,`addCommands`,{name:t.name,options:t.options,storage:this.editor.extensionStorage[t.name],editor:this.editor,type:pu(t.name,this.schema)});return n?{...e,...n()}:e},{})}get plugins(){let{editor:e}=this;return tu([...this.extensions].reverse()).flatMap(t=>{let n={name:t.name,options:t.options,storage:this.editor.extensionStorage[t.name],editor:e,type:pu(t.name,this.schema)},r=[],i=G(t,`addKeyboardShortcuts`,n),a={};if(t.type===`mark`&&G(t,`exitable`,n)&&(a.ArrowRight=()=>sd.handleExit({editor:e,mark:t})),i){let t=Object.fromEntries(Object.entries(i()).map(([t,n])=>[t,()=>n({editor:e})]));a={...a,...t}}let o=gc(a);r.push(o);let s=G(t,`addInputRules`,n);if(bu(t,e.options.enableInputRules)&&s){let t=s();if(t&&t.length){let n=nd({editor:e,rules:t}),i=Array.isArray(n)?n:[n];r.push(...i)}}let c=G(t,`addPasteRules`,n);if(bu(t,e.options.enablePasteRules)&&c){let t=c();if(t&&t.length){let n=md({editor:e,rules:t});r.push(...n)}}let l=G(t,`addProseMirrorPlugins`,n);if(l){let e=l();r.push(...e)}return r})}get attributes(){return Gl(this.extensions)}get nodeViews(){let{editor:e}=this,{nodeExtensions:t}=Wl(this.extensions);return Object.fromEntries(t.filter(e=>!!G(e,`addNodeView`)).map(t=>{let n=this.attributes.filter(e=>e.type===t.name),r=G(t,`addNodeView`,{name:t.name,options:t.options,storage:this.editor.extensionStorage[t.name],editor:e,type:W(t.name,this.schema)});if(!r)return[];let i=r();return i?[t.name,(r,a,o,s,c)=>i({node:r,view:a,getPos:o,decorations:s,innerDecorations:c,editor:e,extension:t,HTMLAttributes:Jl(r,n)})]:[]}))}dispatchTransaction(e){let{editor:t}=this;return tu([...this.extensions].reverse()).reduceRight((e,n)=>{let r={name:n.name,options:n.options,storage:this.editor.extensionStorage[n.name],editor:t,type:pu(n.name,this.schema)},i=G(n,`dispatchTransaction`,r);return i?t=>{i.call(r,{transaction:t,next:e})}:e},e)}transformPastedHTML(e){let{editor:t}=this;return tu([...this.extensions]).reduce((e,n)=>{let r={name:n.name,options:n.options,storage:this.editor.extensionStorage[n.name],editor:t,type:pu(n.name,this.schema)},i=G(n,`transformPastedHTML`,r);return i?(t,n)=>{let a=e(t,n);return i.call(r,a)}:e},e||(e=>e))}get markViews(){let{editor:e}=this,{markExtensions:t}=Wl(this.extensions);return Object.fromEntries(t.filter(e=>!!G(e,`addMarkView`)).map(t=>{let n=this.attributes.filter(e=>e.type===t.name),r=G(t,`addMarkView`,{name:t.name,options:t.options,storage:this.editor.extensionStorage[t.name],editor:e,type:Hc(t.name,this.schema)});return r?[t.name,(i,a,o)=>{let s=Jl(i,n);return r()({mark:i,view:a,inline:o,editor:e,extension:t,HTMLAttributes:s,updateAttributes:t=>{Gd(i,e,t)}})}]:[]}))}setupExtensions(){let e=this.extensions;this.editor.extensionStorage=Object.fromEntries(e.map(e=>[e.name,e.storage])),e.forEach(e=>{let t={name:e.name,options:e.options,storage:this.editor.extensionStorage[e.name],editor:this.editor,type:pu(e.name,this.schema)};e.type===`mark`&&(K(G(e,`keepOnSplit`,t))??!0)&&this.splittableMarks.push(e.name);let n=G(e,`onBeforeCreate`,t),r=G(e,`onCreate`,t),i=G(e,`onUpdate`,t),a=G(e,`onSelectionUpdate`,t),o=G(e,`onTransaction`,t),s=G(e,`onFocus`,t),c=G(e,`onBlur`,t),l=G(e,`onDestroy`,t);n&&this.editor.on(`beforeCreate`,n),r&&this.editor.on(`create`,r),i&&this.editor.on(`update`,i),a&&this.editor.on(`selectionUpdate`,a),o&&this.editor.on(`transaction`,o),s&&this.editor.on(`focus`,s),c&&this.editor.on(`blur`,c),l&&this.editor.on(`destroy`,l)})}};hd.resolve=nu,hd.sort=tu,hd.flatten=Bl,xc({},{ClipboardTextSerializer:()=>gd,Commands:()=>_d,Delete:()=>vd,Drop:()=>yd,Editable:()=>bd,FocusEvents:()=>Sd,Keymap:()=>Cd,Paste:()=>wd,Tabindex:()=>Td,TextDirection:()=>Ed,focusEventsPluginKey:()=>xd});var J=class e extends od{constructor(){super(...arguments),this.type=`extension`}static create(t={}){return new e(typeof t==`function`?t():t)}configure(e){return super.configure(e)}extend(e){let t=typeof e==`function`?e():e;return super.extend(t)}},gd=J.create({name:`clipboardTextSerializer`,addOptions(){return{blockSeparator:void 0}},addProseMirrorPlugins(){return[new N({key:new P(`clipboardTextSerializer`),props:{clipboardTextSerializer:()=>{let{editor:e}=this,{state:t,schema:n}=e,{doc:r,selection:i}=t,{ranges:a}=i,o=Math.min(...a.map(e=>e.$from.pos)),s=Math.max(...a.map(e=>e.$to.pos)),c=au(n);return ru(r,{from:o,to:s},{...this.options.blockSeparator===void 0?{}:{blockSeparator:this.options.blockSeparator},textSerializers:c})}}})]}}),_d=J.create({name:`commands`,addCommands(){return{...wc}}}),vd=J.create({name:`delete`,onUpdate({transaction:e,appendedTransactions:t}){let n=()=>{var n;if(((n=this.editor.options.coreExtensionOptions?.delete)?.filterTransaction)?.call(n,e)??e.getMeta(`y-sync$`))return;let r=Fl(e.before,[e,...t]);uu(r).forEach(t=>{r.mapping.mapResult(t.oldRange.from).deletedAfter&&r.mapping.mapResult(t.oldRange.to).deletedBefore&&r.before.nodesBetween(t.oldRange.from,t.oldRange.to,(n,i)=>{let a=i+n.nodeSize-2,o=t.oldRange.from<=i&&a<=t.oldRange.to;this.editor.emit(`delete`,{type:`node`,node:n,from:i,to:a,newFrom:r.mapping.map(i),newTo:r.mapping.map(a),deletedRange:t.oldRange,newRange:t.newRange,partial:!o,editor:this.editor,transaction:e,combinedTransform:r})})});let i=r.mapping;r.steps.forEach((t,n)=>{if(t instanceof Pt){let a=i.slice(n).map(t.from,-1),o=i.slice(n).map(t.to),s=i.invert().map(a,-1),c=i.invert().map(o),l=a>0?r.doc.nodeAt(a-1)?.marks.some(e=>e.eq(t.mark)):!1,u=r.doc.nodeAt(o)?.marks.some(e=>e.eq(t.mark));this.editor.emit(`delete`,{type:`mark`,mark:t.mark,from:t.from,to:t.to,deletedRange:{from:s,to:c},newRange:{from:a,to:o},partial:!!(u||l),editor:this.editor,transaction:e,combinedTransform:r})}})};this.editor.options.coreExtensionOptions?.delete?.async??!0?setTimeout(n,0):n()}}),yd=J.create({name:`drop`,addProseMirrorPlugins(){return[new N({key:new P(`tiptapDrop`),props:{handleDrop:(e,t,n,r)=>{this.editor.emit(`drop`,{editor:this.editor,event:t,slice:n,moved:r})}}})]}}),bd=J.create({name:`editable`,addProseMirrorPlugins(){return[new N({key:new P(`editable`),props:{editable:()=>this.editor.options.editable}})]}}),xd=new P(`focusEvents`),Sd=J.create({name:`focusEvents`,addProseMirrorPlugins(){let{editor:e}=this;return[new N({key:xd,props:{handleDOMEvents:{focus:(t,n)=>{e.isFocused=!0;let r=e.state.tr.setMeta(`focus`,{event:n}).setMeta(`addToHistory`,!1);return t.dispatch(r),!1},blur:(t,n)=>{e.isFocused=!1;let r=e.state.tr.setMeta(`blur`,{event:n}).setMeta(`addToHistory`,!1);return t.dispatch(r),!1}}}})]}}),Cd=J.create({name:`keymap`,addKeyboardShortcuts(){let e=()=>this.editor.commands.first(({commands:e})=>[()=>e.undoInputRule(),()=>e.command(({tr:t})=>{let{selection:n,doc:r}=t,{empty:i,$anchor:a}=n,{pos:o,parent:s}=a,c=a.parent.isTextblock&&o>0?t.doc.resolve(o-1):a,l=c.parent.type.spec.isolating,u=a.pos-a.parentOffset,d=l&&c.parent.childCount===1?u===a.pos:A.atStart(r).from===o;return!i||!s.type.isTextblock||s.textContent.length||!d||d&&a.parent.type.name===`paragraph`?!1:e.clearNodes()}),()=>e.deleteSelection(),()=>e.joinBackward(),()=>e.selectNodeBackward()]),t=()=>this.editor.commands.first(({commands:e})=>[()=>e.deleteSelection(),()=>e.deleteCurrentNode(),()=>e.joinForward(),()=>e.selectNodeForward()]),n={Enter:()=>this.editor.commands.first(({commands:e})=>[()=>e.newlineInCode(),()=>e.createParagraphNear(),()=>e.liftEmptyBlock(),()=>e.splitBlock()]),"Mod-Enter":()=>this.editor.commands.exitCode(),Backspace:e,"Mod-Backspace":e,"Shift-Backspace":e,Delete:t,"Mod-Delete":t,"Mod-a":()=>this.editor.commands.selectAll()},r={...n},i={...n,"Ctrl-h":e,"Alt-Backspace":e,"Ctrl-d":t,"Ctrl-Alt-Backspace":t,"Alt-Delete":t,"Alt-d":t,"Ctrl-a":()=>this.editor.commands.selectTextblockStart(),"Ctrl-e":()=>this.editor.commands.selectTextblockEnd()};return Yc()||ml()?i:r},addProseMirrorPlugins(){return[new N({key:new P(`clearDocument`),appendTransaction:(e,t,n)=>{if(e.some(e=>e.getMeta(`composition`)))return;let r=e.some(e=>e.docChanged)&&!t.doc.eq(n.doc),i=e.some(e=>e.getMeta(`preventClearDocument`));if(!r||i)return;let{empty:a,from:o,to:s}=t.selection,c=A.atStart(t.doc).from,l=A.atEnd(t.doc).to;if(a||!(o===c&&s===l)||!Su(n.doc))return;let u=n.tr,d=Sc({state:n,transaction:u}),{commands:f}=new Cc({editor:this.editor,state:d});if(f.clearNodes(),u.steps.length)return u}})]}}),wd=J.create({name:`paste`,addProseMirrorPlugins(){return[new N({key:new P(`tiptapPaste`),props:{handlePaste:(e,t,n)=>{this.editor.emit(`paste`,{editor:this.editor,event:t,slice:n})}}})]}}),Td=J.create({name:`tabindex`,addProseMirrorPlugins(){return[new N({key:new P(`tabindex`),props:{attributes:()=>this.editor.isEditable?{tabindex:`0`}:{}}})]}}),Ed=J.create({name:`textDirection`,addOptions(){return{direction:void 0}},addGlobalAttributes(){if(!this.options.direction)return[];let{nodeExtensions:e}=Wl(this.extensions);return[{types:e.filter(e=>e.name!==`text`).map(e=>e.name),attributes:{dir:{default:this.options.direction,parseHTML:e=>{let t=e.getAttribute(`dir`);return t&&(t===`ltr`||t===`rtl`||t===`auto`)?t:this.options.direction},renderHTML:e=>e.dir?{dir:e.dir}:{}}}}]},addProseMirrorPlugins(){return[new N({key:new P(`textDirection`),props:{attributes:()=>{let e=this.options.direction;return e?{dir:e}:{}}}})]}}),Dd=class e{constructor(e,t,n=!1,r=null){this.currentNode=null,this.actualDepth=null,this.isBlock=n,this.resolvedPos=e,this.editor=t,this.currentNode=r}get name(){return this.node.type.name}get node(){return this.currentNode||this.resolvedPos.node()}get element(){return this.editor.view.domAtPos(this.pos).node}get depth(){return this.actualDepth??this.resolvedPos.depth}get pos(){return this.resolvedPos.pos}get content(){return this.node.content}set content(e){let t=this.from,n=this.to;if(this.isBlock){if(this.content.size===0){console.error(`You can\u2019t set content on a block node. Tried to set content on ${this.name} at ${this.pos}`);return}t=this.from+1,n=this.to-1}this.editor.commands.insertContentAt({from:t,to:n},e)}get attributes(){return this.node.attrs}get textContent(){return this.node.textContent}get size(){return this.node.nodeSize}get from(){return this.isBlock?this.pos:this.resolvedPos.start(this.resolvedPos.depth)}get range(){return{from:this.from,to:this.to}}get to(){return this.isBlock?this.pos+this.size:this.resolvedPos.end(this.resolvedPos.depth)+ +!this.node.isText}get parent(){if(this.depth===0)return null;let t=this.resolvedPos.start(this.resolvedPos.depth-1);return new e(this.resolvedPos.doc.resolve(t),this.editor)}get before(){let t=this.resolvedPos.doc.resolve(this.from-(this.isBlock?1:2));return t.depth!==this.depth&&(t=this.resolvedPos.doc.resolve(this.from-3)),new e(t,this.editor)}get after(){let t=this.resolvedPos.doc.resolve(this.to+(this.isBlock?2:1));return t.depth!==this.depth&&(t=this.resolvedPos.doc.resolve(this.to+3)),new e(t,this.editor)}get children(){let t=[];return this.node.content.forEach((n,r)=>{let i=n.isBlock&&!n.isTextblock,a=n.isAtom&&!n.isText,o=n.isInline,s=this.pos+r+ +!a;if(s<0||s>this.resolvedPos.doc.nodeSize-2)return;let c=this.resolvedPos.doc.resolve(s);if(!i&&!o&&c.depth<=this.depth)return;let l=new e(c,this.editor,i,i||o?n:null);i&&(l.actualDepth=this.depth+1),t.push(l)}),t}get firstChild(){return this.children[0]||null}get lastChild(){let e=this.children;return e[e.length-1]||null}closest(e,t={}){let n=null,r=this.parent;for(;r&&!n;){if(r.node.type.name===e)if(Object.keys(t).length>0){let e=r.node.attrs,n=Object.keys(t);for(let r=0;r{n&&r.length>0||(a.node.type.name===e&&i.every(e=>t[e]===a.node.attrs[e])&&r.push(a),!(n&&r.length>0)&&(r=r.concat(a.querySelectorAll(e,t,n))))}),r}setAttribute(e){let{tr:t}=this.editor.state;t.setNodeMarkup(this.from,void 0,{...this.node.attrs,...e}),this.editor.view.dispatch(t)}},Od=`.ProseMirror { + position: relative; +} + +.ProseMirror { + word-wrap: break-word; + white-space: pre-wrap; + white-space: break-spaces; + -webkit-font-variant-ligatures: none; + font-variant-ligatures: none; + font-feature-settings: "liga" 0; /* the above doesn't seem to work in Edge */ +} + +.ProseMirror [contenteditable="false"] { + white-space: normal; +} + +.ProseMirror [contenteditable="false"] [contenteditable="true"] { + white-space: pre-wrap; +} + +.ProseMirror pre { + white-space: pre-wrap; +} + +img.ProseMirror-separator { + display: inline !important; + border: none !important; + margin: 0 !important; + width: 0 !important; + height: 0 !important; +} + +.ProseMirror-gapcursor { + display: none; + pointer-events: none; + position: absolute; + margin: 0; +} + +.ProseMirror-gapcursor:after { + content: ""; + display: block; + position: absolute; + top: -2px; + width: 20px; + border-top: 1px solid black; + animation: ProseMirror-cursor-blink 1.1s steps(2, start) infinite; +} + +@keyframes ProseMirror-cursor-blink { + to { + visibility: hidden; + } +} + +.ProseMirror-hideselection *::selection { + background: transparent; +} + +.ProseMirror-hideselection *::-moz-selection { + background: transparent; +} + +.ProseMirror-hideselection * { + caret-color: transparent; +} + +.ProseMirror-focused .ProseMirror-gapcursor { + display: block; +}`;function kd(e,t,n){let r=document.querySelector(`style[data-tiptap-style${n?`-${n}`:``}]`);if(r!==null)return r;let i=document.createElement(`style`);return t&&i.setAttribute(`nonce`,t),i.setAttribute(`data-tiptap-style${n?`-${n}`:``}`,``),i.innerHTML=e,document.getElementsByTagName(`head`)[0].appendChild(i),i}var Ad=class extends Qu{constructor(e={}){super(),this.css=null,this.className=`tiptap`,this.editorView=null,this.isFocused=!1,this.isInitialized=!1,this.extensionStorage={},this.instanceId=Math.random().toString(36).slice(2,9),this.options={element:typeof document<`u`?document.createElement(`div`):null,content:``,injectCSS:!0,injectNonce:void 0,extensions:[],autofocus:!1,editable:!0,textDirection:void 0,editorProps:{},parseOptions:{},coreExtensionOptions:{},enableInputRules:!0,enablePasteRules:!0,enableCoreExtensions:!0,enableContentCheck:!1,emitContentError:!1,onBeforeCreate:()=>null,onCreate:()=>null,onMount:()=>null,onUnmount:()=>null,onUpdate:()=>null,onSelectionUpdate:()=>null,onTransaction:()=>null,onFocus:()=>null,onBlur:()=>null,onDestroy:()=>null,onContentError:({error:e})=>{throw e},onPaste:()=>null,onDrop:()=>null,onDelete:()=>null,enableExtensionDispatchTransaction:!0},this.isCapturingTransaction=!1,this.capturedTransaction=null,this.utils={getUpdatedPosition:Tu,createMappablePosition:Eu},this.setOptions(e),this.createExtensionManager(),this.createCommandManager(),this.createSchema(),this.on(`beforeCreate`,this.options.onBeforeCreate),this.emit(`beforeCreate`,{editor:this}),this.on(`mount`,this.options.onMount),this.on(`unmount`,this.options.onUnmount),this.on(`contentError`,this.options.onContentError),this.on(`create`,this.options.onCreate),this.on(`update`,this.options.onUpdate),this.on(`selectionUpdate`,this.options.onSelectionUpdate),this.on(`transaction`,this.options.onTransaction),this.on(`focus`,this.options.onFocus),this.on(`blur`,this.options.onBlur),this.on(`destroy`,this.options.onDestroy),this.on(`drop`,({event:e,slice:t,moved:n})=>this.options.onDrop(e,t,n)),this.on(`paste`,({event:e,slice:t})=>this.options.onPaste(e,t)),this.on(`delete`,this.options.onDelete);let t=this.createDoc(),n=qc(t,this.options.autofocus);this.editorState=Jn.create({doc:t,schema:this.schema,selection:n||void 0}),this.options.element&&this.mount(this.options.element)}mount(e){if(typeof document>`u`)throw Error(`[tiptap error]: The editor cannot be mounted because there is no 'document' defined in this environment.`);this.createView(e),this.emit(`mount`,{editor:this}),this.css&&!document.head.contains(this.css)&&document.head.appendChild(this.css),window.setTimeout(()=>{this.isDestroyed||(this.options.autofocus!==!1&&this.options.autofocus!==null&&this.commands.focus(this.options.autofocus),this.emit(`create`,{editor:this}),this.isInitialized=!0)},0)}unmount(){if(this.editorView){let e=this.editorView.dom;e?.editor&&delete e.editor,this.editorView.destroy()}if(this.editorView=null,this.isInitialized=!1,this.css&&!document.querySelectorAll(`.${this.className}`).length)try{typeof this.css.remove==`function`?this.css.remove():this.css.parentNode&&this.css.parentNode.removeChild(this.css)}catch(e){console.warn(`Failed to remove CSS element:`,e)}this.css=null,this.emit(`unmount`,{editor:this})}get storage(){return this.extensionStorage}get commands(){return this.commandManager.commands}chain(){return this.commandManager.chain()}can(){return this.commandManager.can()}injectCSS(){this.options.injectCSS&&typeof document<`u`&&(this.css=kd(Od,this.options.injectNonce))}setOptions(e={}){this.options={...this.options,...e},!(!this.editorView||!this.state||this.isDestroyed)&&(this.options.editorProps&&this.view.setProps(this.options.editorProps),this.view.updateState(this.state))}setEditable(e,t=!0){this.setOptions({editable:e}),t&&this.emit(`update`,{editor:this,transaction:this.state.tr,appendedTransactions:[]})}get isEditable(){return this.options.editable&&this.view&&this.view.editable}get view(){return this.editorView?this.editorView:new Proxy({state:this.editorState,updateState:e=>{this.editorState=e},dispatch:e=>{this.dispatchTransaction(e)},composing:!1,dragging:null,editable:!0,isDestroyed:!1},{get:(e,t)=>{if(this.editorView)return this.editorView[t];if(t===`state`)return this.editorState;if(t in e)return Reflect.get(e,t);throw Error(`[tiptap error]: The editor view is not available. Cannot access view['${t}']. The editor may not be mounted yet.`)}})}get state(){return this.editorView&&(this.editorState=this.view.state),this.editorState}registerPlugin(e,t){let n=Hl(t)?t(e,[...this.state.plugins]):[...this.state.plugins,e],r=this.state.reconfigure({plugins:n});return this.view.updateState(r),r}unregisterPlugin(e){if(this.isDestroyed)return;let t=this.state.plugins,n=t;if([].concat(e).forEach(e=>{let t=typeof e==`string`?`${e}$`:e.key;n=n.filter(e=>!e.key.startsWith(t))}),t.length===n.length)return;let r=this.state.reconfigure({plugins:n});return this.view.updateState(r),r}createExtensionManager(){let e=[...this.options.enableCoreExtensions?[bd,gd.configure({blockSeparator:this.options.coreExtensionOptions?.clipboardTextSerializer?.blockSeparator}),_d,Sd,Cd,Td,yd,wd,vd,Ed.configure({direction:this.options.textDirection})].filter(e=>typeof this.options.enableCoreExtensions==`object`?this.options.enableCoreExtensions[e.name]!==!1:!0):[],...this.options.extensions].filter(e=>[`extension`,`node`,`mark`].includes(e?.type));this.extensionManager=new hd(e,this)}createCommandManager(){this.commandManager=new Cc({editor:this})}createSchema(){this.schema=this.extensionManager.schema}createDoc(){let e;try{e=Ml(this.options.content,this.schema,this.options.parseOptions,{errorOnInvalidContent:this.options.enableContentCheck})}catch(t){if(!(t instanceof Error)||![`[tiptap error]: Invalid JSON content`,`[tiptap error]: Invalid HTML content`].includes(t.message))throw t;this.emit(`contentError`,{editor:this,error:t,disableCollaboration:()=>{`collaboration`in this.storage&&typeof this.storage.collaboration==`object`&&this.storage.collaboration&&(this.storage.collaboration.isDisabled=!0),this.options.extensions=this.options.extensions.filter(e=>e.name!==`collaboration`),this.createExtensionManager()}}),e=Ml(this.options.content,this.schema,this.options.parseOptions,{errorOnInvalidContent:!1})}return e}createView(e){let{editorProps:t,enableExtensionDispatchTransaction:n}=this.options,r=t.dispatchTransaction||this.dispatchTransaction.bind(this),i=n?this.extensionManager.dispatchTransaction(r):r,a=t.transformPastedHTML,o=this.extensionManager.transformPastedHTML(a);this.editorView=new Zs(e,{...t,attributes:{role:`textbox`,...t?.attributes},dispatchTransaction:i,transformPastedHTML:o,state:this.editorState,markViews:this.extensionManager.markViews,nodeViews:this.extensionManager.nodeViews});let s=this.state.reconfigure({plugins:this.extensionManager.plugins});this.view.updateState(s),this.prependClass(),this.injectCSS();let c=this.view.dom;c.editor=this}createNodeViews(){this.view.isDestroyed||this.view.setProps({markViews:this.extensionManager.markViews,nodeViews:this.extensionManager.nodeViews})}prependClass(){this.view.dom.className=`${this.className} ${this.view.dom.className}`}captureTransaction(e){this.isCapturingTransaction=!0,e(),this.isCapturingTransaction=!1;let t=this.capturedTransaction;return this.capturedTransaction=null,t}dispatchTransaction(e){if(this.view.isDestroyed)return;if(this.isCapturingTransaction){if(!this.capturedTransaction){this.capturedTransaction=e;return}e.steps.forEach(e=>this.capturedTransaction?.step(e));return}let{state:t,transactions:n}=this.state.applyTransaction(e),r=!this.state.selection.eq(t.selection),i=n.includes(e),a=this.state;if(this.emit(`beforeTransaction`,{editor:this,transaction:e,nextState:t}),!i)return;this.view.updateState(t),this.emit(`transaction`,{editor:this,transaction:e,appendedTransactions:n.slice(1)}),r&&this.emit(`selectionUpdate`,{editor:this,transaction:e});let o=n.findLast(e=>e.getMeta(`focus`)||e.getMeta(`blur`)),s=o?.getMeta(`focus`),c=o?.getMeta(`blur`);s&&this.emit(`focus`,{editor:this,event:s.event,transaction:o}),c&&this.emit(`blur`,{editor:this,event:c.event,transaction:o}),!(e.getMeta(`preventUpdate`)||!n.some(e=>e.docChanged)||a.doc.eq(t.doc))&&this.emit(`update`,{editor:this,transaction:e,appendedTransactions:n.slice(1)})}getAttributes(e){return su(this.state,e)}isActive(e,t){let n=typeof e==`string`?e:null,r=typeof e==`string`?t:e;return _u(this.state,n,r)}getJSON(){return this.state.doc.toJSON()}getHTML(){return Vl(this.state.doc.content,this.schema)}getText(e){let{blockSeparator:t=` + +`,textSerializers:n={}}=e||{};return iu(this.state.doc,{blockSeparator:t,textSerializers:{...au(this.schema),...n}})}get isEmpty(){return Su(this.state.doc)}destroy(){this.emit(`destroy`),this.unmount(),this.removeAllListeners()}get isDestroyed(){return this.editorView?.isDestroyed??!0}$node(e,t){return this.$doc?.querySelector(e,t)||null}$nodes(e,t){return this.$doc?.querySelectorAll(e,t)||null}$pos(e){return new Dd(this.state.doc.resolve(e),this)}get $doc(){return this.$pos(0)}};function jd(e){return new $u({find:e.find,handler:({state:t,range:n,match:r})=>{let i=K(e.getAttributes,void 0,r);if(i===!1||i===null)return null;let{tr:a}=t,o=r[r.length-1],s=r[0];if(o){let r=s.search(/\S/),c=n.from+s.indexOf(o),l=c+o.length;if(du(n.from,n.to,t.doc).filter(t=>t.mark.type.excluded.find(n=>n===e.type&&n!==t.mark.type)).filter(e=>e.to>c).length)return null;ln.from&&a.delete(n.from+r,c);let u=n.from+r+o.length;a.addMark(n.from+r,u,e.type.create(i||{})),a.removeStoredMark(e.type)}},undoable:e.undoable})}function Md(e){return new $u({find:e.find,handler:({state:t,range:n,match:r})=>{let i=K(e.getAttributes,void 0,r)||{},{tr:a}=t,o=n.from,s=n.to,c=e.type.create(i);if(r[1]){let e=o+r[0].lastIndexOf(r[1]);e>s?e=s:s=e+r[1].length;let 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t={},n=[],r=e.replace(/["']([^"']*)["']/g,e=>(n.push(e),`__QUOTED_${n.length-1}__`)),i=r.match(/(?:^|\s)\.([a-zA-Z][\w-]*)/g);i&&(t.class=i.map(e=>e.trim().slice(1)).join(` `));let a=r.match(/(?:^|\s)#([a-zA-Z][\w-]*)/);a&&(t.id=a[1]),Array.from(r.matchAll(/([a-zA-Z][\w-]*)\s*=\s*(__QUOTED_\d+__)/g)).forEach(([,e,r])=>{let i=n[parseInt(r.match(/__QUOTED_(\d+)__/)?.[1]||`0`,10)];i&&(t[e]=i.slice(1,-1))});let o=r.replace(/(?:^|\s)\.([a-zA-Z][\w-]*)/g,``).replace(/(?:^|\s)#([a-zA-Z][\w-]*)/g,``).replace(/([a-zA-Z][\w-]*)\s*=\s*__QUOTED_\d+__/g,``).trim();return o&&o.split(/\s+/).filter(Boolean).forEach(e=>{e.match(/^[a-zA-Z][\w-]*$/)&&(t[e]=!0)}),t}function Ld(e){if(!e||Object.keys(e).length===0)return``;let t=[];return e.class&&String(e.class).split(/\s+/).filter(Boolean).forEach(e=>t.push(`.${e}`)),e.id&&t.push(`#${e.id}`),Object.entries(e).forEach(([e,n])=>{e===`class`||e===`id`||(n===!0?t.push(e):n!==!1&&n!=null&&t.push(`${e}="${String(n)}"`))}),t.join(` `)}function 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Focus: birth injury, DDH, congenital anomaly. All steps symmetric.`,components:[{name:`Resting posture`,steps:[{label:`Observe posture`,method:`Place supine and undisturbed for 30s`,normal:`Symmetric flexion at hips, knees, elbows`},{label:`Hand position`,method:`Inspect resting hands`,normal:`Loosely fisted; opens intermittently`},{label:`Symmetry`,method:`Compare left vs right side at rest`,normal:`Mirror-image posture`}],abnormalHints:[`Frog-leg (hypotonia)`,`Asymmetric arm (brachial plexus/clavicle fx)`,`Opisthotonos (CNS)`,`Persistent fisting with thumb in palm`]},{name:`Clavicles`,steps:[{label:`Palpate right clavicle`,method:`Trace from sternoclavicular joint to acromion with index finger`,normal:`Smooth, continuous, no step-off`},{label:`Palpate left clavicle`,method:`Same technique on left side`,normal:`Smooth, continuous`},{label:`Crepitus check`,method:`Light pressure along length of clavicle while gently abducting arm`,normal:`No crepitus, no pain response`}],abnormalHints:[`Palpable step-off or callus (fracture — LGA, shoulder dystocia)`,`Asymmetric Moro on affected side`]},{name:`Hips — DDH screen`,steps:[{label:`Thigh/gluteal folds`,method:`Undress completely; compare skin-fold symmetry`,normal:`Symmetric thigh and gluteal folds`},{label:`Abduction`,method:`Flex hips 90°, abduct simultaneously`,normal:`Both hips abduct to ≥75° symmetrically`},{label:`Barlow maneuver`,method:`Thumb on medial thigh, flex hip 90°, adduct, apply gentle posterior pressure`,normal:`No clunk or movement felt (negative)`},{label:`Ortolani maneuver`,method:`From Barlow position: abduct and lift with fingers on greater trochanter`,normal:`No clunk as hip returns (negative)`},{label:`Galeazzi sign`,method:`Knees flexed together with feet on table; compare knee heights`,normal:`Knees level — no leg-length discrepancy`}],abnormalHints:[`Palpable Ortolani clunk (dislocated, reducible)`,`Barlow clunk (dislocatable)`,`Limited abduction`,`Positive Galeazzi (shortened femur)`]},{name:`Spine and back`,steps:[{label:`Position prone`,method:`Turn infant prone, support chest`,normal:`Tolerates position, lifts head briefly`},{label:`Palpate midline`,method:`Run finger from C-spine to coccyx`,normal:`Straight midline, no step-offs or gaps`},{label:`Sacral inspection`,method:`Inspect sacral dimple if present; measure depth, distance from anus`,normal:`No dimple, or dimple <5mm deep and <2.5cm from anus`},{label:`Cutaneous markers`,method:`Inspect midline skin from neck to coccyx`,normal:`No hair tuft, hemangioma, lipoma, or sinus tract`}],abnormalHints:[`Deep sacral dimple (>5mm) or >2.5cm from anus — imaging`,`Hair tuft, hemangioma, lipoma (occult dysraphism)`,`Palpable defect`]},{name:`Upper extremities`,steps:[{label:`Spontaneous movement`,method:`Observe both arms for 30s`,normal:`Symmetric antigravity movement`},{label:`Digits`,method:`Count and inspect fingers both hands`,normal:`5 digits each, no webbing or duplication`},{label:`Palmar creases`,method:`Inspect palmar creases`,normal:`Normal triradiate creases`}],abnormalHints:[`Erb/Klumpke palsy (paucity of movement)`,`Polydactyly, syndactyly`,`Single transverse (simian) palmar crease`]},{name:`Lower extremities / feet`,steps:[{label:`Hip and knee range`,method:`Gently flex, extend, internally/externally rotate each`,normal:`Full symmetric range, no contracture`},{label:`Foot alignment`,method:`Inspect resting foot position`,normal:`Midline or mildly adducted forefoot`},{label:`Passive correction`,method:`Gently attempt to bring foot to neutral`,normal:`Fully correctable to neutral`},{label:`Stroke test`,method:`Stroke lateral border of foot`,normal:`Foot dorsiflexes and everts reflexively`}],abnormalHints:[`Rigid clubfoot (non-correctable talipes equinovarus)`,`Fixed metatarsus adductus`,`Rocker-bottom foot (trisomy 18)`,`Calcaneovalgus`]}]},neuro:{overview:`Primitive reflexes present and symmetric. Tone assessed passively and actively. Full exam 3–5 min on a quiet, fed infant.`,components:[{name:`Alertness and behavior`,steps:[{label:`State cycling`,method:`Observe over 1–2 min for alert periods`,normal:`Alert periods with spontaneous eye opening`},{label:`Response to voice`,method:`Speak softly near ear`,normal:`Quiets to voice or turns toward sound`},{label:`Consolability`,method:`If crying, attempt to soothe with swaddling or voice`,normal:`Consolable within 1–2 min`}],abnormalHints:[`Lethargy`,`Jitteriness not stopped by passive flexion`,`Irritability unrelieved by feeding`]},{name:`Cranial nerves`,steps:[{label:`CN II — pupil response`,method:`Shine light in each eye`,normal:`Pupils equal, reactive to light, direct and consensual`},{label:`CN II — blink to light`,method:`Bright light in the line of sight`,normal:`Reflex blink`},{label:`CN VII — facial symmetry at rest`,method:`Observe resting face`,normal:`Symmetric nasolabial folds`},{label:`CN VII — facial symmetry with cry`,method:`Note face during a cry`,normal:`Symmetric grimace`},{label:`CN IX, X, XII — suck and swallow`,method:`Offer clean gloved finger, pacifier, or during feed`,normal:`Strong coordinated suck-swallow, no choking`}],abnormalHints:[`Asymmetric face (CN VII injury — usually forceps)`,`Poor suck or uncoordinated swallow`,`Fixed or unequal pupil`]},{name:`Tone — passive`,steps:[{label:`Pull-to-sit`,method:`Grasp hands/wrists, pull smoothly to sit`,normal:`Brief head lag at term; not dramatic`},{label:`Ventral suspension`,method:`Suspend prone over hand at chest`,normal:`Head briefly lifts to horizontal; extremities flexed`},{label:`Arm recoil`,method:`Extend both arms fully at elbows, release`,normal:`Rapid return to flexion`},{label:`Popliteal angle`,method:`Hip flexed 90°, extend knee maximally`,normal:`≤110°`}],abnormalHints:[`Marked head lag (hypotonia)`,`Slip-through on vertical suspension`,`Hypertonia / scissoring`,`Floppy limbs with no recoil`]},{name:`Spontaneous movement`,steps:[{label:`Observe limbs`,method:`Undisturbed over 1 min, note movement`,normal:`Symmetric antigravity movement of all 4 limbs`},{label:`Quality of movement`,method:`Note smoothness vs jitteriness`,normal:`Smooth, mildly variable movements`}],abnormalHints:[`Paucity of movement in one limb`,`Coarse jitteriness`,`Clonic jerks`,`Tonic posturing`]},{name:`Primitive reflexes`,steps:[{label:`Moro`,method:`Support head; allow 30° head drop or loud clap`,normal:`Symmetric arm abduction then flexion, often cry`},{label:`Rooting`,method:`Stroke cheek at corner of mouth`,normal:`Turns head toward stroke and opens mouth`},{label:`Palmar grasp`,method:`Press into palm with finger`,normal:`Strong, symmetric finger flexion`},{label:`Plantar grasp`,method:`Press ball of foot below toes`,normal:`Toes flex around finger symmetrically`},{label:`Stepping`,method:`Hold upright with feet touching surface`,normal:`Alternating stepping movements`},{label:`Tonic neck (fencing)`,method:`Turn head to one side with infant supine`,normal:`Same-side arm extends, opposite flexes (not obligate)`},{label:`Galant`,method:`Stroke paravertebrally from shoulder to buttock, one side`,normal:`Trunk curves toward stroked side`}],abnormalHints:[`Absent or asymmetric Moro — CNS injury, brachial plexus, clavicle fx`,`Absent grasps — CNS depression`,`Obligate tonic neck is abnormal`]},{name:`Babinski (plantar response)`,steps:[{label:`Stroke lateral sole`,method:`Firm stroke from heel toward toes along lateral plantar border`,normal:`Up-going great toe with fanning (normal in newborn)`},{label:`Symmetry check`,method:`Repeat opposite foot`,normal:`Symmetric response`}],abnormalHints:[`Asymmetric response is always abnormal`]}]},resp:{overview:`Newborn respiratory transition — RDS, TTN, pneumonia, meconium aspiration dominate the differential. Normal RR ≤ 60. Grunting is an alarm sign.`,components:[{name:`Inspection`,significance:`Detects distress and localises cause. Silverman score quantifies retraction severity.`,pearl:`Grunting is physiologic PEEP against a partially closed glottis — always a sign of significant lung pathology in a newborn. Never dismiss it as fussy breathing.`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s, quiet and undisturbed.`,normal:`40–60 /min; tachypnea > 60`},{label:`Work of breathing (Silverman)`,method:`Inspect for upper-chest retraction, lower-chest retraction, xiphoid retraction, nasal flaring, grunting. Score 0–2 for each.`,normal:`Total Silverman 0 — no distress`},{label:`Audible sounds`,method:`Listen without stethoscope — stridor? grunting? wheeze across the room?`,normal:`Quiet respirations`},{label:`Colour`,method:`Inspect trunk and mucous membranes for central cyanosis; acrocyanosis (blue hands/feet) is normal in the first days.`,normal:`Pink trunk and mucous membranes`},{label:`Chest shape`,method:`Inspect AP:transverse diameter and symmetry.`,normal:`Slightly barrel-shaped is normal; symmetric`}],abnormalHints:[`Grunting — RDS, pneumonia, sepsis, CHD`,`Retractions + tachypnea — RDS, TTN, pneumothorax`,`Central cyanosis — cyanotic CHD, severe lung disease, persistent pulmonary HTN`,`Asymmetric chest movement — pneumothorax, diaphragmatic hernia`]},{name:`Auscultation`,significance:`Short stethoscope time in neonates because they fuss easily — get the most important zones first.`,pearl:`Listen at the axilla, not just the anterior chest — pneumothorax can sound normal anteriorly. Auscultate both axillae systematically.`,steps:[{label:`Air entry — anterior`,method:`Listen bilaterally at the upper and lower anterior chest.`,normal:`Symmetric bilateral air entry`},{label:`Air entry — axillary`,method:`Listen bilaterally at each axilla — this is the most sensitive area for detecting a small pneumothorax.`,normal:`Clear and symmetric`},{label:`Adventitious sounds`,method:`Listen for transmitted upper-airway sounds, crackles (RDS, pneumonia), grunting sounds.`,normal:`No crackles, no wheeze, clear sounds`},{label:`Inspiration:expiration ratio`,method:`Observe breath-sound timing.`,normal:`Inspiration > expiration in length`}],abnormalHints:[`Asymmetric air entry — pneumothorax, diaphragmatic hernia, endobronchial intubation`,`Fine crackles — RDS, TTN, pneumonia`,`Absent breath sounds unilaterally — pneumothorax or selective intubation`]}]},cv:{overview:`Neonatal CV exam screens for CHD — the window of presentation is short and some lesions (duct-dependent) decompensate within hours of birth. Pre/postductal saturations + femoral pulses are the two fastest screens.`,components:[{name:`Inspection and pre/postductal saturations`,significance:`Pre/postductal SpO₂ differential > 3% suggests a duct-dependent lesion or persistent pulmonary HTN. Universal CCHD screening uses this.`,pearl:`Pulse ox on the right hand = preductal (proximal to PDA insertion). Foot = postductal. Both arms and both legs should match; a differential is a red flag for critical CHD.`,steps:[{label:`Central cyanosis`,method:`Inspect tongue, lips, oral mucosa.`,normal:`Pink mucous membranes`},{label:`Pre/postductal SpO₂`,method:`Measure SpO₂ in right hand (preductal) AND either foot (postductal). Baby must be ≥24 hr old for CCHD screening.`,normal:`Both ≥ 95% AND difference < 3%`},{label:`Peripheral perfusion`,method:`Capillary refill on sternum; note mottling or distal cyanosis.`,normal:`Capillary refill < 2 s, warm pink extremities`},{label:`Precordial activity`,method:`Inspect anterior chest for hyperactive precordium.`,normal:`Not visible or minimally visible`}],abnormalHints:[`Central cyanosis with SpO₂ < 95% → cyanotic CHD workup (4-extremity BP, ECG, hyperoxia test, echo)`,`Differential > 3% (pre > post) → duct-dependent systemic flow (HLHS, coarctation, interrupted arch)`,`Preductal < postductal — persistent pulmonary HTN with reversed shunt`]},{name:`Palpation and auscultation`,significance:`Absent femoral pulses + arm-leg BP gradient = coarctation. Many CHD lesions manifest murmurs only after ductus closes (48–72 h).`,pearl:`Always palpate femoral pulses before discharging any newborn. Absent femorals in a well-appearing baby can be the only finding in a ductal-dependent coarctation — catastrophic if missed.`,steps:[{label:`Apex beat`,method:`Palpate at the 4th ICS left of sternum (apex is higher in newborns).`,normal:`Palpable at 4th ICS, mid-clavicular or just lateral`},{label:`Femoral pulses`,method:`Palpate both femoral pulses at the mid-inguinal point while simultaneously feeling the right brachial pulse — detects delay.`,normal:`Present, symmetric, equal timing with brachial`},{label:`Auscultate each cardiac area`,method:`Use pediatric diaphragm at each classic point; baby quiet if possible.`,normal:`S1 S2 crisp; physiologic flow murmur sometimes present in the first 24–48 h`},{label:`Continuous murmur`,method:`Listen below the left clavicle for a continuous ("machinery") murmur of PDA.`,normal:`No continuous murmur after the first day of life in a term baby`},{label:`Four-limb BP (if any concern)`,method:`Right arm, left arm, both legs.`,normal:`Within 10 mmHg across limbs`}],abnormalHints:[`Absent femoral pulses — coarctation of the aorta (surgical emergency if duct-dependent)`,`Harsh holosystolic at LLSB — VSD`,`Continuous machinery murmur — PDA (expected in preterm; in term > 48 h is abnormal)`,`Gallop S3/S4 — heart failure`,`Single S2 — transposition, truncus, severe AS/PS`]}]}},infant:{label:`Infant (1–12 months)`,msk:{overview:`Continued DDH screen through 6 months. Watch motor progression and symmetry of tone/movement.`,components:[{name:`Hips — continued DDH screen`,steps:[{label:`Thigh-fold symmetry`,method:`Inspect with infant supine, thighs flexed`,normal:`Symmetric folds`},{label:`Barlow/Ortolani (through 3mo)`,method:`As in newborn — thumb medial, flex 90°, adduct+push then abduct+lift`,normal:`Negative bilaterally`},{label:`Abduction (any age)`,method:`Flex 90°, abduct simultaneously`,normal:`≥70° symmetric abduction`},{label:`Galeazzi`,method:`Knees flexed feet flat on exam table`,normal:`Knees equal height`}],abnormalHints:[`Clunk on Barlow/Ortolani (<3mo)`,`Limited abduction`,`Asymmetric folds`,`Positive Galeazzi`]},{name:`Gross-motor milestones (age-appropriate)`,steps:[{label:`Head control`,method:`Prone, pull-to-sit, held upright`,normal:`Age-appropriate: 2mo lifts head 45°; 4mo no head lag`},{label:`Rolling`,method:`Observe on flat surface`,normal:`Rolls back-to-front by 5–6mo`},{label:`Sitting`,method:`Place in sitting position`,normal:`Tripod sit by 6mo; sits without support by 7–8mo`},{label:`Standing`,method:`Support under arms`,normal:`Bears weight by 6mo; pulls to stand by 9mo`}],abnormalHints:[`Milestone delay by ≥2mo`,`Loss of previously attained milestone`,`Asymmetric use of limbs`]},{name:`Spine`,steps:[{label:`Palpate seated`,method:`Run finger along spine with infant sitting or held upright`,normal:`Midline, no step-offs`},{label:`Back curvature`,method:`Inspect sitting and lying`,normal:`Physiologic gentle kyphosis in early infancy; lumbar lordosis as sitting develops`}],abnormalHints:[`Fixed kyphoscoliosis`,`Sacral dimple with cutaneous marker`,`Step-off`]},{name:`Extremities`,steps:[{label:`Passive range`,method:`Through each major joint`,normal:`Full symmetric range`},{label:`Joint inspection`,method:`Inspect for swelling, warmth, effusion`,normal:`No swelling, warmth, or effusion`},{label:`Feet alignment`,method:`Observe standing if pulling up, else passive positioning`,normal:`Correctable or aligned feet; flexible`}],abnormalHints:[`Joint swelling/warmth (septic vs reactive arthritis)`,`Rigid clubfoot`,`Persistent asymmetric tone`]}]},neuro:{overview:`Primitive reflexes fading on schedule; protective reflexes emerging; gross motor and tone interlinked.`,components:[{name:`Alertness and social engagement`,steps:[{label:`Social smile`,method:`Face-to-face interaction`,normal:`Social smile by 6–8 weeks`},{label:`Tracking`,method:`Move object across visual field`,normal:`180° horizontal tracking by 3mo`},{label:`Engagement`,method:`Face-to-face, voice, toys`,normal:`Age-appropriate reciprocal interaction`}],abnormalHints:[`No social smile by 3mo`,`Absent tracking past 3mo`,`Poor engagement (developmental concern)`]},{name:`Cranial nerves`,steps:[{label:`Pupils`,method:`Light response each eye`,normal:`Equal reactive`},{label:`Eye alignment`,method:`Inspect with gaze forward and in all directions`,normal:`No strabismus past 4mo`},{label:`Facial symmetry`,method:`Observe smile and cry`,normal:`Symmetric`},{label:`Suck and swallow`,method:`Observe feeding`,normal:`Coordinated, no choking`}],abnormalHints:[`Persistent nystagmus`,`Strabismus past 4mo`,`Asymmetric face`]},{name:`Tone`,steps:[{label:`Pull-to-sit`,method:`Gently pull wrists/hands`,normal:`No head lag by 4mo`},{label:`Ventral suspension`,method:`Support prone, observe`,normal:`Head above horizontal, extremities actively flexed (age-dependent)`},{label:`Vertical suspension`,method:`Support under arms, lift`,normal:`Does not slip through hands`}],abnormalHints:[`Persistent head lag past 4mo (hypotonia)`,`Hypertonia / scissoring (UMN)`,`Slip-through on vertical suspension`]},{name:`Primitive reflex integration`,steps:[{label:`Moro`,method:`Head drop or clap`,normal:`Absent by 6mo`},{label:`Palmar grasp`,method:`Press into palm`,normal:`Integrated by 5–6mo; replaced by voluntary grasp`},{label:`Tonic neck`,method:`Turn head to side`,normal:`Absent by 6mo`},{label:`Rooting`,method:`Stroke cheek`,normal:`Absent by 3–4mo`}],abnormalHints:[`Persistence of any primitive reflex past 6mo warrants eval (CP, CNS injury)`]},{name:`Protective and postural reflexes`,steps:[{label:`Parachute`,method:`Held prone, tilt head downward suddenly`,normal:`Symmetric arm extension protectively by 9mo (emerges 6–9mo)`},{label:`Lateral propping`,method:`Seated infant, gentle tilt to one side`,normal:`Arm extends to catch by 6–7mo`},{label:`Landau`,method:`Suspend prone`,normal:`Extends head, spine, legs by 6mo`}],abnormalHints:[`Absent parachute after 12mo (concerning)`,`Asymmetric lateral propping`,`Absent Landau`]}]},resp:{overview:`Infant respiratory disease centers on bronchiolitis, reactive airways, and pneumonia. Normal RR ≤ 50 (< 2 mo: ≤ 60). Infants are obligate nose-breathers — nasal congestion alone can cause significant WOB.`,components:[{name:`Inspection`,significance:`Infant distress signs escalate fast. Nasal flaring, tracheal tug, head bobbing = significant WOB. Apnea in an infant < 2 mo is an emergency.`,pearl:`A quiet infant with retractions is more worrying than a crying one — exhausted infants stop crying and become hypoxic silently.`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s while quiet.`,normal:`< 2 mo: ≤ 60; 2–12 mo: ≤ 50`},{label:`Work of breathing`,method:`Inspect nasal flaring, subcostal/intercostal/suprasternal retractions, tracheal tug, head-bobbing, accessory muscle use.`,normal:`No retractions, effortless breathing`},{label:`Audible sounds`,method:`Stridor? Wheeze across the room? Grunting? Prolonged expiration?`,normal:`Quiet respirations`},{label:`Colour and feeding history`,method:`Central cyanosis? Poor feeding (feeding is an effort marker in infants)?`,normal:`Pink, feeds well`},{label:`Apnea observation`,method:`Watch for ≥ 20-s pauses or pauses < 20 s with bradycardia/cyanosis.`,normal:`No apneas`}],abnormalHints:[`Grunting / persistent retractions — pneumonia, bronchiolitis, CHF`,`Wheeze — bronchiolitis (RSV), asthma, foreign body`,`Stridor — croup (6 mo–6 y), laryngomalacia (infant), foreign body`,`Apnea — bronchiolitis, sepsis, pertussis, seizure`]},{name:`Auscultation`,significance:`Infants have a thin chest wall — sounds transmit widely. Symmetry, wheeze, and crackles are the main findings.`,pearl:`In bronchiolitis, the classical finding is widespread end-inspiratory fine crackles PLUS expiratory wheeze. Tachypnea + retractions in an RSV-season infant confirms.`,steps:[{label:`Air entry — bilateral`,method:`Warm stethoscope; listen at anterior chest and both axillae, both sides.`,normal:`Symmetric air entry`},{label:`Wheeze`,method:`Listen in expiration. Diffuse wheeze = lower airway; focal wheeze = foreign body or local obstruction.`,normal:`No wheeze`},{label:`Crackles`,method:`Listen in late inspiration. Focal = pneumonia; diffuse fine = bronchiolitis.`,normal:`No crackles`},{label:`Prolonged expiration`,method:`Note expiration:inspiration length ratio.`,normal:`Inspiration ≥ expiration`}],abnormalHints:[`Focal crackles + fever — pneumonia`,`Diffuse wheeze + fine crackles in an RSV-season infant — bronchiolitis`,`Silent chest with extreme WOB — impending respiratory failure`]}]},cv:{overview:`Most CHD manifests in the first year as pulmonary blood-flow changes and the ductus closes. Infant CV exam = growth review + inspection + femoral pulses + auscultation. A harsh pan-systolic LLSB murmur in a 6-week-old = VSD until proven otherwise.`,components:[{name:`Inspection and functional assessment`,significance:`Heart failure in infants presents as poor feeding, sweating during feeds (diaphoresis), tachypnea, and poor weight gain. These historical features predict bad exam findings.`,pearl:`Ask "Does the baby sweat while feeding?" — infant CHF presents with diaphoresis on the forehead during feeds, well before peripheral edema appears.`,steps:[{label:`Growth trajectory`,method:`Plot weight-for-age on WHO chart. Failure to thrive raises CHD concern.`,normal:`Tracking ≥ 10th percentile or stable on personal curve`},{label:`Feeding history`,method:`Ask about feed duration, sweating with feeds, tachypnea with feeds, tiring easily.`,normal:`Feeds < 20 min, no diaphoresis, no tachypnea`},{label:`Central cyanosis`,method:`Inspect tongue and oral mucosa.`,normal:`Pink`},{label:`Clubbing`,method:`Inspect finger nail beds (subtle in infants).`,normal:`No clubbing`},{label:`Peripheral perfusion`,method:`Cap refill, warmth of extremities.`,normal:`Cap refill < 2 s, warm extremities`}],abnormalHints:[`Poor weight gain — consider CHF from L-to-R shunt (VSD, PDA, AVSD)`,`Diaphoresis with feeds — infant CHF`,`Tiring with feeds — significant CHD`,`Central cyanosis — cyanotic CHD (ToF, TGA, TA, etc.)`]},{name:`Palpation and auscultation`,significance:`Femoral pulses + 4-limb BP screen coarctation. A harsh holosystolic murmur at LLSB is almost always a VSD in this age.`,pearl:`Listen over each of the 5 classic points as in the adult exam — the locations shift slightly with infant chest size but relative positions are the same. Also listen at the back: coarctation murmurs radiate there.`,steps:[{label:`Apex beat`,method:`Palpate at 4th ICS mid-clavicular line.`,normal:`Palpable at 4th ICS in infants`},{label:`Femoral pulses`,method:`Palpate bilaterally, simultaneously with right brachial.`,normal:`Present, equal, no delay vs brachial`},{label:`Listen at each classic area (APTM)`,method:`See APTM diagram. Use pediatric stethoscope with both diaphragm and bell.`,normal:`S1 and S2 crisp, no murmur or physiologic only`},{label:`Listen over the back (interscapular)`,method:`Check for radiation of coarctation murmurs.`,normal:`No radiating murmur`}],abnormalHints:[`Harsh holosystolic LLSB murmur — VSD`,`Continuous "machinery" murmur below left clavicle — PDA`,`Systolic ejection at ULSB + fixed split S2 — ASD`,`Ejection murmur at ULSB + cyanosis — tetralogy of Fallot`,`Absent femorals + radio-femoral delay — coarctation`,`Gallop + tachycardia — heart failure`]}]}},toddler:{label:`Toddler (1–3 years)`,msk:{overview:`Gait, physiologic alignment changes, in-toeing, joint range. Cooperation unpredictable — use play.`,components:[{name:`Gait`,steps:[{label:`Base of support`,method:`Have child walk ~10 feet`,normal:`Wide-based initially, narrowing by 2y`},{label:`Heel-strike`,method:`Observe foot contact pattern`,normal:`Heel-strike developing by 18mo, consistent by 2y`},{label:`Arm swing`,method:`Observe reciprocal arm swing`,normal:`Reciprocal arm swing by 18mo`},{label:`Symmetry`,method:`Watch both sides in stance and swing`,normal:`Symmetric stride length and cadence`}],abnormalHints:[`Toe-walking past 2y (idiopathic vs CP vs DMD)`,`Limp (Legg-Calvé-Perthes, transient synovitis, trauma)`,`Wide-based ataxia`]},{name:`Knee alignment`,steps:[{label:`Stand feet together`,method:`Feet/medial malleoli touching; inspect knees`,normal:`Genu varum resolving by 18–24mo; mild genu valgum common by 2–3y`},{label:`Intercondylar or intermalleolar distance`,method:`Measure if alignment appears abnormal`,normal:`<5cm intercondylar (varum) or <8cm intermalleolar (valgum)`},{label:`Symmetry`,method:`Compare sides`,normal:`Symmetric`}],abnormalHints:[`Persistent varum past 2y`,`Severe valgum >8cm`,`Unilateral (Blount disease, rickets)`]},{name:`Feet alignment`,steps:[{label:`In-toeing / out-toeing`,method:`Observe foot angle during gait`,normal:`Mild in-toeing common (tibial torsion, femoral anteversion)`},{label:`Arch during stance`,method:`Stand flat, then on tiptoes`,normal:`Flexible flat foot that forms arch on tiptoe`},{label:`Heel alignment`,method:`View from behind standing`,normal:`Neutral or mildly valgus heel`}],abnormalHints:[`Rigid flat foot (tarsal coalition)`,`Fixed metatarsus adductus`,`Severe in-toeing >15°`]},{name:`Joint range`,steps:[{label:`Hips`,method:`Flex, abduct, rotate each hip`,normal:`Full symmetric range, no pain`},{label:`Knees`,method:`Flex, extend; palpate for effusion`,normal:`Full range, no effusion, stable`},{label:`Ankles`,method:`Dorsiflex, plantarflex, invert, evert`,normal:`Full range`},{label:`Shoulders, elbows, wrists`,method:`Through full range each`,normal:`Full symmetric range`}],abnormalHints:[`Joint effusion (septic vs reactive)`,`Guarded or painful motion`,`Asymmetric limitation`]},{name:`Spine`,steps:[{label:`Inspect standing`,method:`View spine from behind`,normal:`Midline, no prominent curve`},{label:`Palpate midline`,method:`Run finger along spinous processes`,normal:`Midline, no step-off, no tenderness`},{label:`Shoulder/hip symmetry`,method:`Compare shoulder and hip heights`,normal:`Symmetric`}],abnormalHints:[`Fixed scoliosis`,`Abnormal kyphosis`,`Asymmetric shoulder/hip`,`Midline tenderness`]}]},neuro:{overview:`Shifting to adult-pattern exam. Primitive reflexes should be absent. Use play-based techniques.`,components:[{name:`Mental status and language`,steps:[{label:`Engagement`,method:`Interaction with examiner/parent`,normal:`Alert, interactive, age-appropriate`},{label:`Language — expressive`,method:`Note spontaneous utterances`,normal:`1y: 1–3 words; 2y: 2-word phrases; 3y: short sentences`},{label:`Language — receptive`,method:`Ask to point to body parts or follow simple commands`,normal:`Follows age-appropriate commands`}],abnormalHints:[`Language regression (autism, epileptic encephalopathy)`,`Poor engagement`,`No 2-word phrases by 2y`]},{name:`Cranial nerves`,steps:[{label:`CN II — pupil response`,method:`Shine light each eye`,normal:`Pupils equal reactive`},{label:`CN III, IV, VI — EOM`,method:`Follow toy in H pattern`,normal:`Full smooth tracking, no strabismus`},{label:`CN V — facial sensation`,method:`Light touch on forehead, cheek, jaw`,normal:`Responds to touch, symmetric`},{label:`CN VII — face`,method:`Elicit smile, watch eye closure during cry`,normal:`Symmetric face`},{label:`CN IX, X, XII — mouth`,method:`Say "ahh"; stick out tongue`,normal:`Palate rises symmetrically; tongue midline`}],abnormalHints:[`Strabismus`,`Facial asymmetry`,`Tongue deviation`,`Absent palate elevation`]},{name:`Motor — tone and bulk`,steps:[{label:`Passive tone`,method:`Move each limb through full range`,normal:`Normal resistance throughout`},{label:`Bulk inspection`,method:`Inspect muscle bulk of thighs, calves, glutes`,normal:`Symmetric, age-appropriate bulk`},{label:`Contracture check`,method:`Test for heel-cord tightness, hamstring tightness`,normal:`No contractures`}],abnormalHints:[`Spasticity (especially catch in ankles)`,`Hypotonia`,`Calf pseudo-hypertrophy (DMD)`]},{name:`Motor — functional strength`,steps:[{label:`Rising from floor`,method:`Place flat on back; ask to stand up`,normal:`Rises without using hands to push off thighs (no Gowers)`},{label:`Climbing stairs`,method:`Observe or history`,normal:`Climbs holding rail`},{label:`Squatting/getting up`,method:`Encourage via play`,normal:`Squats and rises without help`}],abnormalHints:[`Gowers sign (proximal weakness — DMD)`,`Unable to climb stairs at age expected`,`Calf pain on walking (myositis)`]},{name:`Deep tendon reflexes`,steps:[{label:`Patellar`,method:`Sitting or supine with distraction (toy)`,normal:`2+ symmetric`},{label:`Biceps`,method:`Arm at rest, strike thumb on tendon`,normal:`2+ symmetric`},{label:`Achilles`,method:`With distraction`,normal:`2+ symmetric`}],abnormalHints:[`Hyperreflexia or clonus (UMN, CP)`,`Absent reflexes (LMN, neuropathy)`,`Asymmetry`]},{name:`Coordination and gait`,steps:[{label:`Run`,method:`Watch run ~10 feet`,normal:`Runs with reciprocal arm swing by 2y`},{label:`Stairs`,method:`Observe`,normal:`Climbs with rail`},{label:`Kick ball`,method:`Place ball; observe kick`,normal:`Kicks by 2y`},{label:`Ataxia check`,method:`Watch for fluency of movement`,normal:`Smooth, no tremor`}],abnormalHints:[`Ataxic gait`,`Intention tremor`,`Clumsiness beyond age`]},{name:`Plantar response`,steps:[{label:`Stroke lateral sole`,method:`Firm stroke from heel to toes`,normal:`Down-going great toe (plantar flexion) by age 2`}],abnormalHints:[`Up-going toe after age 2 = UMN sign (Babinski positive)`]}]},resp:{overview:`Toddler respiratory disease: viral URIs, reactive airways, croup (6 mo–6 y classical age), foreign-body aspiration (age 1–3 is peak). Normal RR ≤ 40.`,components:[{name:`Inspection`,pearl:`Sudden onset of unilateral wheeze + choking history in a toddler = foreign body until proven otherwise. CXR in expiration (or decubitus) helps show the trapped air.`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s if possible.`,normal:`≤ 40 /min`},{label:`Work of breathing`,method:`Retractions, nasal flaring, tracheal tug.`,normal:`No retractions`},{label:`Audible sounds`,method:`Stridor (croup), wheeze, barking cough.`,normal:`Quiet respirations`},{label:`Drooling / posture`,method:`Tripod positioning, drooling (epiglottitis in unvaccinated child).`,normal:`No drooling, normal posture`}],abnormalHints:[`Barking cough + stridor — croup`,`Drooling + tripod + toxic — epiglottitis (emergency)`,`Sudden unilateral wheeze — foreign body aspiration`]},{name:`Auscultation`,steps:[{label:`Air entry`,method:`Cooperation variable — listen quickly and systematically.`,normal:`Symmetric`},{label:`Adventitious sounds`,method:`Wheeze, crackles, stridor at the neck.`,normal:`Clear lung fields`},{label:`Unilateral findings`,method:`Focal wheeze, decreased air entry, or asymmetry — think foreign body or pneumonia.`,normal:`Symmetric bilateral`}],abnormalHints:[`Unilateral decreased breath sounds + wheeze — foreign body`,`Focal crackles — pneumonia`,`Diffuse wheeze — asthma/RAD`]}]},cv:{overview:`Most hemodynamically significant CHD has been detected by this age. Innocent murmurs peak here (Still's murmur, venous hum). The exam is adult-pattern but with smaller chest and less cooperation.`,components:[{name:`Inspection and palpation`,pearl:`Innocent murmurs are a normal finding in well toddlers — soft, systolic, at the LLSB, musical, and they change with position. Anything that doesn't fit that pattern deserves referral.`,steps:[{label:`General appearance + growth`,method:`Happy, active, tracking growth.`,normal:`Normal growth and activity`},{label:`Colour and clubbing`,method:`Inspect tongue, nail beds.`,normal:`Pink, no clubbing`},{label:`Apex beat`,method:`Palpate at 5th ICS mid-clavicular line.`,normal:`Located at 5th ICS MCL, tapping quality`},{label:`Peripheral pulses`,method:`Brachial + femoral, symmetric and simultaneous.`,normal:`Symmetric, no delay`}],abnormalHints:[`Tiring with play, poor growth — missed CHD`,`Cyanosis + clubbing — cyanotic CHD`,`Absent femorals — coarctation`]},{name:`Auscultation`,steps:[{label:`All 5 classic points`,method:`See APTM diagram above — Aortic, Pulmonic, Erb's, Tricuspid, Mitral.`,normal:`Crisp S1, S2 with physiologic split at pulmonic area`},{label:`Evaluate any murmur`,method:`Timing, location, radiation, grade. Apply the "7 S" innocent-murmur criteria.`,normal:`No murmur, or soft (≤ grade 2) innocent murmur`},{label:`Change with position`,method:`Have toddler sit, stand, lie down — does the murmur change? Innocent murmurs typically disappear or soften with standing.`,normal:`Murmur (if any) changes with position`}],abnormalHints:[`Harsh, loud (≥3/6), radiating, or diastolic murmur — not innocent, refer`,`Cyanosis + murmur — CHD workup`,`Fixed split S2 — ASD`]}]}},preschool:{label:`Preschool (3–5 years)`,msk:{overview:`Functional gait maneuvers, scoliosis screen, resolving physiologic alignment.`,components:[{name:`Gait — multiple patterns`,steps:[{label:`Normal gait`,method:`Walk ~15 feet barefoot`,normal:`Symmetric, smooth, reciprocal arm swing`},{label:`Heel walking`,method:`Walk on heels only`,normal:`Able by 4y`},{label:`Toe walking`,method:`Walk on toes only`,normal:`Able by 4y`},{label:`Tandem walking`,method:`Heel-to-toe along a line for 5 steps`,normal:`Able by 4y with minimal deviation`},{label:`Hopping`,method:`Hop on one foot`,normal:`3–5 hops on preferred foot by 4y`}],abnormalHints:[`Persistent toe-walking`,`Asymmetric stance/stride`,`Difficulty with any pattern`]},{name:`Alignment`,steps:[{label:`Knee alignment`,method:`Stand feet together`,normal:`Mild residual valgus resolving; neutral by 6–7y`},{label:`Foot arch`,method:`Standing, then tiptoe`,normal:`Arch forms on tiptoe (flexible flat foot)`},{label:`Heel position`,method:`View from behind standing`,normal:`Neutral or mild valgus`}],abnormalHints:[`Persistent unilateral varum`,`Rigid flat foot (no arch on tiptoe)`,`Pes cavus`]},{name:`Scoliosis screen (Adam forward-bend)`,steps:[{label:`Position`,method:`Feet together, bend forward at waist, arms hanging, palms together`,normal:`Arms and head relaxed`},{label:`View from behind`,method:`Examiner at same height; look along back`,normal:`Symmetric paraspinal contour`},{label:`View from side`,method:`Side view for kyphosis`,normal:`Smooth thoracic curve`}],abnormalHints:[`Rib hump (thoracic scoliosis)`,`Lumbar prominence`,`Asymmetric scapular height`]},{name:`Joint range and stability`,steps:[{label:`Active range`,method:`Ask to perform full range at hips, knees, ankles, shoulders, elbows, wrists`,normal:`Full symmetric range, no pain`},{label:`Knee stability`,method:`Palpate for effusion; assess stability if complaint`,normal:`Stable, no effusion`},{label:`Carrying angle (elbows)`,method:`Arms at sides, palms forward`,normal:`Normal valgus carrying angle`}],abnormalHints:[`Joint hypermobility (Beighton score)`,`Effusion`,`Pain with motion`,`Valgus >15°`]},{name:`Feet`,steps:[{label:`Standing inspection`,method:`View from front and behind`,normal:`Symmetric feet, neutral heel, flexible flat feet common`},{label:`Tiptoe`,method:`Stand on tiptoes`,normal:`Arch forms, symmetric`},{label:`Pes planus vs cavus`,method:`Note arch height`,normal:`Flexible flat foot or mild arch`}],abnormalHints:[`Rigid flat foot`,`Pes cavus (Charcot-Marie-Tooth)`,`Pain`]}]},neuro:{overview:`Formal pediatric neuro exam now feasible — most 4- and 5-year-olds cooperate with structured testing.`,components:[{name:`Mental status and language`,steps:[{label:`Orientation (age-appropriate)`,method:`Ask name, age, where you are`,normal:`Knows name and age by 3y; location by 4–5y`},{label:`Speech intelligibility`,method:`Listen to spontaneous speech`,normal:`Strangers understand by 4y`},{label:`Receptive language`,method:`2- and 3-step commands`,normal:`Follows 3-step commands by 4–5y`}],abnormalHints:[`Dysarthria`,`Expressive or receptive language delay`,`Inattention`]},{name:`Cranial nerves (II–XII)`,steps:[{label:`CN II — visual acuity`,method:`HOTV chart or pictures at 10ft, each eye`,normal:`20/30 or better by 4y; 20/25 by 5y`},{label:`CN II — visual fields`,method:`Confrontation with toys from periphery`,normal:`Full fields`},{label:`CN II — pupils`,method:`Light response each eye`,normal:`PERRL`},{label:`CN III, IV, VI — EOM`,method:`Follow toy in H pattern; include convergence`,normal:`Full EOM, convergence present`},{label:`CN V — sensation`,method:`Light touch forehead, cheek, jaw each side`,normal:`Intact, symmetric`},{label:`CN V — motor`,method:`Clench teeth, palpate masseter`,normal:`Symmetric strong bulk`},{label:`CN VII — face`,method:`Smile, wrinkle forehead, close eyes, puff cheeks`,normal:`Symmetric movement of all regions`},{label:`CN VIII — hearing`,method:`Finger rub each ear or whispered words`,normal:`Intact bilaterally`},{label:`CN IX, X — palate`,method:`Open mouth, say "ahh"`,normal:`Palate rises symmetrically, uvula midline`},{label:`CN XI — SCM/trapezius`,method:`Shrug shoulders, turn head against resistance`,normal:`Symmetric strength`},{label:`CN XII — tongue`,method:`Stick tongue out, move side to side`,normal:`Midline, no atrophy, full movement`}],abnormalHints:[`Strabismus (amblyopia risk)`,`Facial weakness`,`Tongue deviation/fasciculations`,`Uvula off-midline`]},{name:`Motor — tone, bulk, strength`,steps:[{label:`Tone inspection`,method:`Passive range all four limbs`,normal:`Normal tone throughout`},{label:`Bulk inspection`,method:`Observe muscle bulk symmetry`,normal:`Symmetric, age-appropriate`},{label:`Strength — shoulder abduction`,method:`Arms out, push down against resistance`,normal:`5/5 bilaterally`},{label:`Strength — elbow flexion`,method:`Flex elbow against resistance`,normal:`5/5 bilaterally`},{label:`Strength — grip`,method:`Squeeze examiner's fingers`,normal:`5/5 symmetric`},{label:`Strength — hip flexion`,method:`Lift leg off table against resistance`,normal:`5/5 bilaterally`},{label:`Strength — knee extension`,method:`Straighten knee against resistance`,normal:`5/5 bilaterally`},{label:`Strength — dorsiflexion`,method:`Pull toes up against resistance`,normal:`5/5 bilaterally`}],abnormalHints:[`Focal weakness`,`Gowers sign`,`Pseudohypertrophy (DMD)`,`Atrophy`]},{name:`Deep tendon reflexes`,steps:[{label:`Biceps`,method:`Thumb on biceps tendon, strike`,normal:`2+ symmetric`},{label:`Patellar`,method:`Knees hanging, strike patellar tendon`,normal:`2+ symmetric`},{label:`Achilles`,method:`Slight dorsiflexion, strike Achilles tendon`,normal:`2+ symmetric`},{label:`Plantar response`,method:`Stroke lateral sole heel-to-toes`,normal:`Down-going great toe`}],abnormalHints:[`Hyperreflexia or clonus (UMN)`,`Hyporeflexia (LMN)`,`Up-going plantar (Babinski — abnormal past 2y)`,`Asymmetry`]},{name:`Coordination`,steps:[{label:`Finger-to-nose`,method:`Touch examiner's finger then own nose, repeat`,normal:`Smooth, no dysmetria`},{label:`Heel-to-shin`,method:`Run heel down opposite shin`,normal:`Smooth bilaterally`},{label:`Rapid alternating movements`,method:`Tap palm with opposite hand alternating palm/back`,normal:`Rhythmic, symmetric`},{label:`Tandem walk`,method:`Heel-to-toe for 5 steps`,normal:`Minimal deviation`}],abnormalHints:[`Dysmetria`,`Dysdiadochokinesia`,`Intention tremor`,`Ataxic tandem`]},{name:`Sensory`,steps:[{label:`Light touch — hands`,method:`Cotton wisp on palm/dorsum, eyes closed`,normal:`Feels each touch`},{label:`Light touch — feet`,method:`Same on dorsum of foot bilaterally`,normal:`Feels each touch`}],abnormalHints:[`Focal sensory loss`,`Stocking-glove loss`]},{name:`Gait and Romberg`,steps:[{label:`Normal gait`,method:`Walk ~20 feet`,normal:`Smooth, symmetric`},{label:`Heel walk`,method:`Walk on heels`,normal:`Able without difficulty`},{label:`Toe walk`,method:`Walk on toes`,normal:`Able without difficulty`},{label:`Tandem`,method:`Heel-to-toe`,normal:`Intact`},{label:`Romberg (5y+)`,method:`Feet together, eyes closed, stand 10s`,normal:`Stable without sway`}],abnormalHints:[`Ataxic gait (cerebellar)`,`Romberg positive (dorsal column)`,`Circumduction (UMN)`]}]},resp:{overview:`Adult-pattern but shorter. Cooperation better than toddler. RR ≤ 30. Common: asthma/RAD, pneumonia, URIs.`,components:[{name:`Inspection`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s quietly.`,normal:`≤ 30 /min`},{label:`Work of breathing`,method:`Retractions, nasal flaring, accessory muscle use.`,normal:`Effortless breathing`},{label:`Audible sounds`,method:`Wheeze, stridor, cough quality (barking = croup).`,normal:`Quiet`},{label:`Chest shape`,method:`AP:transverse, hyperinflation signs.`,normal:`Not barrel-chested`}],abnormalHints:[`Barrel chest — chronic asthma, cystic fibrosis`,`Retractions + wheeze — asthma exacerbation`]},{name:`Auscultation`,steps:[{label:`Systematic zones`,method:`Upper, mid, lower fields anteriorly and posteriorly; axillae bilaterally. Cooperative deep breaths through mouth.`,normal:`Symmetric vesicular sounds`},{label:`Wheeze`,method:`Expiratory, diffuse (asthma) or focal (foreign body, rare at this age).`,normal:`No wheeze`},{label:`Crackles`,method:`Focal = pneumonia; diffuse fine = interstitial disease (rare in kids).`,normal:`No crackles`}],abnormalHints:[`Focal crackles + fever — pneumonia`,`Diffuse wheeze — asthma`,`Prolonged expiration with wheeze — lower airway obstruction`]}]},cv:{overview:`Most CHD is detected by this age. Innocent murmurs peak in this range. Sports participation exams require thorough CV screening.`,components:[{name:`Inspection and palpation`,steps:[{label:`General and growth`,method:`Track on growth curve; activity tolerance.`,normal:`Normal growth, active`},{label:`Apex beat`,method:`5th ICS mid-clavicular line.`,normal:`Normal position and character`},{label:`Peripheral pulses`,method:`Brachial + femoral simultaneously. BP in arm and leg if HTN.`,normal:`Symmetric, no delay`}],abnormalHints:[`Absent femorals or arm-leg BP gradient — coarctation (always check in HTN screening)`,`Displaced apex — cardiomegaly`]},{name:`Auscultation`,pearl:`The 7 "S" criteria and the 5 classic innocent murmurs (see panel above) handle most murmurs you'll find in this age group. Still's murmur is the single most common.`,steps:[{label:`All 5 classic points`,method:`Walk through A → P → E → T → M with diaphragm then bell.`,normal:`S1 S2 clear, physiologic S2 split at pulmonic, no added sounds`},{label:`Any murmur`,method:`Characterise: timing, location, radiation, grade, character. Apply 7 S criteria + compare to innocent-murmur panel.`,normal:`No murmur, or innocent flow murmur meeting all 7 S criteria`},{label:`Position change`,method:`Standing vs supine. Innocent murmurs typically soften or disappear on standing.`,normal:`Murmur (if any) changes with position`},{label:`Sports screening extras (if applicable)`,method:`Screen for HOCM — murmur intensifies with Valsalva and standing (opposite of most).`,normal:`No murmur worsening on Valsalva`}],abnormalHints:[`Murmur breaking any of the 7 S criteria — refer`,`Harsh systolic at LUSB + fixed split S2 — ASD`,`Murmur louder with Valsalva — HOCM (sports participation risk)`,`Diastolic murmur — always pathologic`]}]}},school:{label:`School-age (6–11 years)`,msk:{overview:`Scoliosis screening peri-puberty, sports overuse injuries, resolving alignment.`,components:[{name:`Scoliosis screen (forward-bend + scoliometer)`,steps:[{label:`Standing inspection`,method:`Shoulders and iliac crest heights`,normal:`Symmetric shoulder and pelvic heights`},{label:`Forward bend (Adam test)`,method:`Feet together, bend forward at waist, arms hanging palms together`,normal:`Symmetric paraspinal contour`},{label:`Rib hump`,method:`View tangentially from behind at level of curve`,normal:`No rib hump`},{label:`Lumbar prominence`,method:`Same view at lumbar level`,normal:`No prominence`},{label:`Scoliometer (if available)`,method:`Place scoliometer across rib hump, read angle of trunk rotation`,normal:`ATR < 5°; ≥7° → refer`}],abnormalHints:[`Rib hump`,`ATR ≥7°`,`Asymmetric shoulders or pelvis`,`Decompensation (plumb line offset)`]},{name:`Back and spine`,steps:[{label:`Posture inspection`,method:`Standing, view front/back/side`,normal:`Normal spinal curves; plumb line centered`},{label:`Palpate spinous processes`,method:`From C2 to S1`,normal:`No tenderness, no step-off`},{label:`Range of motion`,method:`Flex, extend, lateral bend, rotate`,normal:`Full painless range`}],abnormalHints:[`Midline tenderness`,`Step-off (spondylolisthesis)`,`Limited motion with pain`]},{name:`Alignment`,steps:[{label:`Knees`,method:`Feet together, inspect`,normal:`Neutral alignment by 6–7y`},{label:`Feet`,method:`Stand, then tiptoes`,normal:`Medial arch present, symmetric`},{label:`Leg lengths`,method:`Supine, measure ASIS to medial malleolus if asymmetric`,normal:`Equal within 1cm`}],abnormalHints:[`Residual valgum`,`Pes cavus`,`Leg-length discrepancy >1cm`]},{name:`Joint stability and sports exam (if active)`,steps:[{label:`Active range all joints`,method:`Through full range`,normal:`Full symmetric range, no pain or crepitus`},{label:`Knee — Lachman (if sports-active)`,method:`Knee 20° flexion, stabilize femur, pull tibia forward`,normal:`Firm endpoint, no laxity`},{label:`Knee — McMurray`,method:`Flexed knee, rotate tibia while extending`,normal:`No pain or click`},{label:`Shoulder — impingement (Neer/Hawkins)`,method:`Passive shoulder flexion with arm in internal rotation`,normal:`No pain`},{label:`Ankle stability`,method:`Anterior drawer and talar tilt`,normal:`No laxity`}],abnormalHints:[`ACL laxity (positive Lachman)`,`Meniscal click`,`Shoulder impingement`,`Ankle instability`]},{name:`Gait and functional movement`,steps:[{label:`Normal gait`,method:`Walk 20 feet`,normal:`Smooth, symmetric`},{label:`Single-leg stance`,method:`Stand on one foot 10s each side`,normal:`Stable without Trendelenburg drop`},{label:`Squat`,method:`Full squat and rise`,normal:`Full squat without pain or asymmetry`},{label:`Hop on one foot`,method:`5 hops each side`,normal:`Able and symmetric`}],abnormalHints:[`Trendelenburg sign (hip abductor weakness)`,`Antalgic gait`,`Asymmetric squat`,`Pain with hop`]}]},neuro:{overview:`Adult-pattern six-component exam: mental status, CN, motor, reflexes, sensory, coordination/gait.`,components:[{name:`Mental status`,steps:[{label:`Orientation`,method:`Name, age, school, city, day of week`,normal:`Oriented x 4`},{label:`Attention`,method:`Count backward from 20; days of week backward`,normal:`Intact`},{label:`3-item recall`,method:`Ball-flag-tree; ask at 3 and 5 min`,normal:`3/3 recall at 5 min`},{label:`Language`,method:`Name common objects; repeat a sentence`,normal:`Fluent, no paraphasia`}],abnormalHints:[`Inattention (ADHD features)`,`Memory deficits`,`Word-finding difficulty`,`Perseveration`]},{name:`Cranial nerves (II–XII)`,steps:[{label:`CN II — acuity`,method:`Snellen at 20ft each eye with corrective lenses if worn`,normal:`20/20 or baseline`},{label:`CN II — fields`,method:`Confrontation, 4 quadrants each eye`,normal:`Full fields`},{label:`CN II — fundoscopy (if indicated)`,method:`Direct ophthalmoscopy — disc, vessels, macula`,normal:`Sharp disc, normal cup-disc ratio, no papilledema`},{label:`CN II, III — pupils`,method:`Direct and consensual light, accommodation`,normal:`PERRLA`},{label:`CN III, IV, VI — EOM`,method:`Follow finger in H pattern; convergence`,normal:`Full EOM, no nystagmus, convergence intact`},{label:`CN V — sensation`,method:`Light touch V1 (forehead), V2 (cheek), V3 (jaw) each side`,normal:`Intact, symmetric`},{label:`CN V — motor`,method:`Clench teeth, palpate masseter/temporalis; jaw opening`,normal:`Symmetric strength`},{label:`CN VII`,method:`Raise eyebrows, close eyes tight, smile/show teeth, puff cheeks`,normal:`Symmetric movement, all regions`},{label:`CN VIII`,method:`Finger rub each ear; Weber/Rinne if deficit`,normal:`Hears bilaterally`},{label:`CN IX, X`,method:`Palate elevation with "ahh"; uvula midline; voice quality`,normal:`Symmetric elevation, uvula midline, normal voice`},{label:`CN XI`,method:`Shrug shoulders against resistance; head turn against resistance`,normal:`5/5 SCM and trapezius`},{label:`CN XII`,method:`Stick tongue out; side-to-side`,normal:`Midline, no atrophy or fasciculations`}],abnormalHints:[`Papilledema (increased ICP)`,`Focal cranial nerve deficit — any warrants workup`,`Tongue fasciculations (LMN/MND)`]},{name:`Motor — bulk, tone, strength`,steps:[{label:`Bulk inspection`,method:`Shoulders, thighs, calves, intrinsic hand muscles`,normal:`Symmetric, no atrophy`},{label:`Tone`,method:`Passive range at elbows, wrists, knees, ankles`,normal:`Normal resistance throughout`},{label:`Strength — deltoids`,method:`Shoulder abduction against resistance`,normal:`5/5 bilaterally`},{label:`Strength — biceps`,method:`Elbow flexion against resistance`,normal:`5/5`},{label:`Strength — triceps`,method:`Elbow extension against resistance`,normal:`5/5`},{label:`Strength — grip`,method:`Squeeze 2 fingers`,normal:`5/5 symmetric`},{label:`Strength — finger abduction`,method:`Spread fingers against resistance`,normal:`5/5`},{label:`Strength — hip flexion`,method:`Lift leg supine against resistance`,normal:`5/5`},{label:`Strength — knee extension`,method:`Straighten knee against resistance`,normal:`5/5`},{label:`Strength — dorsiflexion`,method:`Pull toes up against resistance`,normal:`5/5`},{label:`Strength — plantarflexion`,method:`Push foot down against resistance`,normal:`5/5`}],abnormalHints:[`Focal weakness (localize)`,`Spasticity (UMN)`,`Atrophy`,`Fasciculations`]},{name:`Deep tendon reflexes`,steps:[{label:`Biceps (C5-C6)`,method:`Thumb on tendon, strike`,normal:`2+ symmetric`},{label:`Triceps (C7-C8)`,method:`Strike triceps tendon`,normal:`2+ symmetric`},{label:`Brachioradialis (C5-C6)`,method:`Strike distal radius`,normal:`2+ symmetric`},{label:`Patellar (L3-L4)`,method:`Knees hanging, strike tendon`,normal:`2+ symmetric`},{label:`Achilles (S1)`,method:`Slight dorsiflexion, strike tendon`,normal:`2+ symmetric`},{label:`Plantar response`,method:`Stroke lateral sole heel-to-toes`,normal:`Down-going bilaterally`},{label:`Clonus`,method:`Rapid dorsiflexion at ankle`,normal:`No sustained clonus`}],abnormalHints:[`Hyperreflexia with clonus (UMN: stroke, MS, cord lesion)`,`Hyporeflexia (LMN, neuropathy, myopathy)`,`Asymmetry`,`Up-going Babinski`,`Sustained clonus`]},{name:`Sensory`,steps:[{label:`Light touch — upper`,method:`Cotton wisp dorsum of hands, eyes closed`,normal:`Intact, symmetric`},{label:`Light touch — lower`,method:`Same on dorsum of feet`,normal:`Intact, symmetric`},{label:`Pain — upper`,method:`Broken Q-tip or pin on hands`,normal:`Intact, symmetric`},{label:`Pain — lower`,method:`Same on feet`,normal:`Intact, symmetric`},{label:`Vibration`,method:`128 Hz tuning fork at distal IP joint of great toes`,normal:`Feels vibration; counts down seconds`},{label:`Proprioception`,method:`Move great toe up/down with eyes closed`,normal:`Identifies direction correctly`}],abnormalHints:[`Dermatomal loss (nerve root)`,`Stocking-glove (neuropathy)`,`Loss of vibration/proprioception (dorsal column — B12, tabes, MS)`]},{name:`Coordination`,steps:[{label:`Finger-nose-finger`,method:`Touch examiner finger then own nose, examiner moves target`,normal:`Smooth, accurate, no dysmetria`},{label:`Heel-to-shin`,method:`Supine: heel down opposite shin`,normal:`Smooth, on-target`},{label:`Rapid alternating movements`,method:`Supinate/pronate hand on knee rapidly`,normal:`Rhythmic, symmetric`},{label:`Fine motor`,method:`Finger tapping (thumb to each finger in sequence)`,normal:`Rhythmic, accurate`}],abnormalHints:[`Dysmetria (past-pointing, overshoot)`,`Intention tremor`,`Dysdiadochokinesia`]},{name:`Gait and Romberg`,steps:[{label:`Normal gait`,method:`Walk 20 feet`,normal:`Narrow-based, smooth, reciprocal arm swing`},{label:`Heel walk`,method:`Walk on heels`,normal:`Able without difficulty`},{label:`Toe walk`,method:`Walk on toes`,normal:`Able without difficulty`},{label:`Tandem`,method:`Heel-to-toe along a line`,normal:`Minimal deviation, 10+ steps`},{label:`Romberg`,method:`Feet together, eyes closed, 30s`,normal:`Stable without fall or significant sway`}],abnormalHints:[`Wide-based (cerebellar)`,`Steppage (peripheral neuropathy)`,`Scissoring (UMN)`,`Romberg positive (dorsal column)`,`Circumduction`]}]},resp:{overview:`Nearly adult-pattern. Exam the same as adolescent with slightly more flexibility in cooperation. RR ≤ 30 in younger school-age, ≤ 20 in older. Sports history relevant (exercise-induced asthma).`,components:[{name:`Inspection`,steps:[{label:`Respiratory rate`,method:`Count over 60 s.`,normal:`≤ 30 (6–11 y)`},{label:`Work of breathing`,method:`Retractions, accessory muscles.`,normal:`Effortless`},{label:`Audible sounds`,method:`Listen for wheeze, stridor.`,normal:`Quiet`},{label:`Chest shape`,method:`Barrel chest, pectus deformities.`,normal:`Normal shape`},{label:`Clubbing`,method:`Schamroth window test.`,normal:`No clubbing`}],abnormalHints:[`Clubbing — CF, chronic hypoxemia, bronchiectasis`,`Barrel chest — chronic asthma, CF`]},{name:`Palpation and percussion`,steps:[{label:`Tracheal position`,method:`Middle finger in suprasternal notch.`,normal:`Midline`},{label:`Chest expansion`,method:`Hands laterally, thumbs meeting at spine. Deep breath.`,normal:`Symmetric 3–5 cm`},{label:`Tactile fremitus`,method:`Ulnar side of hand; "ninety-nine". Compare sides.`,normal:`Symmetric`},{label:`Percussion`,method:`Pleximeter + plexor technique. Compare sides.`,normal:`Resonant throughout`}],abnormalHints:[`Deviated trachea — pneumothorax, effusion, collapse`,`Dull percussion — consolidation, effusion`,`Hyper-resonant — pneumothorax, hyperinflation`]},{name:`Auscultation`,steps:[{label:`Systematic zones`,method:`Six anterior + four lateral + six posterior zones, compare side-to-side.`,normal:`Symmetric vesicular sounds`},{label:`Adventitious sounds`,method:`Wheeze, crackles, rhonchi, rub, stridor at neck. Use sounds library for reference.`,normal:`No added sounds`},{label:`Cough re-listen`,method:`Secretions (rhonchi, coarse crackles) should clear; fibrosis crackles do not.`,normal:`Secretion-based sounds clear with cough`}],abnormalHints:[`Focal crackles + fever — pneumonia`,`Diffuse fine crackles — early interstitial disease`,`Expiratory wheeze — asthma / RAD`]}]},cv:{overview:`Nearly adult-pattern. Sports participation screening is a key indication in this age. HOCM screening (family history of sudden cardiac death, exertional syncope, murmur louder with Valsalva) is specifically relevant.`,components:[{name:`Inspection and palpation`,pearl:`For sports participation exams, always ask about exertional symptoms (syncope, chest pain, unexpected fatigue) AND family history of sudden cardiac death before age 50. Screening exam alone catches only ~3% of HOCM.`,steps:[{label:`General and growth`,method:`Track on growth curve; review activity tolerance.`,normal:`Normal growth, age-appropriate activity`},{label:`Colour and clubbing`,method:`Inspect mucous membranes and nail beds.`,normal:`Pink, no clubbing`},{label:`Apex beat`,method:`Palpate at 5th ICS mid-clavicular line.`,normal:`Normal position, tapping character`},{label:`Peripheral pulses`,method:`Simultaneous brachial + femoral.`,normal:`Symmetric, no delay`},{label:`Blood pressure`,method:`Measure BP with appropriately sized cuff. If elevated, check both arms and one leg.`,normal:`Age-appropriate (< 120/80 roughly by 10+ years)`}],abnormalHints:[`Exertional syncope — HOCM, arrhythmia, LQTS`,`BP differential — coarctation`,`Displaced apex — cardiomegaly`]},{name:`Auscultation`,steps:[{label:`All 5 classic points`,method:`See APTM diagram. A → P → E → T → M with diaphragm and bell.`,normal:`S1, S2 clear with physiologic split at P, no added sounds`},{label:`Grade any murmur`,method:`Levine 1–6 (see scales above); characterise timing, location, radiation.`,normal:`No murmur, or innocent flow murmur meeting all 7 S criteria`},{label:`Innocent vs pathologic`,method:`Apply 7 S criteria; compare to innocent-murmur panel.`,normal:`Innocent murmur (if present) clearly fits all 7 S features`},{label:`Dynamic maneuvers`,method:`Standing: HOCM louder; most others soften. Valsalva: HOCM louder.`,normal:`Murmur (if any) softens on standing and Valsalva`}],abnormalHints:[`Murmur louder with Valsalva / standing — HOCM (sports disqualification considerations)`,`Any diastolic murmur`,`Murmur ≥ grade 3, radiating, or with thrill`]}]}},adolescent:{label:`Adolescent (12–21 years)`,msk:{overview:`Sports-related injuries, adolescent scoliosis, apophyseal overuse, hypermobility screening.`,components:[{name:`Scoliosis screen`,steps:[{label:`Standing inspection`,method:`Patient undressed to waist (keep privacy); compare shoulders, iliac crests, scapular heights`,normal:`Symmetric shoulders and pelvis`},{label:`Forward bend (Adam)`,method:`Feet together, bend forward, arms hanging palms together`,normal:`Symmetric paraspinal contour`},{label:`Scoliometer`,method:`Place across thoracic and lumbar regions at maximum prominence`,normal:`ATR <5°; 5–6° monitor; ≥7° refer`},{label:`Plumb line check`,method:`Drop plumb from C7; note where it falls`,normal:`Passes through gluteal cleft (compensated)`},{label:`Leg lengths`,method:`Supine; ASIS to medial malleolus each side`,normal:`Within 1cm`}],abnormalHints:[`Rib/lumbar hump`,`ATR ≥7°`,`Decompensation (plumb off gluteal cleft)`,`Leg-length discrepancy driving apparent curve`]},{name:`Back pain evaluation (if complaint)`,steps:[{label:`Inspect and palpate`,method:`Spinous processes, paraspinal muscles, SI joints`,normal:`Non-tender`},{label:`Range of motion`,method:`Flex, extend, lateral bend, rotate`,normal:`Full painless range`},{label:`Single-leg hyperextension (stork)`,method:`Stand on one foot, extend back — each side`,normal:`No pain (negative for spondylolysis)`},{label:`Straight-leg raise`,method:`Supine, lift straight leg to 70°+`,normal:`No radicular pain to 70°`},{label:`SI joint tests`,method:`FABER, SI compression`,normal:`No pain`}],abnormalHints:[`Spondylolysis (positive stork test)`,`Radicular pain (disc herniation)`,`SI joint pathology`,`Inflammatory back pain pattern`]},{name:`Joint stability — sports-specific`,steps:[{label:`Knee — Lachman`,method:`Knee 20° flexion, stabilize femur, pull tibia anteriorly`,normal:`Firm endpoint, no laxity (ACL intact)`},{label:`Knee — anterior drawer`,method:`Knee 90°, pull tibia forward`,normal:`No excess anterior translation`},{label:`Knee — varus/valgus stress`,method:`Stress at 0 and 30° flexion`,normal:`No gap opening (LCL/MCL intact)`},{label:`Knee — McMurray`,method:`Flex, rotate tibia while extending`,normal:`No pain or click`},{label:`Shoulder — apprehension`,method:`Abduct and externally rotate`,normal:`No apprehension`},{label:`Shoulder — Neer/Hawkins`,method:`Passive flexion with internal rotation`,normal:`No pain`},{label:`Ankle — anterior drawer`,method:`Pull heel forward with tibia stabilized`,normal:`No laxity`},{label:`Ankle — talar tilt`,method:`Invert heel with tibia stabilized`,normal:`No excess tilt`}],abnormalHints:[`ACL/PCL tear`,`MCL/LCL laxity`,`Meniscal injury`,`Shoulder instability/impingement`,`Ankle ligament laxity`]},{name:`Apophysitis and overuse screen`,steps:[{label:`Tibial tubercle`,method:`Palpate with knee flexed`,normal:`Non-tender`},{label:`Calcaneal apophysis`,method:`Palpate posterior calcaneus`,normal:`Non-tender`},{label:`Iliac apophyses`,method:`Palpate ASIS, AIIS, iliac crest`,normal:`Non-tender`},{label:`Rotator cuff`,method:`Empty-can (Jobe) test`,normal:`No pain or weakness`}],abnormalHints:[`Osgood-Schlatter (tibial tubercle tender)`,`Sever (calcaneal tender)`,`Iliac apophysitis`,`Rotator cuff tendinopathy`]},{name:`Hypermobility screen (Beighton)`,steps:[{label:`Fifth finger extension`,method:`Passive extension of fifth MCP to >90°`,normal:`No hyperextension (1 pt each side if positive)`},{label:`Thumb to forearm`,method:`Passive flexion of thumb to touch forearm`,normal:`Does not reach (1 pt each side if positive)`},{label:`Elbow hyperextension`,method:`Hyperextension >10°`,normal:`No hyperextension (1 pt each side if positive)`},{label:`Knee hyperextension`,method:`Hyperextension >10°`,normal:`No hyperextension (1 pt each side if positive)`},{label:`Palms to floor`,method:`Feet together, bend forward, palms flat on floor with knees straight`,normal:`Cannot reach (1 pt if positive)`}],abnormalHints:[`Beighton ≥5/9 suggests hypermobility spectrum (hEDS workup if with other features)`]},{name:`Alignment and gait`,steps:[{label:`Standing alignment`,method:`View knees, feet`,normal:`Neutral alignment, medial arch`},{label:`Normal gait`,method:`Walk 20 feet`,normal:`Symmetric, smooth`},{label:`Functional movements`,method:`Squat, single-leg stance, hop`,normal:`Full symmetric function`}],abnormalHints:[`Antalgic gait`,`Trendelenburg`,`Asymmetric squat`]}]},neuro:{overview:`Full adult-pattern neuro exam across six pillars: mental status, cranial nerves, motor, reflexes, sensory, coordination/gait. In adolescents, screen concussion sequelae if sports-active; frontal release signs must be absent.`,components:[{name:`Mental status`,significance:`Detects cognitive change (concussion, substance use, mood disorder, rare neurodegenerative disease).`,pearl:`Attention precedes memory. A patient who can't attend (serial 7s, months backward) will fail memory even with intact hippocampus — distinguish before calling it a memory problem.`,steps:[{label:`Orientation`,method:`Name, age, date, location, situation`,normal:`Oriented x 4`},{label:`Attention`,method:`Count backward from 100 by 7s (serial 7s) or months of year backward`,normal:`Intact`},{label:`Short-term memory`,method:`3-item registration and recall at 5 min`,normal:`3/3 recall`},{label:`Language`,method:`Object naming; sentence repetition; reading; writing`,normal:`Fluent, no paraphasia, comprehends written and spoken`},{label:`Executive function`,method:`Similarities (apple/orange); interpret proverb`,normal:`Abstract, age-appropriate`}],abnormalHints:[`Post-concussion cognitive changes`,`Mood or personality changes`,`Subtle executive dysfunction`,`Word-finding difficulty`]},{name:`Cranial nerves (II–XII, full formal exam)`,significance:`Localises brainstem, base-of-skull, and specific nerve pathology. Subtle deficits (RAPD, mild facial weakness, Horner) are easily missed — exam discipline matters.`,pearl:`The fastest screen for a CN deficit is asking the patient to speak, smile, look around, and swallow water. What's preserved in everyday function tells you what's likely intact — then examine formally to confirm and to catch the subtle.`,steps:[{label:`CN I (if indicated)`,method:`Coffee or cinnamon each nostril separately`,normal:`Identifies both`},{label:`CN II — acuity`,method:`Snellen at 20ft each eye; corrective lenses if worn`,normal:`20/20 or baseline`},{label:`CN II — fields`,method:`Confrontation, 4 quadrants each eye`,normal:`Full fields`},{label:`CN II — fundoscopy`,method:`Direct ophthalmoscopy — disc, vessels, macula`,normal:`Sharp disc, normal cup/disc, no papilledema`},{label:`CN II, III — pupils`,method:`Direct, consensual, swinging flashlight, accommodation`,normal:`PERRLA, no RAPD`},{label:`CN III, IV, VI — EOM`,method:`H pattern, convergence, note nystagmus or ptosis`,normal:`Full conjugate movement, no nystagmus, convergence intact`},{label:`CN V — sensation`,method:`Light touch V1, V2, V3 each side`,normal:`Intact, symmetric`},{label:`CN V — motor`,method:`Clench jaw, palpate masseter/temporalis; lateral jaw movement`,normal:`Symmetric strength and bulk`},{label:`CN V — corneal reflex (if indicated)`,method:`Cotton wisp to cornea`,normal:`Blinks bilaterally`},{label:`CN VII`,method:`Wrinkle forehead, close eyes against resistance, smile/bare teeth, puff cheeks`,normal:`Symmetric all four movements`},{label:`CN VIII — hearing`,method:`Finger rub each ear; Weber (midline) + Rinne (air > bone) if deficit`,normal:`Equal bilaterally`},{label:`CN IX, X`,method:`Palate elevation with "ahh"; uvula midline; voice; gag (if indicated)`,normal:`Symmetric palate, uvula midline, normal voice`},{label:`CN XI`,method:`Shoulder shrug and head turn against resistance`,normal:`5/5 SCM and trapezius bilaterally`},{label:`CN XII`,method:`Tongue protrusion, side to side; inspect for fasciculations/atrophy`,normal:`Midline, no atrophy or fasciculations, full movement`}],abnormalHints:[`Any focal cranial nerve deficit`,`Papilledema`,`RAPD`,`Nystagmus`,`Facial asymmetry`,`Tongue deviation`]},{name:`Motor — bulk, tone, strength`,significance:`Localises lesion to UMN vs LMN vs muscle vs junction. Pattern of weakness (proximal vs distal, symmetric vs focal) narrows differential.`,pearl:`Pronator drift is the most sensitive screen for subtle UMN weakness — a normal-feeling arm that drifts down with eyes closed still has corticospinal tract dysfunction. Always do it even when formal strength is 5/5.`,steps:[{label:`Bulk inspection`,method:`Inspect shoulders, biceps, thighs, calves, dorsal interossei (between metacarpals) of hands.`,normal:`Symmetric bulk; no atrophy, no pseudohypertrophy`},{label:`Tone — upper`,method:`Passive flex-extend elbow and pronate-supinate wrist at slow then quick speeds. Then pronator drift: arms outstretched, palms up, eyes closed for 10 s.`,normal:`Smooth passive range; no drift, no pronation of the outstretched hand`},{label:`Tone — lower`,method:`Passive knee flexion-extension; quick ankle dorsiflexion to check for catch. Heel-slap test: roll thigh and watch for ankle swing.`,normal:`Normal resistance, no catch, symmetric`},{label:`Strength — deltoid (C5)`,method:`Patient abducts both arms to 90°. Examiner pushes down on each arm just above the elbow while patient resists. Compare sides.`,normal:`Holds against full resistance — MRC 5/5 bilaterally`},{label:`Strength — biceps (C5–C6)`,method:`Elbow flexed 90°, supinated. Examiner grasps wrist and pulls to extend while patient resists.`,normal:`Holds against full resistance — 5/5`},{label:`Strength — triceps (C7)`,method:`Elbow flexed 90°. Examiner pushes wrist toward shoulder while patient extends against resistance.`,normal:`Extends against full resistance — 5/5`},{label:`Strength — wrist extension (C6–C7)`,method:`Patient makes fist, extends wrist. Examiner pushes down on knuckles while patient holds wrist up.`,normal:`Holds against full resistance — 5/5`},{label:`Strength — finger flexion / grip (C8)`,method:`Patient grips two of examiner's crossed fingers as hard as possible. Compare sides.`,normal:`Strong symmetric grip — 5/5`},{label:`Strength — finger abduction (T1)`,method:`Patient spreads fingers wide. Examiner squeezes index and little fingers together while patient resists.`,normal:`Holds fingers apart — 5/5`},{label:`Strength — hip flexion (L2–L3)`,method:`Supine. Patient lifts straight leg 30° off table. Examiner pushes down on thigh just above knee while patient resists.`,normal:`Holds thigh up against full resistance — 5/5`},{label:`Strength — knee extension (L3–L4)`,method:`Sitting, knee 90°. Patient straightens knee while examiner pushes distal shin down.`,normal:`Extends against full resistance — 5/5`},{label:`Strength — ankle dorsiflexion (L4–L5)`,method:`Patient pulls toes and foot up toward shin. Examiner pushes foot down at the dorsum.`,normal:`Holds dorsiflexion against full resistance — 5/5; preserved heel-walk`},{label:`Strength — great toe extension (L5)`,method:`Patient extends great toe up while examiner pushes it down with thumb.`,normal:`Holds against full resistance — 5/5 (classic L5 test)`},{label:`Strength — ankle plantarflexion (S1)`,method:`Patient pushes foot down against examiner's hand at the ball. OR ask patient to toe-walk 10 steps (more sensitive — unilateral plantarflexion weakness shows immediately).`,normal:`Full power; toe-walks symmetrically — 5/5`}],abnormalHints:[`Focal weakness → localise by myotome`,`Pronator drift (subtle UMN, always check even with 5/5)`,`Spasticity / catch (UMN)`,`Atrophy (LMN, disuse)`,`Fasciculations (MND, ALS)`,`Pseudohypertrophy of calves (DMD in a young male)`]},{name:`Deep tendon reflexes`,significance:`Reflex pattern (increased, decreased, asymmetric) localises UMN vs LMN vs root vs peripheral nerve. Inexpensive and fast, but asymmetry is the most informative finding.`,pearl:`A reinforced reflex is still a reflex. If you can't elicit it initially, use Jendrassik (teeth clench or pull interlocked fingers apart) to boost — absent reflexes without reinforcement aren't truly absent.`,steps:[{label:`Biceps (C5–C6)`,method:`Patient's arm relaxed across lap. Examiner places thumb firmly on biceps tendon at the cubital fossa, strikes thumb with reflex hammer. Compare both sides sequentially.`,normal:`2+ symmetric — visible contraction of biceps, slight elbow flexion`},{label:`Brachioradialis (C5–C6)`,method:`Arm relaxed. Strike the distal radius about 3 cm proximal to the wrist, on its radial (thumb) side.`,normal:`2+ symmetric — elbow flexion and slight forearm supination`},{label:`Triceps (C7)`,method:`Support the patient's arm at the wrist with elbow at 90°. Strike the triceps tendon just above the olecranon.`,normal:`2+ symmetric — triceps contraction, slight elbow extension`},{label:`Finger flexors — Hoffmann sign`,method:`Grasp the middle finger's distal phalanx, flick it downward quickly and release. Watch the thumb and index finger.`,normal:`Negative — no thumb flexion, no index flexion (positive = corticospinal tract dysfunction)`},{label:`Patellar (L3–L4)`,method:`Patient sits with knees hanging freely off the table. Strike the patellar tendon just below the patella.`,normal:`2+ symmetric — quadriceps contraction with knee extension`},{label:`Achilles (S1)`,method:`Patient's knee slightly flexed and leg externally rotated, or kneeling on a chair. Slightly dorsiflex the foot and strike the Achilles tendon.`,normal:`2+ symmetric — plantar flexion of the foot`},{label:`Plantar response (Babinski)`,method:`Stroke the lateral aspect of the sole firmly from the heel toward the little toe, then curve across the ball of the foot.`,normal:`Toes flex downward (plantar flexion, "down-going") bilaterally in anyone ≥ 2 years`},{label:`Ankle clonus`,method:`Knee slightly bent. Support the shin with one hand, quickly and sharply dorsiflex the foot with the other, hold in dorsiflexion.`,normal:`≤ 3 non-sustained beats is acceptable; sustained rhythmic oscillation = pathological clonus (UMN)`}],abnormalHints:[`Hyperreflexia + sustained clonus = UMN (MS, myelopathy, cord lesion, stroke)`,`Symmetric hyporeflexia = peripheral polyneuropathy, GBS, myopathy, hypothyroid, B12 deficiency`,`Asymmetric hyporeflexia = radiculopathy at that segment`,`Hoffmann positive = corticospinal tract dysfunction at cervical cord or above`,`Up-going Babinski after age 2 = UMN (always abnormal)`]},{name:`Sensory`,steps:[{label:`Light touch — upper`,method:`Cotton wisp, dorsum of hands, eyes closed`,normal:`Intact, symmetric`},{label:`Light touch — lower`,method:`Dorsum of feet`,normal:`Intact, symmetric`},{label:`Pain — upper`,method:`Broken Q-tip sharp end, hands`,normal:`Intact, symmetric`},{label:`Pain — lower`,method:`Same on feet`,normal:`Intact, symmetric`},{label:`Temperature (if indicated)`,method:`Cold tuning fork each area`,normal:`Intact`},{label:`Vibration`,method:`128 Hz tuning fork at distal IP of great toes; count seconds to fade`,normal:`Feels vibration; appropriate duration`},{label:`Proprioception`,method:`Move great toe up/down with eyes closed`,normal:`Identifies direction correctly`},{label:`Two-point discrimination (if indicated)`,method:`Blunt calipers on fingertip`,normal:`<5mm on fingertip`},{label:`Stereognosis (if indicated)`,method:`Identify coin/key in hand with eyes closed`,normal:`Correct identification`}],abnormalHints:[`Dermatomal loss (nerve root)`,`Stocking-glove loss (length-dependent neuropathy)`,`Dorsal column loss (B12, tabes, MS — positive Romberg, vibration loss)`,`Cortical deficit (astereognosis, impaired 2-pt)`]},{name:`Coordination`,steps:[{label:`Finger-nose-finger`,method:`Alternate examiner's finger and own nose; examiner moves target`,normal:`Smooth, accurate bilaterally`},{label:`Heel-to-shin`,method:`Supine: heel down opposite shin and back`,normal:`Smooth, accurate`},{label:`Rapid alternating (Dysdiadochokinesis)`,method:`Supinate/pronate hand rapidly on thigh`,normal:`Rhythmic, symmetric`},{label:`Finger tapping`,method:`Thumb to each finger in sequence rapidly`,normal:`Rhythmic, smooth, symmetric`}],abnormalHints:[`Dysmetria (cerebellar)`,`Intention tremor`,`Dysdiadochokinesia`,`Decomposed movement`]},{name:`Gait and Romberg`,steps:[{label:`Normal gait`,method:`Walk 20 feet`,normal:`Narrow-based, smooth, reciprocal arm swing`},{label:`Heel walk`,method:`Walk on heels only`,normal:`Able without difficulty`},{label:`Toe walk`,method:`Walk on toes only`,normal:`Able without difficulty`},{label:`Tandem`,method:`Heel-to-toe along a line, 10+ steps`,normal:`Minimal deviation`},{label:`Romberg`,method:`Feet together, eyes open then closed, 30s`,normal:`Stable — no significant sway or fall with eyes closed`},{label:`Single-leg stance`,method:`10s each side, eyes open`,normal:`Stable without drift`}],abnormalHints:[`Ataxic (wide-based — cerebellar)`,`Steppage (peripheral neuropathy / foot drop)`,`Circumduction (UMN hemiparesis)`,`Scissoring`,`Romberg positive (dorsal column)`]},{name:`Frontal release / primitive reflexes`,steps:[{label:`Grasp reflex`,method:`Stroke palm`,normal:`Absent`},{label:`Snout reflex`,method:`Tap upper lip`,normal:`No lip pucker`},{label:`Glabellar tap`,method:`Tap between eyebrows — should habituate after 3–4 taps`,normal:`Habituates (no sustained blink)`},{label:`Palmomental`,method:`Stroke thenar eminence`,normal:`No ipsilateral chin twitch`}],abnormalHints:[`Presence suggests frontal lobe pathology, neurodegenerative disease, or severe TBI — rare in adolescence but relevant in post-concussion workup`]}]},resp:{overview:`Systematic respiratory exam: inspection → palpation → percussion → auscultation → special maneuvers. Always start from observation — rate, pattern, work of breathing, and audible sounds (stridor, grunting) can be diagnostic before the stethoscope touches the chest.`,components:[{name:`Inspection — observation before touching`,significance:`Detects respiratory distress and localises the level of airway compromise before any equipment is used. High yield: RR, WOB, audible sounds, chest shape, colour.`,pearl:`Audible stridor at rest from across the room = upper-airway obstruction, often urgent. Grunting in an infant = significant distress — never dismiss as fussiness.`,steps:[{label:`Respiratory rate`,method:`Count over a full 60 seconds (not 15×4) — children normally breathe irregularly. Count while the patient is calm, before any interaction.`,normal:`Within age-appropriate range (see scales card above)`},{label:`Respiratory pattern`,method:`Observe depth, regularity, and inspiration:expiration ratio. Watch for prolonged expiration, paradoxical chest-abdominal movement, or apneas.`,normal:`Regular, I:E ratio ~1:2, no pauses > 10 s in an infant`},{label:`Work of breathing`,method:`Inspect for nasal flaring, suprasternal/intercostal/subcostal retractions, accessory muscle use (SCM, abdominals), tripod positioning, head-bobbing in infants.`,normal:`No retractions; breathing effortless`},{label:`Audible sounds (no stethoscope)`,method:`Listen at the bedside without the stethoscope. Grunting? Stridor? Wheezing audible across the room? Hoarse voice?`,normal:`No audible stridor, grunting, or wheeze`},{label:`Chest shape and symmetry`,method:`Inspect from front and lateral. Note AP-to-transverse diameter, pectus excavatum/carinatum, chest wall asymmetry.`,normal:`AP:transverse ~1:2 (not barrel-chested); symmetric`},{label:`Colour and perfusion`,method:`Inspect lips, tongue, nail beds for central cyanosis. Check peripheral perfusion (capillary refill, mottling).`,normal:`Pink, cap refill < 2 s, no cyanosis`},{label:`Clubbing`,method:`Inspect fingernails: Schamroth sign (reverse a finger against its mirror — normal forms a diamond-shaped window, clubbed does not).`,normal:`Normal nail angle, Schamroth window present`}],abnormalHints:[`Audible stridor — upper airway (croup, epiglottitis, foreign body, laryngomalacia)`,`Grunting in infant — significant distress`,`Tripod positioning, accessory muscle use — severe distress`,`Barrel chest — chronic air-trapping (asthma, CF)`,`Central cyanosis — significant hypoxemia`,`Clubbing in a child — cystic fibrosis, chronic hypoxemia, bronchiectasis, cyanotic CHD`]},{name:`Palpation`,significance:`Localises pathology: consolidation increases tactile fremitus; pneumothorax/effusion decreases it. Trachea deviates AWAY from expanding lesions and TOWARD collapsing ones.`,pearl:`Tracheal deviation is one of the fastest bedside clues to mediastinal shift — tension pneumothorax pushes it away, lobar collapse pulls it toward. Palpate with the middle finger in the suprasternal notch.`,steps:[{label:`Tracheal position`,method:`Patient sitting upright, neck slightly extended. Place middle finger in the suprasternal notch, check equal distance to each SCM.`,normal:`Midline`},{label:`Chest expansion — symmetry`,method:`Hands on lateral chest wall with thumbs meeting at the spine (posterior) or xiphoid (anterior). Patient takes a deep breath. Watch thumbs separate symmetrically.`,normal:`Symmetric 3–5 cm separation`},{label:`Tactile fremitus`,method:`Ulnar surface of hand on chest wall. Ask patient to say "ninety-nine" repeatedly. Move hand systematically across each zone, comparing sides.`,normal:`Equal mild vibration bilaterally over lung fields`},{label:`Chest wall tenderness`,method:`Palpate ribs, costochondral junctions, sternum, and intercostal spaces.`,normal:`No tenderness`},{label:`Subcutaneous emphysema`,method:`Gentle palpation along clavicles, neck, chest wall.`,normal:`No crepitus under skin`}],abnormalHints:[`Tracheal deviation — tension pneumothorax, large pleural effusion (away); upper lobe collapse (toward)`,`Asymmetric expansion — pneumothorax, large effusion, lobar collapse, phrenic palsy`,`Increased fremitus — consolidation (pneumonia), lobar pneumonia`,`Decreased/absent fremitus — pleural effusion, pneumothorax, obstruction`,`Costochondral tenderness — costochondritis, trauma`,`Subcutaneous emphysema — pneumothorax, tracheobronchial injury`]},{name:`Percussion`,significance:`Differentiates air (hyper-resonant), fluid (dull), and consolidated lung (dull) without imaging. Well-performed percussion detects a pleural effusion > 300 mL or a pneumothorax with ~90% sensitivity.`,pearl:`Pleximeter fingertip must be flat against the chest wall — lift other fingers off. The "feel" of a percussion note is as informative as the sound: dullness has a dense, reflected quality; hyper-resonance feels hollow and springy.`,steps:[{label:`Technique`,method:`Place middle finger of non-dominant hand (pleximeter) flat on chest wall; strike distal IP joint with tip of dominant middle finger (plexor) using a quick wrist flick.`,normal:`N/A — technique step`},{label:`Systematic zones`,method:`Percuss from apex to base, comparing side-to-side at each level. Include anterior, lateral (mid-axillary), and posterior fields.`,normal:`Resonant throughout lung fields`},{label:`Cardiac dullness`,method:`Percuss from resonant lung toward the heart border. Left sternal border dullness starts at the 3rd–5th ICS.`,normal:`Dullness beginning at the expected cardiac border`},{label:`Hepatic dullness`,method:`Right 5th–6th ICS mid-clavicular line transitions from resonant to dull.`,normal:`Liver edge dullness at expected level`},{label:`Diaphragmatic excursion`,method:`Patient inhales fully then exhales fully; mark level of dullness at each end. Difference is diaphragm excursion.`,normal:`3–5 cm excursion bilaterally`}],abnormalHints:[`Hyper-resonant — pneumothorax, emphysematous bulla, severe asthma attack`,`Dull — consolidation, pleural effusion (stony dull), atelectasis, pleural thickening, large mass`,`Raised diaphragm (loss of excursion) — effusion, paralysis, subdiaphragmatic pathology`]},{name:`Auscultation — normal breath sounds`,significance:`Breath sound quality varies by location. Bronchial sounds heard peripherally = consolidation; absent breath sounds = pneumothorax, effusion, obstruction.`,pearl:`Always compare corresponding points side-to-side sequentially — your ear calibrates to "normal" one side and immediately hears asymmetry. Listen through a full respiratory cycle at each zone.`,steps:[{label:`Technique`,method:`Diaphragm of stethoscope directly on skin (not over clothing). Patient breathes slowly and deeply through an open mouth.`,normal:`N/A — technique`},{label:`Vesicular sounds (peripheral)`,method:`Listen over lung fields away from the sternum. Play the "Normal vesicular" sample above for reference.`,normal:`Soft, low-pitched, inspiration > expiration in length and loudness`},{label:`Bronchovesicular (over main bronchi)`,method:`Listen at the 1st–2nd ICS anteriorly and between scapulae posteriorly.`,normal:`Intermediate pitch, inspiration = expiration`},{label:`Bronchial (over trachea)`,method:`Listen directly over the manubrium or trachea.`,normal:`Harsh, high-pitched, expiration > inspiration`},{label:`Systematic comparison`,method:`Six zones anteriorly (upper/mid/lower × L/R), four lateral, six posterior. Compare side-to-side at each zone.`,normal:`Symmetric breath sounds at every paired zone`}],abnormalHints:[`Bronchial sounds heard peripherally — consolidation (pneumonia)`,`Absent/diminished breath sounds — pneumothorax, effusion, severe obstruction, obesity / muscular chest`,`Prolonged expiration — lower airway obstruction (asthma, bronchiolitis)`]},{name:`Auscultation — adventitious sounds`,significance:`Adventitious (added) sounds are the key diagnostic finding. Timing (inspiratory vs expiratory vs biphasic), character (continuous vs discontinuous), and location are all informative.`,pearl:`Ask the patient to cough and re-listen. Secretions (rhonchi, some coarse crackles) clear or change; fine crackles of fibrosis or early pneumonia do not. The cough test separates two differential groups in one maneuver.`,steps:[{label:`Listen for wheeze`,method:`Continuous musical sounds, typically expiratory. Use the "Wheeze" sample for reference.`,normal:`No wheeze`},{label:`Listen for crackles — fine`,method:`Short, high-pitched, discontinuous "Velcro" sounds. Typically end-inspiratory, bibasilar. Use the "Fine crackles" sample.`,normal:`No crackles`},{label:`Listen for crackles — coarse`,method:`Longer, lower-pitched, louder than fine. Use the "Coarse crackles" sample.`,normal:`No crackles`},{label:`Listen for rhonchi`,method:`Low-pitched, continuous, snore-like. Often change with cough. Use the "Rhonchi" sample.`,normal:`No rhonchi`},{label:`Listen for pleural rub`,method:`Grating, creaky, biphasic, does NOT clear with cough. Use the "Pleural rub" sample.`,normal:`No pleural rub`},{label:`Listen at the neck (for stridor)`,method:`Place stethoscope over the anterior neck. Stridor is loudest here and differentiates from wheeze (loudest over chest). Use the "Stridor" sample.`,normal:`No stridor`},{label:`Listen for expiratory grunting (infants)`,method:`Often audible without a stethoscope at the bedside — short, low-pitched sound at the end of each expiration (glottal closure against exhaled air).`,normal:`No grunting`},{label:`Cough re-listen`,method:`Have patient cough forcefully; re-listen to any abnormal area. Note if the sound clears or changes.`,normal:`Any secretion-based sound should clear or change with cough`}],abnormalHints:[`Wheeze — asthma, bronchiolitis, foreign body (localised), anaphylaxis`,`Fine crackles — pulmonary edema, interstitial lung disease, early pneumonia`,`Coarse crackles — bronchitis, pneumonia, bronchiectasis, aspiration`,`Rhonchi — large-airway secretions`,`Pleural rub — pleurisy, PE, pneumonia with pleural involvement`,`Stridor — upper airway obstruction (croup, epiglottitis, FB)`]},{name:`Special maneuvers — transmitted voice sounds`,significance:`Vocal resonance tests detect consolidation (increased transmission) and effusion/pneumothorax (decreased). Useful when auscultation suggests asymmetry.`,pearl:`Whispered pectoriloquy is the most sensitive of the three — whispered words transmitted clearly through consolidated lung. If "one, two, three" whispered becomes clearly audible over one lung zone, there is consolidation underneath.`,steps:[{label:`Bronchophony`,method:`Patient says "ninety-nine" in normal voice. Listen at each lung zone with the stethoscope.`,normal:`Muffled, indistinct sound`},{label:`Egophony`,method:`Patient says "ee" continuously. Listen over any suspicious area.`,normal:`"Ee" sounds like "ee" (no change)`},{label:`Whispered pectoriloquy`,method:`Patient whispers "one, two, three" or "ninety-nine". Listen over each zone.`,normal:`Whisper is faint and indistinct`}],abnormalHints:[`Bronchophony increased — consolidation`,`Egophony positive ("ee" → "A" / "ay") — consolidation, sometimes top of an effusion`,`Whispered pectoriloquy positive (whisper clearly audible) — consolidation`]}]},cv:{overview:`Systematic cardiovascular exam: inspection → palpation → auscultation at the five classic points → peripheral vascular exam. Always palpate the apex BEFORE auscultating — knowing where the apex lies tells you where to put the stethoscope and flags cardiomegaly immediately.`,components:[{name:`Inspection`,significance:`Detects obvious precordial activity, chest-wall signs of congenital heart disease, and systemic markers (cyanosis, clubbing, dysmorphic features).`,pearl:`Clubbing + central cyanosis in a well-appearing adolescent = cyanotic congenital heart disease until proven otherwise. Inspect the fingernails before reaching for the stethoscope.`,steps:[{label:`General appearance`,method:`Observe body habitus, features suggesting syndromic CHD (Turner, Down, Marfan, Williams).`,normal:`No dysmorphic features, appropriate growth`},{label:`Central cyanosis`,method:`Inspect lips, tongue, and oral mucosa for bluish discoloration.`,normal:`Pink oral mucosa, no cyanosis`},{label:`Peripheral cyanosis / clubbing`,method:`Inspect nail beds; do Schamroth's window (oppose nails of 4th fingers — normally forms a diamond-shaped window).`,normal:`Pink nail beds, Schamroth window present`},{label:`Precordial bulge`,method:`Inspect anterior chest wall tangentially for asymmetric prominence over the heart.`,normal:`Symmetric chest, no bulge`},{label:`Visible apex beat`,method:`Inspect for a visible cardiac impulse at the 5th ICS mid-clavicular line.`,normal:`Apex may be visible in thin patients; should not be displaced`},{label:`Neck veins (JVP)`,method:`Patient reclined 45°, head turned slightly left. Observe the right internal jugular pulsation; measure vertical height above the sternal angle.`,normal:`≤ 4 cm above sternal angle (≤ 9 cm H₂O from right atrium)`}],abnormalHints:[`Central cyanosis — right-to-left shunt, severe hypoxemia`,`Clubbing — cyanotic CHD, chronic hypoxemia`,`Precordial bulge — long-standing cardiomegaly (grew during skeletal growth)`,`Visible apex displaced lateral/inferior — cardiomegaly`,`Elevated JVP — right-heart failure, fluid overload, cardiac tamponade`]},{name:`Palpation`,significance:`Localises the apex (confirms cardiac size), detects thrills (loud murmurs), and identifies a parasternal heave (RV hypertrophy).`,pearl:`If you feel a thrill, the murmur is at least grade 4/6 — grade your murmur as ≥4 even if it sounds less impressive. Thrill = loud, palpable turbulence.`,steps:[{label:`Apex beat — localise`,method:`Feel with the tips of the fingers at the 5th ICS mid-clavicular line. If not found, roll the patient to the left lateral decubitus position.`,normal:`Located at 5th ICS, mid-clavicular line, less than 2 cm in diameter`},{label:`Apex character`,method:`Describe: tapping (normal), heaving (pressure overload, e.g. AS/HTN), thrusting (volume overload, e.g. AR/MR), dyskinetic (MI/aneurysm).`,normal:`Brief tapping quality`},{label:`Parasternal heave`,method:`Place the heel of the hand along the left sternal border. Sustained outward movement with each systole = heave.`,normal:`No heave`},{label:`Thrills`,method:`Use the palmar aspect of the hand at each of the 5 auscultation areas (A, P, E, T, M). A thrill = palpable turbulence.`,normal:`No thrills`},{label:`Peripheral pulses — upper`,method:`Palpate radial pulses bilaterally, then brachial. Note rate, rhythm, volume, and symmetry.`,normal:`Symmetric 2+ pulses, regular rhythm, age-appropriate rate`},{label:`Peripheral pulses — lower`,method:`Palpate femoral pulses. Compare to brachial — radio-femoral or brachio-femoral delay suggests coarctation of the aorta.`,normal:`Femoral pulses 2+ symmetric, no delay relative to radial`}],abnormalHints:[`Apex displaced laterally/inferiorly — cardiomegaly`,`Heaving apex — pressure overload (AS, HTN)`,`Thrusting apex — volume overload (AR, MR)`,`Thrill over precordium — always pathological; at least grade 4/6 murmur`,`Parasternal heave — RV hypertrophy (pulmonary HTN, pulmonary stenosis, VSD with Eisenmenger)`,`Radio-femoral delay — coarctation of the aorta (always check in a hypertensive adolescent)`]},{name:`Auscultation — approach`,significance:`Systematic technique ensures every relevant finding is detected. Listen at all 5 points, with both diaphragm and bell, in supine/sitting/left-lateral positions as needed.`,pearl:`Time every murmur by simultaneously palpating the carotid pulse with the fingers of your free hand. Pulse = systole. Murmur heard during the pulse = systolic; in between pulses = diastolic.`,steps:[{label:`Positioning`,method:`Patient supine, head of bed at 30°. Exam room quiet, patient relaxed. Warm the stethoscope first.`,normal:`N/A — technique`},{label:`Diaphragm technique`,method:`Firm contact with skin. Detects HIGH-pitched sounds: S1, S2, systolic ejection murmurs, AR, MR.`,normal:`N/A — technique`},{label:`Bell technique`,method:`Very light contact — enough to make a seal but not stretch the skin. Detects LOW-pitched sounds: S3, S4, mitral stenosis rumble.`,normal:`N/A — technique`},{label:`Listen at each of the 5 points`,method:`A → P → E → T → M in order, each with diaphragm then bell. Spend a full cycle at each zone.`,normal:`S1 crisp, S2 clear (splits physiologically on inspiration at P), no added sounds, no murmur`},{label:`Left lateral decubitus position`,method:`If apex murmur suspected. Roll patient to left side. Listen at the apex with the BELL for mitral stenosis rumble or S3/S4.`,normal:`No added sounds, no diastolic rumble`},{label:`Sitting forward, held expiration`,method:`Patient leans forward, exhales fully, holds. Listen at left lower sternal border and Erb's point with the DIAPHRAGM for aortic regurgitation (soft early diastolic decrescendo).`,normal:`No early-diastolic murmur`}],abnormalHints:[`Fixed split S2 (no change with respiration) — ASD`,`Loud S2 at pulmonic area — pulmonary HTN`,`S3 — volume overload, CHF (can be normal in young athletes)`,`S4 — stiff ventricle (HTN, HCM, ischemia)`,`Audible opening snap — mitral stenosis (rare in children)`]},{name:`Auscultation — heart sounds and murmurs`,significance:`Characterising a murmur by timing, location, radiation, pitch, quality, and dynamic maneuvers narrows the differential.`,pearl:`Innocent murmurs in children share 7 "S" features: Soft (≤ grade 2), Systolic, Short, Single (no added S3/S4), Small (localised, non-radiating), Sweet (musical), Sensitive to position/respiration (louder supine, softer standing). Anything breaking this pattern deserves workup.`,steps:[{label:`S1`,method:`Listen at the apex (mitral). Coincides with the carotid pulse upstroke. Mitral + tricuspid closure.`,normal:`Single, crisp, single-component sound`},{label:`S2`,method:`Listen at the pulmonic area in HELD INSPIRATION and HELD EXPIRATION. Note whether S2 splits physiologically (wider in inspiration, narrower/absent in expiration).`,normal:`Physiologic split (widens on inspiration, narrows on expiration)`},{label:`S3 / S4 gallops`,method:`Bell at the apex in left lateral decubitus. S3 = early diastole (after S2), low-pitched. S4 = late diastole (just before S1).`,normal:`Absent in adults; S3 can be normal in young athletes under age 30`},{label:`Identify murmur — timing`,method:`Time vs carotid pulse. Systolic (during pulse) vs diastolic (between pulses) vs continuous.`,normal:`No murmur, or only soft innocent flow murmur`},{label:`Identify murmur — location + radiation`,method:`Where loudest? Does it radiate? AS → carotids. MR → axilla. Coarctation → back.`,normal:`N/A — characterise only if murmur present`},{label:`Identify murmur — character`,method:`Crescendo-decrescendo (ejection) vs holosystolic (plateau) vs decrescendo early-diastolic (AR, PR) vs mid-diastolic rumble (MS, TS).`,normal:`N/A — characterise only if murmur present`},{label:`Grade intensity`,method:`Levine 1–6 scale (see scales card above).`,normal:`No murmur, or grade ≤ 2 soft innocent flow murmur`},{label:`Dynamic maneuvers`,method:`Standing: ↑HOCM, ↑MVP click (earlier). Squatting: opposite. Valsalva: ↑HOCM, most others decrease.`,normal:`No significant change with posture`}],abnormalHints:[`Holosystolic murmur at apex → axilla — mitral regurgitation`,`Holosystolic at lower left sternal border (LLSB) — VSD, tricuspid regurgitation`,`Systolic ejection at upper right sternal border → carotids — aortic stenosis`,`Systolic ejection at upper left sternal border — pulmonary stenosis`,`Continuous "machinery" below left clavicle — PDA`,`Early diastolic at Erb's point, leaning forward — aortic regurgitation`,`Diastolic rumble at apex, bell in left-lateral — mitral stenosis`,`Fixed split S2 + systolic flow murmur — ASD`]},{name:`Peripheral vascular exam`,significance:`Coarctation of the aorta hides until BP and pulses are checked in all four extremities. Differential diagnosis of a hypertensive adolescent should include this in the first 60 seconds.`,pearl:`Four-limb BP measurement is mandatory in any adolescent with hypertension or a murmur. Upper-extremity BP > lower-extremity BP (or brachio-femoral delay) = coarctation until excluded.`,steps:[{label:`Four-limb blood pressure`,method:`Measure BP in right arm, left arm, and at least one leg. Use appropriately sized cuff (bladder width 40% of limb circumference, length 80–100%).`,normal:`Arm BPs within 10 mmHg of each other; leg systolic within 20 mmHg of arm systolic (may be higher)`},{label:`Radial pulses`,method:`Palpate both radials simultaneously — note any delay or asymmetry.`,normal:`Simultaneous, symmetric, 2+`},{label:`Radio-femoral delay`,method:`Palpate radial and femoral simultaneously. Feel the femoral as clearly "after" the radial = delay.`,normal:`No delay`},{label:`Femoral pulses`,method:`Palpate both femoral pulses at the mid-inguinal point. Compare amplitude to radials.`,normal:`Symmetric 2+ pulses, equal amplitude to radial`},{label:`Dorsalis pedis + posterior tibialis`,method:`Palpate in both feet.`,normal:`2+ pulses bilaterally`},{label:`Capillary refill`,method:`Press and release the nail bed; time to normal colour.`,normal:`< 2 sec`}],abnormalHints:[`Asymmetric upper-extremity BP (> 10 mmHg) — subclavian stenosis or coarctation at the origin`,`Upper >> lower-extremity BP — coarctation of the aorta`,`Diminished or absent femoral pulses with brachio-femoral delay — coarctation`,`Bounding pulses with wide pulse pressure — AR, PDA, arteriovenous fistula, thyrotoxicosis, anemia`,`Weak thready pulses — low output state (heart failure, shock, hypovolemia)`,`Prolonged capillary refill — dehydration, shock, cold stress`]}]}}},u={mrc:{title:`MRC strength grade (0–5)`,icon:`fa-hand-fist`,rows:[[`5`,`Normal power — holds against full resistance`],[`4`,`Reduced — moves against gravity + some resistance`],[`3`,`Moves against gravity only (no added resistance)`],[`2`,`Full range with gravity eliminated (horizontal plane)`],[`1`,`Flicker / trace contraction, no joint movement`],[`0`,`No contraction`]]},dtr:{title:`Deep-tendon reflex grade (0–4+)`,icon:`fa-circle-dot`,rows:[[`0`,`Absent`],[`1+`,`Hypoactive — trace, only with reinforcement`],[`2+`,`Normal`],[`3+`,`Brisk — may still be normal in anxious patients`],[`4+`,`Hyperactive with sustained clonus — always abnormal`]]},plantar:{title:`Plantar response (Babinski)`,icon:`fa-shoe-prints`,rows:[[`Down-going`,`Normal in anyone ≥ 2 years`],[`Up-going`,`Normal < 2 years; abnormal after — UMN lesion`],[`Asymmetric`,`Always abnormal at any age`]]},beighton:{title:`Beighton hypermobility score (0–9)`,icon:`fa-hands`,rows:[[`≤ 3`,`Normal flexibility`],[`4`,`Borderline — consider in context`],[`≥ 5`,`Hypermobility spectrum; screen for hEDS if other features present`]]},atr:{title:`Scoliometer — angle of trunk rotation`,icon:`fa-ruler`,rows:[[`< 5°`,`Normal, no follow-up`],[`5–6°`,`Borderline — re-check at each visit`],[`≥ 7°`,`Refer for PA/lateral spine x-ray + orthopedic evaluation`]]},rr:{title:`Respiratory rate — upper limit by age (awake)`,icon:`fa-lungs`,rows:[[`Newborn`,`≤ 60 /min`],[`< 2 months`,`≤ 60 /min (WHO tachypnea cutoff)`],[`2–12 months`,`≤ 50 /min (WHO tachypnea cutoff)`],[`1–5 years`,`≤ 40 /min (WHO tachypnea cutoff)`],[`6–11 years`,`≤ 30 /min`],[`≥ 12 years`,`≤ 20 /min (adult pattern)`]]},spo2:{title:`Pulse oximetry (SpO₂) — at room air`,icon:`fa-heart-pulse`,rows:[[`≥ 95%`,`Normal`],[`92–94%`,`Mild hypoxemia — investigate cause`],[`< 92%`,`Moderate hypoxemia — supplemental O₂`],[`< 88%`,`Severe — urgent intervention; target ≥ 90% acutely`]]},silverman:{title:`Silverman–Andersen retraction score (neonatal, 0–10)`,icon:`fa-baby`,rows:[[`0`,`No respiratory distress`],[`1–3`,`Mild — close observation`],[`4–6`,`Moderate distress — consider CPAP / support`],[`7–10`,`Severe — imminent respiratory failure, intubate`]]},westley:{title:`Westley croup severity score`,icon:`fa-stethoscope`,rows:[[`≤ 2`,`Mild — home management, cool mist, oral dexamethasone`],[`3–5`,`Moderate — nebulised epinephrine + dexamethasone`],[`6–11`,`Severe — admit, continuous monitoring`],[`≥ 12`,`Impending respiratory failure — ICU / airway management`]]},murmurGrade:{title:`Heart-murmur grading (Levine 1–6)`,icon:`fa-wave-square`,rows:[[`1/6`,`Very faint — heard only with concentration`],[`2/6`,`Soft but readily heard`],[`3/6`,`Moderately loud, no thrill`],[`4/6`,`Loud WITH a palpable thrill`],[`5/6`,`Very loud; audible with stethoscope just off the chest`],[`6/6`,`Audible without the stethoscope touching the chest`]]},pulseAmp:{title:`Pulse amplitude grade (0–4)`,icon:`fa-heart-pulse`,rows:[[`0`,`Absent`],[`1+`,`Diminished, thready`],[`2+`,`Normal`],[`3+`,`Bounding`],[`4+`,`Bounding with visible pulsation (e.g., aortic regurgitation)`]]},capRefill:{title:`Capillary refill time`,icon:`fa-hand`,rows:[[`< 2 sec`,`Normal`],[`2–3 sec`,`Borderline — consider hydration / perfusion`],[`≥ 3 sec`,`Delayed — dehydration, shock, low cardiac output`]]}},d={msk:[`atr`,`beighton`],neuro:[`mrc`,`dtr`,`plantar`],resp:[`rr`,`spo2`,`silverman`,`westley`],cv:[`murmurGrade`,`pulseAmp`,`capRefill`]},f=[{letter:`A`,color:`#dc2626`,title:`Aortic area`,location:`2nd ICS, right sternal border`,listen:`S2 (aortic component), aortic stenosis, aortic regurgitation`},{letter:`P`,color:`#2563eb`,title:`Pulmonic area`,location:`2nd ICS, left sternal border`,listen:`S2 (pulmonic component), pulmonic stenosis, PDA, physiologic split of S2`,innocent:`Pulmonary flow murmur (children, adolescents) — upper left sternal border`},{letter:`E`,color:`#059669`,title:`Erb's point`,location:`3rd ICS, left sternal border`,listen:`Aortic regurgitation (best here), transitional zone murmurs`,innocent:`Still's murmur classically radiates to Erb's / LLSB`},{letter:`T`,color:`#d97706`,title:`Tricuspid area`,location:`4th–5th ICS, lower left sternal border`,listen:`Tricuspid regurgitation, VSD, S3/S4, holosystolic murmurs`,innocent:`Still's murmur — vibratory, musical, age 3–7 y (loudest between LLSB and apex)`},{letter:`M`,color:`#7c3aed`,title:`Mitral area (apex)`,location:`5th ICS, mid-clavicular line`,listen:`S1, mitral regurgitation, mitral stenosis (with bell, left-lateral decubitus)`}],p=[{name:`Still's (vibratory) murmur`,age:`3–7 y (most common in children)`,location:`LLSB, radiating to apex`,character:`Low-frequency vibratory / musical systolic, grade 2–3/6, mid-systolic, "twanging-string" quality`,confirm:`Louder supine, softer or disappears on standing or Valsalva. No radiation to neck/back. Normal S2.`},{name:`Pulmonary flow murmur`,age:`School-age and adolescents, thin chest`,location:`Upper left sternal border (2nd–3rd ICS)`,character:`Soft blowing early systolic ejection, grade 1–2/6, higher-pitched`,confirm:`No ejection click. Physiologic split of S2. Louder supine, softer on standing. No radiation.`},{name:`Venous hum`,age:`Ages 3–8, disappears by adolescence`,location:`Supraclavicular or infraclavicular area, usually right`,character:`Soft continuous hum, louder in diastole. Only innocent continuous murmur.`,confirm:`Disappears when supine OR when jugular vein is gently compressed (key maneuver). Turning head to opposite side also alters it.`},{name:`Carotid bruit / supraclavicular bruit`,age:`Children and adolescents`,location:`Supraclavicular fossa, right > left; may radiate to carotid`,character:`Brief early systolic, grade 2–3/6, higher-pitched than Still's`,confirm:`Softer or disappears with hyperextension of the shoulders. Normal cardiac exam otherwise. No radiation below the clavicles.`},{name:`Peripheral pulmonary stenosis (PPS, neonatal)`,age:`Newborns and infants < 6–12 months`,location:`Upper LSB, radiates to BOTH axillae and the back`,character:`Soft systolic ejection murmur, grade 1–2/6`,confirm:`Typical age + radiation to back/axillae. Resolves by age 1 as branch pulmonary arteries grow. Persistence or louder grade warrants echo.`}],m=[{key:`normal`,src:`/audio/respiratory/normal-vesicular.ogg`,title:`Normal vesicular breath sounds`,where:`Peripheral lung fields`,features:`Soft, rustling. Inspiration louder and longer than expiration.`,clinical:`Baseline — deviation elsewhere is what you listen for.`},{key:`wheeze`,src:`/audio/respiratory/wheeze.ogg`,title:`Wheeze`,where:`Diffuse in asthma; localised in foreign body`,features:`Continuous, high-pitched, musical. Usually expiratory; biphasic if severe.`,clinical:`Lower-airway narrowing — asthma, bronchiolitis, foreign body, bronchomalacia. Silent chest in severe asthma is an ominous sign.`},{key:`stridor`,src:`/audio/respiratory/stridor.ogg`,title:`Stridor`,where:`Louder over neck than chest — upper airway`,features:`Continuous, high-pitched, harsh. Classically inspiratory (extrathoracic obstruction); biphasic if fixed.`,clinical:`Croup, epiglottitis, foreign body, laryngomalacia (infant). Distinguish from wheeze by auscultating the neck — stridor is loudest there.`},{key:`finecrackles`,src:`/audio/respiratory/crackles-fine.ogg`,title:`Fine (end-inspiratory) crackles`,where:`Bibasilar in pulmonary edema/fibrosis; focal in pneumonia`,features:`Discontinuous, brief, high-pitched. "Velcro" quality. Late inspiratory, do NOT clear with cough.`,clinical:`Alveolar opening — pulmonary fibrosis, pulmonary edema, early pneumonia, atelectasis.`},{key:`coarsecrackles`,src:`/audio/respiratory/crackles-coarse.ogg`,title:`Coarse crackles`,where:`Lower lobes; either side`,features:`Discontinuous, longer and louder than fine crackles. Lower-pitched. Can be early or late inspiratory; often clear partly with cough.`,clinical:`Secretions in larger airways — bronchitis, later pneumonia, bronchiectasis, aspiration.`},{key:`rhonchi`,src:`/audio/respiratory/rhonchi.ogg`,title:`Rhonchi`,where:`Central or anywhere with airway secretions`,features:`Continuous, low-pitched, snore-like. Typically expiratory. Clear or change with cough.`,clinical:`Large-airway secretions — bronchitis, pneumonia with large-airway involvement, cystic fibrosis, bronchiectasis.`},{key:`pleuralrub`,src:`/audio/respiratory/pleural-rub.ogg`,title:`Pleural friction rub`,where:`Focal, often lateral or posterior lower chest`,features:`Grating, creaky — "leather on leather". Biphasic (heard in inspiration and expiration). Does NOT clear with cough.`,clinical:`Pleural inflammation — pleuritis, pulmonary embolism, pneumonia with pleural involvement, viral pleurisy.`}],h=[{key:`normal`,src:`/audio/cardiac/normal.ogg`,title:`Normal heart sounds (S1, S2)`,where:`All four classic auscultation points`,rate:`~61 bpm reference`,features:`"lub-dub": S1 (closure of mitral + tricuspid) louder at apex; S2 (closure of aortic + pulmonic) louder at base. Physiologic S2 split on inspiration.`,clinical:`Reference for rhythm, rate, and the normal S1–S2 interval. Listen for what's changed — not just what's added.`},{key:`infant-normal`,src:`/audio/cardiac/infant-normal.ogg`,title:`Infant normal heart sounds`,where:`Infant chest — rate will be higher than adult`,rate:`Pediatric reference (120–160 bpm range)`,features:`Same S1–S2 pattern, faster rate. Short diastole makes murmurs easier to miss — careful auscultation needed.`,clinical:`Reference for neonatal/infant rhythm. Any murmur in the first 72 h should prompt pre/postductal sat screening.`},{key:`vsd`,src:`/audio/cardiac/vsd.wav`,title:`Ventricular septal defect (VSD)`,where:`Lower left sternal border (4th ICS)`,features:`Harsh, blowing, holosystolic (pansystolic) murmur — plateau shape through all of systole. Often accompanied by a thrill if large.`,clinical:`Most common congenital heart defect. Small VSD: loud murmur, usually asymptomatic, may close spontaneously. Large VSD: softer murmur (less pressure gradient) but signs of heart failure, pulmonary hypertension.`},{key:`mvp`,src:`/audio/cardiac/mitral-prolapse.wav`,title:`Mitral valve prolapse (MVP) — click + late systolic murmur`,where:`Apex (5th ICS, mid-clavicular line)`,features:`Mid-systolic click followed by a late-systolic crescendo murmur. Timing of click changes with maneuvers: earlier with standing or Valsalva, later with squatting.`,clinical:`Often benign, especially in thin young women. 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Focus: birth injury, DDH, congenital anomaly. All steps symmetric.`,components:[{name:`Resting posture`,steps:[{label:`Observe posture`,method:`Place supine and undisturbed for 30s`,normal:`Symmetric flexion at hips, knees, elbows`},{label:`Hand position`,method:`Inspect resting hands`,normal:`Loosely fisted; opens intermittently`},{label:`Symmetry`,method:`Compare left vs right side at rest`,normal:`Mirror-image posture`}],abnormalHints:[`Frog-leg (hypotonia)`,`Asymmetric arm (brachial plexus/clavicle fx)`,`Opisthotonos (CNS)`,`Persistent fisting with thumb in palm`]},{name:`Clavicles`,steps:[{label:`Palpate right clavicle`,method:`Trace from sternoclavicular joint to acromion with index finger`,normal:`Smooth, continuous, no step-off`},{label:`Palpate left clavicle`,method:`Same technique on left side`,normal:`Smooth, continuous`},{label:`Crepitus check`,method:`Light pressure along length of clavicle while gently abducting arm`,normal:`No crepitus, no pain response`}],abnormalHints:[`Palpable step-off or callus (fracture — LGA, shoulder dystocia)`,`Asymmetric Moro on affected side`]},{name:`Hips — DDH screen`,steps:[{label:`Thigh/gluteal folds`,method:`Undress completely; compare skin-fold symmetry`,normal:`Symmetric thigh and gluteal folds`},{label:`Abduction`,method:`Flex hips 90°, abduct simultaneously`,normal:`Both hips abduct to ≥75° symmetrically`},{label:`Barlow maneuver`,method:`Thumb on medial thigh, flex hip 90°, adduct, apply gentle posterior pressure`,normal:`No clunk or movement felt (negative)`},{label:`Ortolani maneuver`,method:`From Barlow position: abduct and lift with fingers on greater trochanter`,normal:`No clunk as hip returns (negative)`},{label:`Galeazzi sign`,method:`Knees flexed together with feet on table; compare knee heights`,normal:`Knees level — no leg-length discrepancy`}],abnormalHints:[`Palpable Ortolani clunk (dislocated, reducible)`,`Barlow clunk (dislocatable)`,`Limited abduction`,`Positive Galeazzi (shortened femur)`]},{name:`Spine and back`,steps:[{label:`Position prone`,method:`Turn infant prone, support chest`,normal:`Tolerates position, lifts head briefly`},{label:`Palpate midline`,method:`Run finger from C-spine to coccyx`,normal:`Straight midline, no step-offs or gaps`},{label:`Sacral inspection`,method:`Inspect sacral dimple if present; measure depth, distance from anus`,normal:`No dimple, or dimple <5mm deep and <2.5cm from anus`},{label:`Cutaneous markers`,method:`Inspect midline skin from neck to coccyx`,normal:`No hair tuft, hemangioma, lipoma, or sinus tract`}],abnormalHints:[`Deep sacral dimple (>5mm) or >2.5cm from anus — imaging`,`Hair tuft, hemangioma, lipoma (occult dysraphism)`,`Palpable defect`]},{name:`Upper extremities`,steps:[{label:`Spontaneous movement`,method:`Observe both arms for 30s`,normal:`Symmetric antigravity movement`},{label:`Digits`,method:`Count and inspect fingers both hands`,normal:`5 digits each, no webbing or duplication`},{label:`Palmar creases`,method:`Inspect palmar creases`,normal:`Normal triradiate creases`}],abnormalHints:[`Erb/Klumpke palsy (paucity of movement)`,`Polydactyly, syndactyly`,`Single transverse (simian) palmar crease`]},{name:`Lower extremities / feet`,steps:[{label:`Hip and knee range`,method:`Gently flex, extend, internally/externally rotate each`,normal:`Full symmetric range, no contracture`},{label:`Foot alignment`,method:`Inspect resting foot position`,normal:`Midline or mildly adducted forefoot`},{label:`Passive correction`,method:`Gently attempt to bring foot to neutral`,normal:`Fully correctable to neutral`},{label:`Stroke test`,method:`Stroke lateral border of foot`,normal:`Foot dorsiflexes and everts reflexively`}],abnormalHints:[`Rigid clubfoot (non-correctable talipes equinovarus)`,`Fixed metatarsus adductus`,`Rocker-bottom foot (trisomy 18)`,`Calcaneovalgus`]}]},neuro:{overview:`Primitive reflexes present and symmetric. Tone assessed passively and actively. Full exam 3–5 min on a quiet, fed infant.`,components:[{name:`Alertness and behavior`,steps:[{label:`State cycling`,method:`Observe over 1–2 min for alert periods`,normal:`Alert periods with spontaneous eye opening`},{label:`Response to voice`,method:`Speak softly near ear`,normal:`Quiets to voice or turns toward sound`},{label:`Consolability`,method:`If crying, attempt to soothe with swaddling or voice`,normal:`Consolable within 1–2 min`}],abnormalHints:[`Lethargy`,`Jitteriness not stopped by passive flexion`,`Irritability unrelieved by feeding`]},{name:`Cranial nerves`,steps:[{label:`CN II — pupil response`,method:`Shine light in each eye`,normal:`Pupils equal, reactive to light, direct and consensual`},{label:`CN II — blink to light`,method:`Bright light in the line of sight`,normal:`Reflex blink`},{label:`CN VII — facial symmetry at rest`,method:`Observe resting face`,normal:`Symmetric nasolabial folds`},{label:`CN VII — facial symmetry with cry`,method:`Note face during a cry`,normal:`Symmetric grimace`},{label:`CN IX, X, XII — suck and swallow`,method:`Offer clean gloved finger, pacifier, or during feed`,normal:`Strong coordinated suck-swallow, no choking`}],abnormalHints:[`Asymmetric face (CN VII injury — usually forceps)`,`Poor suck or uncoordinated swallow`,`Fixed or unequal pupil`]},{name:`Tone — passive`,steps:[{label:`Pull-to-sit`,method:`Grasp hands/wrists, pull smoothly to sit`,normal:`Brief head lag at term; not dramatic`},{label:`Ventral suspension`,method:`Suspend prone over hand at chest`,normal:`Head briefly lifts to horizontal; extremities flexed`},{label:`Arm recoil`,method:`Extend both arms fully at elbows, release`,normal:`Rapid return to flexion`},{label:`Popliteal angle`,method:`Hip flexed 90°, extend knee maximally`,normal:`≤110°`}],abnormalHints:[`Marked head lag (hypotonia)`,`Slip-through on vertical suspension`,`Hypertonia / scissoring`,`Floppy limbs with no recoil`]},{name:`Spontaneous movement`,steps:[{label:`Observe limbs`,method:`Undisturbed over 1 min, note movement`,normal:`Symmetric antigravity movement of all 4 limbs`},{label:`Quality of movement`,method:`Note smoothness vs jitteriness`,normal:`Smooth, mildly variable movements`}],abnormalHints:[`Paucity of movement in one limb`,`Coarse jitteriness`,`Clonic jerks`,`Tonic posturing`]},{name:`Primitive reflexes`,steps:[{label:`Moro`,method:`Support head; allow 30° head drop or loud clap`,normal:`Symmetric arm abduction then flexion, often cry`},{label:`Rooting`,method:`Stroke cheek at corner of mouth`,normal:`Turns head toward stroke and opens mouth`},{label:`Palmar grasp`,method:`Press into palm with finger`,normal:`Strong, symmetric finger flexion`},{label:`Plantar grasp`,method:`Press ball of foot below toes`,normal:`Toes flex around finger symmetrically`},{label:`Stepping`,method:`Hold upright with feet touching surface`,normal:`Alternating stepping movements`},{label:`Tonic neck (fencing)`,method:`Turn head to one side with infant supine`,normal:`Same-side arm extends, opposite flexes (not obligate)`},{label:`Galant`,method:`Stroke paravertebrally from shoulder to buttock, one side`,normal:`Trunk curves toward stroked side`}],abnormalHints:[`Absent or asymmetric Moro — CNS injury, brachial plexus, clavicle fx`,`Absent grasps — CNS depression`,`Obligate tonic neck is abnormal`]},{name:`Babinski (plantar response)`,steps:[{label:`Stroke lateral sole`,method:`Firm stroke from heel toward toes along lateral plantar border`,normal:`Up-going great toe with fanning (normal in newborn)`},{label:`Symmetry check`,method:`Repeat opposite foot`,normal:`Symmetric response`}],abnormalHints:[`Asymmetric response is always abnormal`]}]},resp:{overview:`Newborn respiratory transition — RDS, TTN, pneumonia, meconium aspiration dominate the differential. Normal RR ≤ 60. Grunting is an alarm sign.`,components:[{name:`Inspection`,significance:`Detects distress and localises cause. Silverman score quantifies retraction severity.`,pearl:`Grunting is physiologic PEEP against a partially closed glottis — always a sign of significant lung pathology in a newborn. Never dismiss it as fussy breathing.`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s, quiet and undisturbed.`,normal:`40–60 /min; tachypnea > 60`},{label:`Work of breathing (Silverman)`,method:`Inspect for upper-chest retraction, lower-chest retraction, xiphoid retraction, nasal flaring, grunting. Score 0–2 for each.`,normal:`Total Silverman 0 — no distress`},{label:`Audible sounds`,method:`Listen without stethoscope — stridor? grunting? wheeze across the room?`,normal:`Quiet respirations`},{label:`Colour`,method:`Inspect trunk and mucous membranes for central cyanosis; acrocyanosis (blue hands/feet) is normal in the first days.`,normal:`Pink trunk and mucous membranes`},{label:`Chest shape`,method:`Inspect AP:transverse diameter and symmetry.`,normal:`Slightly barrel-shaped is normal; symmetric`}],abnormalHints:[`Grunting — RDS, pneumonia, sepsis, CHD`,`Retractions + tachypnea — RDS, TTN, pneumothorax`,`Central cyanosis — cyanotic CHD, severe lung disease, persistent pulmonary HTN`,`Asymmetric chest movement — pneumothorax, diaphragmatic hernia`]},{name:`Auscultation`,significance:`Short stethoscope time in neonates because they fuss easily — get the most important zones first.`,pearl:`Listen at the axilla, not just the anterior chest — pneumothorax can sound normal anteriorly. Auscultate both axillae systematically.`,steps:[{label:`Air entry — anterior`,method:`Listen bilaterally at the upper and lower anterior chest.`,normal:`Symmetric bilateral air entry`},{label:`Air entry — axillary`,method:`Listen bilaterally at each axilla — this is the most sensitive area for detecting a small pneumothorax.`,normal:`Clear and symmetric`},{label:`Adventitious sounds`,method:`Listen for transmitted upper-airway sounds, crackles (RDS, pneumonia), grunting sounds.`,normal:`No crackles, no wheeze, clear sounds`},{label:`Inspiration:expiration ratio`,method:`Observe breath-sound timing.`,normal:`Inspiration > expiration in length`}],abnormalHints:[`Asymmetric air entry — pneumothorax, diaphragmatic hernia, endobronchial intubation`,`Fine crackles — RDS, TTN, pneumonia`,`Absent breath sounds unilaterally — pneumothorax or selective intubation`]}]},cv:{overview:`Neonatal CV exam screens for CHD — the window of presentation is short and some lesions (duct-dependent) decompensate within hours of birth. Pre/postductal saturations + femoral pulses are the two fastest screens.`,components:[{name:`Inspection and pre/postductal saturations`,significance:`Pre/postductal SpO₂ differential > 3% suggests a duct-dependent lesion or persistent pulmonary HTN. Universal CCHD screening uses this.`,pearl:`Pulse ox on the right hand = preductal (proximal to PDA insertion). Foot = postductal. Both arms and both legs should match; a differential is a red flag for critical CHD.`,steps:[{label:`Central cyanosis`,method:`Inspect tongue, lips, oral mucosa.`,normal:`Pink mucous membranes`},{label:`Pre/postductal SpO₂`,method:`Measure SpO₂ in right hand (preductal) AND either foot (postductal). Baby must be ≥24 hr old for CCHD screening.`,normal:`Both ≥ 95% AND difference < 3%`},{label:`Peripheral perfusion`,method:`Capillary refill on sternum; note mottling or distal cyanosis.`,normal:`Capillary refill < 2 s, warm pink extremities`},{label:`Precordial activity`,method:`Inspect anterior chest for hyperactive precordium.`,normal:`Not visible or minimally visible`}],abnormalHints:[`Central cyanosis with SpO₂ < 95% → cyanotic CHD workup (4-extremity BP, ECG, hyperoxia test, echo)`,`Differential > 3% (pre > post) → duct-dependent systemic flow (HLHS, coarctation, interrupted arch)`,`Preductal < postductal — persistent pulmonary HTN with reversed shunt`]},{name:`Palpation and auscultation`,significance:`Absent femoral pulses + arm-leg BP gradient = coarctation. Many CHD lesions manifest murmurs only after ductus closes (48–72 h).`,pearl:`Always palpate femoral pulses before discharging any newborn. Absent femorals in a well-appearing baby can be the only finding in a ductal-dependent coarctation — catastrophic if missed.`,steps:[{label:`Apex beat`,method:`Palpate at the 4th ICS left of sternum (apex is higher in newborns).`,normal:`Palpable at 4th ICS, mid-clavicular or just lateral`},{label:`Femoral pulses`,method:`Palpate both femoral pulses at the mid-inguinal point while simultaneously feeling the right brachial pulse — detects delay.`,normal:`Present, symmetric, equal timing with brachial`},{label:`Auscultate each cardiac area`,method:`Use pediatric diaphragm at each classic point; baby quiet if possible.`,normal:`S1 S2 crisp; physiologic flow murmur sometimes present in the first 24–48 h`},{label:`Continuous murmur`,method:`Listen below the left clavicle for a continuous ("machinery") murmur of PDA.`,normal:`No continuous murmur after the first day of life in a term baby`},{label:`Four-limb BP (if any concern)`,method:`Right arm, left arm, both legs.`,normal:`Within 10 mmHg across limbs`}],abnormalHints:[`Absent femoral pulses — coarctation of the aorta (surgical emergency if duct-dependent)`,`Harsh holosystolic at LLSB — VSD`,`Continuous machinery murmur — PDA (expected in preterm; in term > 48 h is abnormal)`,`Gallop S3/S4 — heart failure`,`Single S2 — transposition, truncus, severe AS/PS`]}]}},infant:{label:`Infant (1–12 months)`,msk:{overview:`Continued DDH screen through 6 months. Watch motor progression and symmetry of tone/movement.`,components:[{name:`Hips — continued DDH screen`,steps:[{label:`Thigh-fold symmetry`,method:`Inspect with infant supine, thighs flexed`,normal:`Symmetric folds`},{label:`Barlow/Ortolani (through 3mo)`,method:`As in newborn — thumb medial, flex 90°, adduct+push then abduct+lift`,normal:`Negative bilaterally`},{label:`Abduction (any age)`,method:`Flex 90°, abduct simultaneously`,normal:`≥70° symmetric abduction`},{label:`Galeazzi`,method:`Knees flexed feet flat on exam table`,normal:`Knees equal height`}],abnormalHints:[`Clunk on Barlow/Ortolani (<3mo)`,`Limited abduction`,`Asymmetric folds`,`Positive Galeazzi`]},{name:`Gross-motor milestones (age-appropriate)`,steps:[{label:`Head control`,method:`Prone, pull-to-sit, held upright`,normal:`Age-appropriate: 2mo lifts head 45°; 4mo no head lag`},{label:`Rolling`,method:`Observe on flat surface`,normal:`Rolls back-to-front by 5–6mo`},{label:`Sitting`,method:`Place in sitting position`,normal:`Tripod sit by 6mo; sits without support by 7–8mo`},{label:`Standing`,method:`Support under arms`,normal:`Bears weight by 6mo; pulls to stand by 9mo`}],abnormalHints:[`Milestone delay by ≥2mo`,`Loss of previously attained milestone`,`Asymmetric use of limbs`]},{name:`Spine`,steps:[{label:`Palpate seated`,method:`Run finger along spine with infant sitting or held upright`,normal:`Midline, no step-offs`},{label:`Back curvature`,method:`Inspect sitting and lying`,normal:`Physiologic gentle kyphosis in early infancy; lumbar lordosis as sitting develops`}],abnormalHints:[`Fixed kyphoscoliosis`,`Sacral dimple with cutaneous marker`,`Step-off`]},{name:`Extremities`,steps:[{label:`Passive range`,method:`Through each major joint`,normal:`Full symmetric range`},{label:`Joint inspection`,method:`Inspect for swelling, warmth, effusion`,normal:`No swelling, warmth, or effusion`},{label:`Feet alignment`,method:`Observe standing if pulling up, else passive positioning`,normal:`Correctable or aligned feet; flexible`}],abnormalHints:[`Joint swelling/warmth (septic vs reactive arthritis)`,`Rigid clubfoot`,`Persistent asymmetric tone`]}]},neuro:{overview:`Primitive reflexes fading on schedule; protective reflexes emerging; gross motor and tone interlinked.`,components:[{name:`Alertness and social engagement`,steps:[{label:`Social smile`,method:`Face-to-face interaction`,normal:`Social smile by 6–8 weeks`},{label:`Tracking`,method:`Move object across visual field`,normal:`180° horizontal tracking by 3mo`},{label:`Engagement`,method:`Face-to-face, voice, toys`,normal:`Age-appropriate reciprocal interaction`}],abnormalHints:[`No social smile by 3mo`,`Absent tracking past 3mo`,`Poor engagement (developmental concern)`]},{name:`Cranial nerves`,steps:[{label:`Pupils`,method:`Light response each eye`,normal:`Equal reactive`},{label:`Eye alignment`,method:`Inspect with gaze forward and in all directions`,normal:`No strabismus past 4mo`},{label:`Facial symmetry`,method:`Observe smile and cry`,normal:`Symmetric`},{label:`Suck and swallow`,method:`Observe feeding`,normal:`Coordinated, no choking`}],abnormalHints:[`Persistent nystagmus`,`Strabismus past 4mo`,`Asymmetric face`]},{name:`Tone`,steps:[{label:`Pull-to-sit`,method:`Gently pull wrists/hands`,normal:`No head lag by 4mo`},{label:`Ventral suspension`,method:`Support prone, observe`,normal:`Head above horizontal, extremities actively flexed (age-dependent)`},{label:`Vertical suspension`,method:`Support under arms, lift`,normal:`Does not slip through hands`}],abnormalHints:[`Persistent head lag past 4mo (hypotonia)`,`Hypertonia / scissoring (UMN)`,`Slip-through on vertical suspension`]},{name:`Primitive reflex integration`,steps:[{label:`Moro`,method:`Head drop or clap`,normal:`Absent by 6mo`},{label:`Palmar grasp`,method:`Press into palm`,normal:`Integrated by 5–6mo; replaced by voluntary grasp`},{label:`Tonic neck`,method:`Turn head to side`,normal:`Absent by 6mo`},{label:`Rooting`,method:`Stroke cheek`,normal:`Absent by 3–4mo`}],abnormalHints:[`Persistence of any primitive reflex past 6mo warrants eval (CP, CNS injury)`]},{name:`Protective and postural reflexes`,steps:[{label:`Parachute`,method:`Held prone, tilt head downward suddenly`,normal:`Symmetric arm extension protectively by 9mo (emerges 6–9mo)`},{label:`Lateral propping`,method:`Seated infant, gentle tilt to one side`,normal:`Arm extends to catch by 6–7mo`},{label:`Landau`,method:`Suspend prone`,normal:`Extends head, spine, legs by 6mo`}],abnormalHints:[`Absent parachute after 12mo (concerning)`,`Asymmetric lateral propping`,`Absent Landau`]}]},resp:{overview:`Infant respiratory disease centers on bronchiolitis, reactive airways, and pneumonia. Normal RR ≤ 50 (< 2 mo: ≤ 60). Infants are obligate nose-breathers — nasal congestion alone can cause significant WOB.`,components:[{name:`Inspection`,significance:`Infant distress signs escalate fast. Nasal flaring, tracheal tug, head bobbing = significant WOB. Apnea in an infant < 2 mo is an emergency.`,pearl:`A quiet infant with retractions is more worrying than a crying one — exhausted infants stop crying and become hypoxic silently.`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s while quiet.`,normal:`< 2 mo: ≤ 60; 2–12 mo: ≤ 50`},{label:`Work of breathing`,method:`Inspect nasal flaring, subcostal/intercostal/suprasternal retractions, tracheal tug, head-bobbing, accessory muscle use.`,normal:`No retractions, effortless breathing`},{label:`Audible sounds`,method:`Stridor? Wheeze across the room? Grunting? Prolonged expiration?`,normal:`Quiet respirations`},{label:`Colour and feeding history`,method:`Central cyanosis? Poor feeding (feeding is an effort marker in infants)?`,normal:`Pink, feeds well`},{label:`Apnea observation`,method:`Watch for ≥ 20-s pauses or pauses < 20 s with bradycardia/cyanosis.`,normal:`No apneas`}],abnormalHints:[`Grunting / persistent retractions — pneumonia, bronchiolitis, CHF`,`Wheeze — bronchiolitis (RSV), asthma, foreign body`,`Stridor — croup (6 mo–6 y), laryngomalacia (infant), foreign body`,`Apnea — bronchiolitis, sepsis, pertussis, seizure`]},{name:`Auscultation`,significance:`Infants have a thin chest wall — sounds transmit widely. Symmetry, wheeze, and crackles are the main findings.`,pearl:`In bronchiolitis, the classical finding is widespread end-inspiratory fine crackles PLUS expiratory wheeze. Tachypnea + retractions in an RSV-season infant confirms.`,steps:[{label:`Air entry — bilateral`,method:`Warm stethoscope; listen at anterior chest and both axillae, both sides.`,normal:`Symmetric air entry`},{label:`Wheeze`,method:`Listen in expiration. Diffuse wheeze = lower airway; focal wheeze = foreign body or local obstruction.`,normal:`No wheeze`},{label:`Crackles`,method:`Listen in late inspiration. Focal = pneumonia; diffuse fine = bronchiolitis.`,normal:`No crackles`},{label:`Prolonged expiration`,method:`Note expiration:inspiration length ratio.`,normal:`Inspiration ≥ expiration`}],abnormalHints:[`Focal crackles + fever — pneumonia`,`Diffuse wheeze + fine crackles in an RSV-season infant — bronchiolitis`,`Silent chest with extreme WOB — impending respiratory failure`]}]},cv:{overview:`Most CHD manifests in the first year as pulmonary blood-flow changes and the ductus closes. Infant CV exam = growth review + inspection + femoral pulses + auscultation. A harsh pan-systolic LLSB murmur in a 6-week-old = VSD until proven otherwise.`,components:[{name:`Inspection and functional assessment`,significance:`Heart failure in infants presents as poor feeding, sweating during feeds (diaphoresis), tachypnea, and poor weight gain. These historical features predict bad exam findings.`,pearl:`Ask "Does the baby sweat while feeding?" — infant CHF presents with diaphoresis on the forehead during feeds, well before peripheral edema appears.`,steps:[{label:`Growth trajectory`,method:`Plot weight-for-age on WHO chart. Failure to thrive raises CHD concern.`,normal:`Tracking ≥ 10th percentile or stable on personal curve`},{label:`Feeding history`,method:`Ask about feed duration, sweating with feeds, tachypnea with feeds, tiring easily.`,normal:`Feeds < 20 min, no diaphoresis, no tachypnea`},{label:`Central cyanosis`,method:`Inspect tongue and oral mucosa.`,normal:`Pink`},{label:`Clubbing`,method:`Inspect finger nail beds (subtle in infants).`,normal:`No clubbing`},{label:`Peripheral perfusion`,method:`Cap refill, warmth of extremities.`,normal:`Cap refill < 2 s, warm extremities`}],abnormalHints:[`Poor weight gain — consider CHF from L-to-R shunt (VSD, PDA, AVSD)`,`Diaphoresis with feeds — infant CHF`,`Tiring with feeds — significant CHD`,`Central cyanosis — cyanotic CHD (ToF, TGA, TA, etc.)`]},{name:`Palpation and auscultation`,significance:`Femoral pulses + 4-limb BP screen coarctation. A harsh holosystolic murmur at LLSB is almost always a VSD in this age.`,pearl:`Listen over each of the 5 classic points as in the adult exam — the locations shift slightly with infant chest size but relative positions are the same. Also listen at the back: coarctation murmurs radiate there.`,steps:[{label:`Apex beat`,method:`Palpate at 4th ICS mid-clavicular line.`,normal:`Palpable at 4th ICS in infants`},{label:`Femoral pulses`,method:`Palpate bilaterally, simultaneously with right brachial.`,normal:`Present, equal, no delay vs brachial`},{label:`Listen at each classic area (APTM)`,method:`See APTM diagram. Use pediatric stethoscope with both diaphragm and bell.`,normal:`S1 and S2 crisp, no murmur or physiologic only`},{label:`Listen over the back (interscapular)`,method:`Check for radiation of coarctation murmurs.`,normal:`No radiating murmur`}],abnormalHints:[`Harsh holosystolic LLSB murmur — VSD`,`Continuous "machinery" murmur below left clavicle — PDA`,`Systolic ejection at ULSB + fixed split S2 — ASD`,`Ejection murmur at ULSB + cyanosis — tetralogy of Fallot`,`Absent femorals + radio-femoral delay — coarctation`,`Gallop + tachycardia — heart failure`]}]}},toddler:{label:`Toddler (1–3 years)`,msk:{overview:`Gait, physiologic alignment changes, in-toeing, joint range. Cooperation unpredictable — use play.`,components:[{name:`Gait`,steps:[{label:`Base of support`,method:`Have child walk ~10 feet`,normal:`Wide-based initially, narrowing by 2y`},{label:`Heel-strike`,method:`Observe foot contact pattern`,normal:`Heel-strike developing by 18mo, consistent by 2y`},{label:`Arm swing`,method:`Observe reciprocal arm swing`,normal:`Reciprocal arm swing by 18mo`},{label:`Symmetry`,method:`Watch both sides in stance and swing`,normal:`Symmetric stride length and cadence`}],abnormalHints:[`Toe-walking past 2y (idiopathic vs CP vs DMD)`,`Limp (Legg-Calvé-Perthes, transient synovitis, trauma)`,`Wide-based ataxia`]},{name:`Knee alignment`,steps:[{label:`Stand feet together`,method:`Feet/medial malleoli touching; inspect knees`,normal:`Genu varum resolving by 18–24mo; mild genu valgum common by 2–3y`},{label:`Intercondylar or intermalleolar distance`,method:`Measure if alignment appears abnormal`,normal:`<5cm intercondylar (varum) or <8cm intermalleolar (valgum)`},{label:`Symmetry`,method:`Compare sides`,normal:`Symmetric`}],abnormalHints:[`Persistent varum past 2y`,`Severe valgum >8cm`,`Unilateral (Blount disease, rickets)`]},{name:`Feet alignment`,steps:[{label:`In-toeing / out-toeing`,method:`Observe foot angle during gait`,normal:`Mild in-toeing common (tibial torsion, femoral anteversion)`},{label:`Arch during stance`,method:`Stand flat, then on tiptoes`,normal:`Flexible flat foot that forms arch on tiptoe`},{label:`Heel alignment`,method:`View from behind standing`,normal:`Neutral or mildly valgus heel`}],abnormalHints:[`Rigid flat foot (tarsal coalition)`,`Fixed metatarsus adductus`,`Severe in-toeing >15°`]},{name:`Joint range`,steps:[{label:`Hips`,method:`Flex, abduct, rotate each hip`,normal:`Full symmetric range, no pain`},{label:`Knees`,method:`Flex, extend; palpate for effusion`,normal:`Full range, no effusion, stable`},{label:`Ankles`,method:`Dorsiflex, plantarflex, invert, evert`,normal:`Full range`},{label:`Shoulders, elbows, wrists`,method:`Through full range each`,normal:`Full symmetric range`}],abnormalHints:[`Joint effusion (septic vs reactive)`,`Guarded or painful motion`,`Asymmetric limitation`]},{name:`Spine`,steps:[{label:`Inspect standing`,method:`View spine from behind`,normal:`Midline, no prominent curve`},{label:`Palpate midline`,method:`Run finger along spinous processes`,normal:`Midline, no step-off, no tenderness`},{label:`Shoulder/hip symmetry`,method:`Compare shoulder and hip heights`,normal:`Symmetric`}],abnormalHints:[`Fixed scoliosis`,`Abnormal kyphosis`,`Asymmetric shoulder/hip`,`Midline tenderness`]}]},neuro:{overview:`Shifting to adult-pattern exam. Primitive reflexes should be absent. Use play-based techniques.`,components:[{name:`Mental status and language`,steps:[{label:`Engagement`,method:`Interaction with examiner/parent`,normal:`Alert, interactive, age-appropriate`},{label:`Language — expressive`,method:`Note spontaneous utterances`,normal:`1y: 1–3 words; 2y: 2-word phrases; 3y: short sentences`},{label:`Language — receptive`,method:`Ask to point to body parts or follow simple commands`,normal:`Follows age-appropriate commands`}],abnormalHints:[`Language regression (autism, epileptic encephalopathy)`,`Poor engagement`,`No 2-word phrases by 2y`]},{name:`Cranial nerves`,steps:[{label:`CN II — pupil response`,method:`Shine light each eye`,normal:`Pupils equal reactive`},{label:`CN III, IV, VI — EOM`,method:`Follow toy in H pattern`,normal:`Full smooth tracking, no strabismus`},{label:`CN V — facial sensation`,method:`Light touch on forehead, cheek, jaw`,normal:`Responds to touch, symmetric`},{label:`CN VII — face`,method:`Elicit smile, watch eye closure during cry`,normal:`Symmetric face`},{label:`CN IX, X, XII — mouth`,method:`Say "ahh"; stick out tongue`,normal:`Palate rises symmetrically; tongue midline`}],abnormalHints:[`Strabismus`,`Facial asymmetry`,`Tongue deviation`,`Absent palate elevation`]},{name:`Motor — tone and bulk`,steps:[{label:`Passive tone`,method:`Move each limb through full range`,normal:`Normal resistance throughout`},{label:`Bulk inspection`,method:`Inspect muscle bulk of thighs, calves, glutes`,normal:`Symmetric, age-appropriate bulk`},{label:`Contracture check`,method:`Test for heel-cord tightness, hamstring tightness`,normal:`No contractures`}],abnormalHints:[`Spasticity (especially catch in ankles)`,`Hypotonia`,`Calf pseudo-hypertrophy (DMD)`]},{name:`Motor — functional strength`,steps:[{label:`Rising from floor`,method:`Place flat on back; ask to stand up`,normal:`Rises without using hands to push off thighs (no Gowers)`},{label:`Climbing stairs`,method:`Observe or history`,normal:`Climbs holding rail`},{label:`Squatting/getting up`,method:`Encourage via play`,normal:`Squats and rises without help`}],abnormalHints:[`Gowers sign (proximal weakness — DMD)`,`Unable to climb stairs at age expected`,`Calf pain on walking (myositis)`]},{name:`Deep tendon reflexes`,steps:[{label:`Patellar`,method:`Sitting or supine with distraction (toy)`,normal:`2+ symmetric`},{label:`Biceps`,method:`Arm at rest, strike thumb on tendon`,normal:`2+ symmetric`},{label:`Achilles`,method:`With distraction`,normal:`2+ symmetric`}],abnormalHints:[`Hyperreflexia or clonus (UMN, CP)`,`Absent reflexes (LMN, neuropathy)`,`Asymmetry`]},{name:`Coordination and gait`,steps:[{label:`Run`,method:`Watch run ~10 feet`,normal:`Runs with reciprocal arm swing by 2y`},{label:`Stairs`,method:`Observe`,normal:`Climbs with rail`},{label:`Kick ball`,method:`Place ball; observe kick`,normal:`Kicks by 2y`},{label:`Ataxia check`,method:`Watch for fluency of movement`,normal:`Smooth, no tremor`}],abnormalHints:[`Ataxic gait`,`Intention tremor`,`Clumsiness beyond age`]},{name:`Plantar response`,steps:[{label:`Stroke lateral sole`,method:`Firm stroke from heel to toes`,normal:`Down-going great toe (plantar flexion) by age 2`}],abnormalHints:[`Up-going toe after age 2 = UMN sign (Babinski positive)`]}]},resp:{overview:`Toddler respiratory disease: viral URIs, reactive airways, croup (6 mo–6 y classical age), foreign-body aspiration (age 1–3 is peak). Normal RR ≤ 40.`,components:[{name:`Inspection`,pearl:`Sudden onset of unilateral wheeze + choking history in a toddler = foreign body until proven otherwise. CXR in expiration (or decubitus) helps show the trapped air.`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s if possible.`,normal:`≤ 40 /min`},{label:`Work of breathing`,method:`Retractions, nasal flaring, tracheal tug.`,normal:`No retractions`},{label:`Audible sounds`,method:`Stridor (croup), wheeze, barking cough.`,normal:`Quiet respirations`},{label:`Drooling / posture`,method:`Tripod positioning, drooling (epiglottitis in unvaccinated child).`,normal:`No drooling, normal posture`}],abnormalHints:[`Barking cough + stridor — croup`,`Drooling + tripod + toxic — epiglottitis (emergency)`,`Sudden unilateral wheeze — foreign body aspiration`]},{name:`Auscultation`,steps:[{label:`Air entry`,method:`Cooperation variable — listen quickly and systematically.`,normal:`Symmetric`},{label:`Adventitious sounds`,method:`Wheeze, crackles, stridor at the neck.`,normal:`Clear lung fields`},{label:`Unilateral findings`,method:`Focal wheeze, decreased air entry, or asymmetry — think foreign body or pneumonia.`,normal:`Symmetric bilateral`}],abnormalHints:[`Unilateral decreased breath sounds + wheeze — foreign body`,`Focal crackles — pneumonia`,`Diffuse wheeze — asthma/RAD`]}]},cv:{overview:`Most hemodynamically significant CHD has been detected by this age. Innocent murmurs peak here (Still's murmur, venous hum). The exam is adult-pattern but with smaller chest and less cooperation.`,components:[{name:`Inspection and palpation`,pearl:`Innocent murmurs are a normal finding in well toddlers — soft, systolic, at the LLSB, musical, and they change with position. Anything that doesn't fit that pattern deserves referral.`,steps:[{label:`General appearance + growth`,method:`Happy, active, tracking growth.`,normal:`Normal growth and activity`},{label:`Colour and clubbing`,method:`Inspect tongue, nail beds.`,normal:`Pink, no clubbing`},{label:`Apex beat`,method:`Palpate at 5th ICS mid-clavicular line.`,normal:`Located at 5th ICS MCL, tapping quality`},{label:`Peripheral pulses`,method:`Brachial + femoral, symmetric and simultaneous.`,normal:`Symmetric, no delay`}],abnormalHints:[`Tiring with play, poor growth — missed CHD`,`Cyanosis + clubbing — cyanotic CHD`,`Absent femorals — coarctation`]},{name:`Auscultation`,steps:[{label:`All 5 classic points`,method:`See APTM diagram above — Aortic, Pulmonic, Erb's, Tricuspid, Mitral.`,normal:`Crisp S1, S2 with physiologic split at pulmonic area`},{label:`Evaluate any murmur`,method:`Timing, location, radiation, grade. Apply the "7 S" innocent-murmur criteria.`,normal:`No murmur, or soft (≤ grade 2) innocent murmur`},{label:`Change with position`,method:`Have toddler sit, stand, lie down — does the murmur change? Innocent murmurs typically disappear or soften with standing.`,normal:`Murmur (if any) changes with position`}],abnormalHints:[`Harsh, loud (≥3/6), radiating, or diastolic murmur — not innocent, refer`,`Cyanosis + murmur — CHD workup`,`Fixed split S2 — ASD`]}]}},preschool:{label:`Preschool (3–5 years)`,msk:{overview:`Functional gait maneuvers, scoliosis screen, resolving physiologic alignment.`,components:[{name:`Gait — multiple patterns`,steps:[{label:`Normal gait`,method:`Walk ~15 feet barefoot`,normal:`Symmetric, smooth, reciprocal arm swing`},{label:`Heel walking`,method:`Walk on heels only`,normal:`Able by 4y`},{label:`Toe walking`,method:`Walk on toes only`,normal:`Able by 4y`},{label:`Tandem walking`,method:`Heel-to-toe along a line for 5 steps`,normal:`Able by 4y with minimal deviation`},{label:`Hopping`,method:`Hop on one foot`,normal:`3–5 hops on preferred foot by 4y`}],abnormalHints:[`Persistent toe-walking`,`Asymmetric stance/stride`,`Difficulty with any pattern`]},{name:`Alignment`,steps:[{label:`Knee alignment`,method:`Stand feet together`,normal:`Mild residual valgus resolving; neutral by 6–7y`},{label:`Foot arch`,method:`Standing, then tiptoe`,normal:`Arch forms on tiptoe (flexible flat foot)`},{label:`Heel position`,method:`View from behind standing`,normal:`Neutral or mild valgus`}],abnormalHints:[`Persistent unilateral varum`,`Rigid flat foot (no arch on tiptoe)`,`Pes cavus`]},{name:`Scoliosis screen (Adam forward-bend)`,steps:[{label:`Position`,method:`Feet together, bend forward at waist, arms hanging, palms together`,normal:`Arms and head relaxed`},{label:`View from behind`,method:`Examiner at same height; look along back`,normal:`Symmetric paraspinal contour`},{label:`View from side`,method:`Side view for kyphosis`,normal:`Smooth thoracic curve`}],abnormalHints:[`Rib hump (thoracic scoliosis)`,`Lumbar prominence`,`Asymmetric scapular height`]},{name:`Joint range and stability`,steps:[{label:`Active range`,method:`Ask to perform full range at hips, knees, ankles, shoulders, elbows, wrists`,normal:`Full symmetric range, no pain`},{label:`Knee stability`,method:`Palpate for effusion; assess stability if complaint`,normal:`Stable, no effusion`},{label:`Carrying angle (elbows)`,method:`Arms at sides, palms forward`,normal:`Normal valgus carrying angle`}],abnormalHints:[`Joint hypermobility (Beighton score)`,`Effusion`,`Pain with motion`,`Valgus >15°`]},{name:`Feet`,steps:[{label:`Standing inspection`,method:`View from front and behind`,normal:`Symmetric feet, neutral heel, flexible flat feet common`},{label:`Tiptoe`,method:`Stand on tiptoes`,normal:`Arch forms, symmetric`},{label:`Pes planus vs cavus`,method:`Note arch height`,normal:`Flexible flat foot or mild arch`}],abnormalHints:[`Rigid flat foot`,`Pes cavus (Charcot-Marie-Tooth)`,`Pain`]}]},neuro:{overview:`Formal pediatric neuro exam now feasible — most 4- and 5-year-olds cooperate with structured testing.`,components:[{name:`Mental status and language`,steps:[{label:`Orientation (age-appropriate)`,method:`Ask name, age, where you are`,normal:`Knows name and age by 3y; location by 4–5y`},{label:`Speech intelligibility`,method:`Listen to spontaneous speech`,normal:`Strangers understand by 4y`},{label:`Receptive language`,method:`2- and 3-step commands`,normal:`Follows 3-step commands by 4–5y`}],abnormalHints:[`Dysarthria`,`Expressive or receptive language delay`,`Inattention`]},{name:`Cranial nerves (II–XII)`,steps:[{label:`CN II — visual acuity`,method:`HOTV chart or pictures at 10ft, each eye`,normal:`20/30 or better by 4y; 20/25 by 5y`},{label:`CN II — visual fields`,method:`Confrontation with toys from periphery`,normal:`Full fields`},{label:`CN II — pupils`,method:`Light response each eye`,normal:`PERRL`},{label:`CN III, IV, VI — EOM`,method:`Follow toy in H pattern; include convergence`,normal:`Full EOM, convergence present`},{label:`CN V — sensation`,method:`Light touch forehead, cheek, jaw each side`,normal:`Intact, symmetric`},{label:`CN V — motor`,method:`Clench teeth, palpate masseter`,normal:`Symmetric strong bulk`},{label:`CN VII — face`,method:`Smile, wrinkle forehead, close eyes, puff cheeks`,normal:`Symmetric movement of all regions`},{label:`CN VIII — hearing`,method:`Finger rub each ear or whispered words`,normal:`Intact bilaterally`},{label:`CN IX, X — palate`,method:`Open mouth, say "ahh"`,normal:`Palate rises symmetrically, uvula midline`},{label:`CN XI — SCM/trapezius`,method:`Shrug shoulders, turn head against resistance`,normal:`Symmetric strength`},{label:`CN XII — tongue`,method:`Stick tongue out, move side to side`,normal:`Midline, no atrophy, full movement`}],abnormalHints:[`Strabismus (amblyopia risk)`,`Facial weakness`,`Tongue deviation/fasciculations`,`Uvula off-midline`]},{name:`Motor — tone, bulk, strength`,steps:[{label:`Tone inspection`,method:`Passive range all four limbs`,normal:`Normal tone throughout`},{label:`Bulk inspection`,method:`Observe muscle bulk symmetry`,normal:`Symmetric, age-appropriate`},{label:`Strength — shoulder abduction`,method:`Arms out, push down against resistance`,normal:`5/5 bilaterally`},{label:`Strength — elbow flexion`,method:`Flex elbow against resistance`,normal:`5/5 bilaterally`},{label:`Strength — grip`,method:`Squeeze examiner's fingers`,normal:`5/5 symmetric`},{label:`Strength — hip flexion`,method:`Lift leg off table against resistance`,normal:`5/5 bilaterally`},{label:`Strength — knee extension`,method:`Straighten knee against resistance`,normal:`5/5 bilaterally`},{label:`Strength — dorsiflexion`,method:`Pull toes up against resistance`,normal:`5/5 bilaterally`}],abnormalHints:[`Focal weakness`,`Gowers sign`,`Pseudohypertrophy (DMD)`,`Atrophy`]},{name:`Deep tendon reflexes`,steps:[{label:`Biceps`,method:`Thumb on biceps tendon, strike`,normal:`2+ symmetric`},{label:`Patellar`,method:`Knees hanging, strike patellar tendon`,normal:`2+ symmetric`},{label:`Achilles`,method:`Slight dorsiflexion, strike Achilles tendon`,normal:`2+ symmetric`},{label:`Plantar response`,method:`Stroke lateral sole heel-to-toes`,normal:`Down-going great toe`}],abnormalHints:[`Hyperreflexia or clonus (UMN)`,`Hyporeflexia (LMN)`,`Up-going plantar (Babinski — abnormal past 2y)`,`Asymmetry`]},{name:`Coordination`,steps:[{label:`Finger-to-nose`,method:`Touch examiner's finger then own nose, repeat`,normal:`Smooth, no dysmetria`},{label:`Heel-to-shin`,method:`Run heel down opposite shin`,normal:`Smooth bilaterally`},{label:`Rapid alternating movements`,method:`Tap palm with opposite hand alternating palm/back`,normal:`Rhythmic, symmetric`},{label:`Tandem walk`,method:`Heel-to-toe for 5 steps`,normal:`Minimal deviation`}],abnormalHints:[`Dysmetria`,`Dysdiadochokinesia`,`Intention tremor`,`Ataxic tandem`]},{name:`Sensory`,steps:[{label:`Light touch — hands`,method:`Cotton wisp on palm/dorsum, eyes closed`,normal:`Feels each touch`},{label:`Light touch — feet`,method:`Same on dorsum of foot bilaterally`,normal:`Feels each touch`}],abnormalHints:[`Focal sensory loss`,`Stocking-glove loss`]},{name:`Gait and Romberg`,steps:[{label:`Normal gait`,method:`Walk ~20 feet`,normal:`Smooth, symmetric`},{label:`Heel walk`,method:`Walk on heels`,normal:`Able without difficulty`},{label:`Toe walk`,method:`Walk on toes`,normal:`Able without difficulty`},{label:`Tandem`,method:`Heel-to-toe`,normal:`Intact`},{label:`Romberg (5y+)`,method:`Feet together, eyes closed, stand 10s`,normal:`Stable without sway`}],abnormalHints:[`Ataxic gait (cerebellar)`,`Romberg positive (dorsal column)`,`Circumduction (UMN)`]}]},resp:{overview:`Adult-pattern but shorter. Cooperation better than toddler. RR ≤ 30. Common: asthma/RAD, pneumonia, URIs.`,components:[{name:`Inspection`,steps:[{label:`Respiratory rate`,method:`Count over full 60 s quietly.`,normal:`≤ 30 /min`},{label:`Work of breathing`,method:`Retractions, nasal flaring, accessory muscle use.`,normal:`Effortless breathing`},{label:`Audible sounds`,method:`Wheeze, stridor, cough quality (barking = croup).`,normal:`Quiet`},{label:`Chest shape`,method:`AP:transverse, hyperinflation signs.`,normal:`Not barrel-chested`}],abnormalHints:[`Barrel chest — chronic asthma, cystic fibrosis`,`Retractions + wheeze — asthma exacerbation`]},{name:`Auscultation`,steps:[{label:`Systematic zones`,method:`Upper, mid, lower fields anteriorly and posteriorly; axillae bilaterally. Cooperative deep breaths through mouth.`,normal:`Symmetric vesicular sounds`},{label:`Wheeze`,method:`Expiratory, diffuse (asthma) or focal (foreign body, rare at this age).`,normal:`No wheeze`},{label:`Crackles`,method:`Focal = pneumonia; diffuse fine = interstitial disease (rare in kids).`,normal:`No crackles`}],abnormalHints:[`Focal crackles + fever — pneumonia`,`Diffuse wheeze — asthma`,`Prolonged expiration with wheeze — lower airway obstruction`]}]},cv:{overview:`Most CHD is detected by this age. Innocent murmurs peak in this range. Sports participation exams require thorough CV screening.`,components:[{name:`Inspection and palpation`,steps:[{label:`General and growth`,method:`Track on growth curve; activity tolerance.`,normal:`Normal growth, active`},{label:`Apex beat`,method:`5th ICS mid-clavicular line.`,normal:`Normal position and character`},{label:`Peripheral pulses`,method:`Brachial + femoral simultaneously. BP in arm and leg if HTN.`,normal:`Symmetric, no delay`}],abnormalHints:[`Absent femorals or arm-leg BP gradient — coarctation (always check in HTN screening)`,`Displaced apex — cardiomegaly`]},{name:`Auscultation`,pearl:`The 7 "S" criteria and the 5 classic innocent murmurs (see panel above) handle most murmurs you'll find in this age group. Still's murmur is the single most common.`,steps:[{label:`All 5 classic points`,method:`Walk through A → P → E → T → M with diaphragm then bell.`,normal:`S1 S2 clear, physiologic S2 split at pulmonic, no added sounds`},{label:`Any murmur`,method:`Characterise: timing, location, radiation, grade, character. Apply 7 S criteria + compare to innocent-murmur panel.`,normal:`No murmur, or innocent flow murmur meeting all 7 S criteria`},{label:`Position change`,method:`Standing vs supine. Innocent murmurs typically soften or disappear on standing.`,normal:`Murmur (if any) changes with position`},{label:`Sports screening extras (if applicable)`,method:`Screen for HOCM — murmur intensifies with Valsalva and standing (opposite of most).`,normal:`No murmur worsening on Valsalva`}],abnormalHints:[`Murmur breaking any of the 7 S criteria — refer`,`Harsh systolic at LUSB + fixed split S2 — ASD`,`Murmur louder with Valsalva — HOCM (sports participation risk)`,`Diastolic murmur — always pathologic`]}]}},school:{label:`School-age (6–11 years)`,msk:{overview:`Scoliosis screening peri-puberty, sports overuse injuries, resolving alignment.`,components:[{name:`Scoliosis screen (forward-bend + scoliometer)`,steps:[{label:`Standing inspection`,method:`Shoulders and iliac crest heights`,normal:`Symmetric shoulder and pelvic heights`},{label:`Forward bend (Adam test)`,method:`Feet together, bend forward at waist, arms hanging palms together`,normal:`Symmetric paraspinal contour`},{label:`Rib hump`,method:`View tangentially from behind at level of curve`,normal:`No rib hump`},{label:`Lumbar prominence`,method:`Same view at lumbar level`,normal:`No prominence`},{label:`Scoliometer (if available)`,method:`Place scoliometer across rib hump, read angle of trunk rotation`,normal:`ATR < 5°; ≥7° → refer`}],abnormalHints:[`Rib hump`,`ATR ≥7°`,`Asymmetric shoulders or pelvis`,`Decompensation (plumb line offset)`]},{name:`Back and spine`,steps:[{label:`Posture inspection`,method:`Standing, view front/back/side`,normal:`Normal spinal curves; plumb line centered`},{label:`Palpate spinous processes`,method:`From C2 to S1`,normal:`No tenderness, no step-off`},{label:`Range of motion`,method:`Flex, extend, lateral bend, rotate`,normal:`Full painless range`}],abnormalHints:[`Midline tenderness`,`Step-off (spondylolisthesis)`,`Limited motion with pain`]},{name:`Alignment`,steps:[{label:`Knees`,method:`Feet together, inspect`,normal:`Neutral alignment by 6–7y`},{label:`Feet`,method:`Stand, then tiptoes`,normal:`Medial arch present, symmetric`},{label:`Leg lengths`,method:`Supine, measure ASIS to medial malleolus if asymmetric`,normal:`Equal within 1cm`}],abnormalHints:[`Residual valgum`,`Pes cavus`,`Leg-length discrepancy >1cm`]},{name:`Joint stability and sports exam (if active)`,steps:[{label:`Active range all joints`,method:`Through full range`,normal:`Full symmetric range, no pain or crepitus`},{label:`Knee — Lachman (if sports-active)`,method:`Knee 20° flexion, stabilize femur, pull tibia forward`,normal:`Firm endpoint, no laxity`},{label:`Knee — McMurray`,method:`Flexed knee, rotate tibia while extending`,normal:`No pain or click`},{label:`Shoulder — impingement (Neer/Hawkins)`,method:`Passive shoulder flexion with arm in internal rotation`,normal:`No pain`},{label:`Ankle stability`,method:`Anterior drawer and talar tilt`,normal:`No laxity`}],abnormalHints:[`ACL laxity (positive Lachman)`,`Meniscal click`,`Shoulder impingement`,`Ankle instability`]},{name:`Gait and functional movement`,steps:[{label:`Normal gait`,method:`Walk 20 feet`,normal:`Smooth, symmetric`},{label:`Single-leg stance`,method:`Stand on one foot 10s each side`,normal:`Stable without Trendelenburg drop`},{label:`Squat`,method:`Full squat and rise`,normal:`Full squat without pain or asymmetry`},{label:`Hop on one foot`,method:`5 hops each side`,normal:`Able and symmetric`}],abnormalHints:[`Trendelenburg sign (hip abductor weakness)`,`Antalgic gait`,`Asymmetric squat`,`Pain with hop`]}]},neuro:{overview:`Adult-pattern six-component exam: mental status, CN, motor, reflexes, sensory, coordination/gait.`,components:[{name:`Mental status`,steps:[{label:`Orientation`,method:`Name, age, school, city, day of week`,normal:`Oriented x 4`},{label:`Attention`,method:`Count backward from 20; days of week backward`,normal:`Intact`},{label:`3-item recall`,method:`Ball-flag-tree; ask at 3 and 5 min`,normal:`3/3 recall at 5 min`},{label:`Language`,method:`Name common objects; repeat a sentence`,normal:`Fluent, no paraphasia`}],abnormalHints:[`Inattention (ADHD features)`,`Memory deficits`,`Word-finding difficulty`,`Perseveration`]},{name:`Cranial nerves (II–XII)`,steps:[{label:`CN II — acuity`,method:`Snellen at 20ft each eye with corrective lenses if worn`,normal:`20/20 or baseline`},{label:`CN II — fields`,method:`Confrontation, 4 quadrants each eye`,normal:`Full fields`},{label:`CN II — fundoscopy (if indicated)`,method:`Direct ophthalmoscopy — disc, vessels, macula`,normal:`Sharp disc, normal cup-disc ratio, no papilledema`},{label:`CN II, III — pupils`,method:`Direct and consensual light, accommodation`,normal:`PERRLA`},{label:`CN III, IV, VI — EOM`,method:`Follow finger in H pattern; convergence`,normal:`Full EOM, no nystagmus, convergence intact`},{label:`CN V — sensation`,method:`Light touch V1 (forehead), V2 (cheek), V3 (jaw) each side`,normal:`Intact, symmetric`},{label:`CN V — motor`,method:`Clench teeth, palpate masseter/temporalis; jaw opening`,normal:`Symmetric strength`},{label:`CN VII`,method:`Raise eyebrows, close eyes tight, smile/show teeth, puff cheeks`,normal:`Symmetric movement, all regions`},{label:`CN VIII`,method:`Finger rub each ear; Weber/Rinne if deficit`,normal:`Hears bilaterally`},{label:`CN IX, X`,method:`Palate elevation with "ahh"; uvula midline; voice quality`,normal:`Symmetric elevation, uvula midline, normal voice`},{label:`CN XI`,method:`Shrug shoulders against resistance; head turn against resistance`,normal:`5/5 SCM and trapezius`},{label:`CN XII`,method:`Stick tongue out; side-to-side`,normal:`Midline, no atrophy or fasciculations`}],abnormalHints:[`Papilledema (increased ICP)`,`Focal cranial nerve deficit — any warrants workup`,`Tongue fasciculations (LMN/MND)`]},{name:`Motor — bulk, tone, strength`,steps:[{label:`Bulk inspection`,method:`Shoulders, thighs, calves, intrinsic hand muscles`,normal:`Symmetric, no atrophy`},{label:`Tone`,method:`Passive range at elbows, wrists, knees, ankles`,normal:`Normal resistance throughout`},{label:`Strength — deltoids`,method:`Shoulder abduction against resistance`,normal:`5/5 bilaterally`},{label:`Strength — biceps`,method:`Elbow flexion against resistance`,normal:`5/5`},{label:`Strength — triceps`,method:`Elbow extension against resistance`,normal:`5/5`},{label:`Strength — grip`,method:`Squeeze 2 fingers`,normal:`5/5 symmetric`},{label:`Strength — finger abduction`,method:`Spread fingers against resistance`,normal:`5/5`},{label:`Strength — hip flexion`,method:`Lift leg supine against resistance`,normal:`5/5`},{label:`Strength — knee extension`,method:`Straighten knee against resistance`,normal:`5/5`},{label:`Strength — dorsiflexion`,method:`Pull toes up against resistance`,normal:`5/5`},{label:`Strength — plantarflexion`,method:`Push foot down against resistance`,normal:`5/5`}],abnormalHints:[`Focal weakness (localize)`,`Spasticity (UMN)`,`Atrophy`,`Fasciculations`]},{name:`Deep tendon reflexes`,steps:[{label:`Biceps (C5-C6)`,method:`Thumb on tendon, strike`,normal:`2+ symmetric`},{label:`Triceps (C7-C8)`,method:`Strike triceps tendon`,normal:`2+ symmetric`},{label:`Brachioradialis (C5-C6)`,method:`Strike distal radius`,normal:`2+ symmetric`},{label:`Patellar (L3-L4)`,method:`Knees hanging, strike tendon`,normal:`2+ symmetric`},{label:`Achilles (S1)`,method:`Slight dorsiflexion, strike tendon`,normal:`2+ symmetric`},{label:`Plantar response`,method:`Stroke lateral sole heel-to-toes`,normal:`Down-going bilaterally`},{label:`Clonus`,method:`Rapid dorsiflexion at ankle`,normal:`No sustained clonus`}],abnormalHints:[`Hyperreflexia with clonus (UMN: stroke, MS, cord lesion)`,`Hyporeflexia (LMN, neuropathy, myopathy)`,`Asymmetry`,`Up-going Babinski`,`Sustained clonus`]},{name:`Sensory`,steps:[{label:`Light touch — upper`,method:`Cotton wisp dorsum of hands, eyes closed`,normal:`Intact, symmetric`},{label:`Light touch — lower`,method:`Same on dorsum of feet`,normal:`Intact, symmetric`},{label:`Pain — upper`,method:`Broken Q-tip or pin on hands`,normal:`Intact, symmetric`},{label:`Pain — lower`,method:`Same on feet`,normal:`Intact, symmetric`},{label:`Vibration`,method:`128 Hz tuning fork at distal IP joint of great toes`,normal:`Feels vibration; counts down seconds`},{label:`Proprioception`,method:`Move great toe up/down with eyes closed`,normal:`Identifies direction correctly`}],abnormalHints:[`Dermatomal loss (nerve root)`,`Stocking-glove (neuropathy)`,`Loss of vibration/proprioception (dorsal column — B12, tabes, MS)`]},{name:`Coordination`,steps:[{label:`Finger-nose-finger`,method:`Touch examiner finger then own nose, examiner moves target`,normal:`Smooth, accurate, no dysmetria`},{label:`Heel-to-shin`,method:`Supine: heel down opposite shin`,normal:`Smooth, on-target`},{label:`Rapid alternating movements`,method:`Supinate/pronate hand on knee rapidly`,normal:`Rhythmic, symmetric`},{label:`Fine motor`,method:`Finger tapping (thumb to each finger in sequence)`,normal:`Rhythmic, accurate`}],abnormalHints:[`Dysmetria (past-pointing, overshoot)`,`Intention tremor`,`Dysdiadochokinesia`]},{name:`Gait and Romberg`,steps:[{label:`Normal gait`,method:`Walk 20 feet`,normal:`Narrow-based, smooth, reciprocal arm swing`},{label:`Heel walk`,method:`Walk on heels`,normal:`Able without difficulty`},{label:`Toe walk`,method:`Walk on toes`,normal:`Able without difficulty`},{label:`Tandem`,method:`Heel-to-toe along a line`,normal:`Minimal deviation, 10+ steps`},{label:`Romberg`,method:`Feet together, eyes closed, 30s`,normal:`Stable without fall or significant sway`}],abnormalHints:[`Wide-based (cerebellar)`,`Steppage (peripheral neuropathy)`,`Scissoring (UMN)`,`Romberg positive (dorsal column)`,`Circumduction`]}]},resp:{overview:`Nearly adult-pattern. Exam the same as adolescent with slightly more flexibility in cooperation. RR ≤ 30 in younger school-age, ≤ 20 in older. Sports history relevant (exercise-induced asthma).`,components:[{name:`Inspection`,steps:[{label:`Respiratory rate`,method:`Count over 60 s.`,normal:`≤ 30 (6–11 y)`},{label:`Work of breathing`,method:`Retractions, accessory muscles.`,normal:`Effortless`},{label:`Audible sounds`,method:`Listen for wheeze, stridor.`,normal:`Quiet`},{label:`Chest shape`,method:`Barrel chest, pectus deformities.`,normal:`Normal shape`},{label:`Clubbing`,method:`Schamroth window test.`,normal:`No clubbing`}],abnormalHints:[`Clubbing — CF, chronic hypoxemia, bronchiectasis`,`Barrel chest — chronic asthma, CF`]},{name:`Palpation and percussion`,steps:[{label:`Tracheal position`,method:`Middle finger in suprasternal notch.`,normal:`Midline`},{label:`Chest expansion`,method:`Hands laterally, thumbs meeting at spine. Deep breath.`,normal:`Symmetric 3–5 cm`},{label:`Tactile fremitus`,method:`Ulnar side of hand; "ninety-nine". Compare sides.`,normal:`Symmetric`},{label:`Percussion`,method:`Pleximeter + plexor technique. Compare sides.`,normal:`Resonant throughout`}],abnormalHints:[`Deviated trachea — pneumothorax, effusion, collapse`,`Dull percussion — consolidation, effusion`,`Hyper-resonant — pneumothorax, hyperinflation`]},{name:`Auscultation`,steps:[{label:`Systematic zones`,method:`Six anterior + four lateral + six posterior zones, compare side-to-side.`,normal:`Symmetric vesicular sounds`},{label:`Adventitious sounds`,method:`Wheeze, crackles, rhonchi, rub, stridor at neck. Use sounds library for reference.`,normal:`No added sounds`},{label:`Cough re-listen`,method:`Secretions (rhonchi, coarse crackles) should clear; fibrosis crackles do not.`,normal:`Secretion-based sounds clear with cough`}],abnormalHints:[`Focal crackles + fever — pneumonia`,`Diffuse fine crackles — early interstitial disease`,`Expiratory wheeze — asthma / RAD`]}]},cv:{overview:`Nearly adult-pattern. Sports participation screening is a key indication in this age. HOCM screening (family history of sudden cardiac death, exertional syncope, murmur louder with Valsalva) is specifically relevant.`,components:[{name:`Inspection and palpation`,pearl:`For sports participation exams, always ask about exertional symptoms (syncope, chest pain, unexpected fatigue) AND family history of sudden cardiac death before age 50. Screening exam alone catches only ~3% of HOCM.`,steps:[{label:`General and growth`,method:`Track on growth curve; review activity tolerance.`,normal:`Normal growth, age-appropriate activity`},{label:`Colour and clubbing`,method:`Inspect mucous membranes and nail beds.`,normal:`Pink, no clubbing`},{label:`Apex beat`,method:`Palpate at 5th ICS mid-clavicular line.`,normal:`Normal position, tapping character`},{label:`Peripheral pulses`,method:`Simultaneous brachial + femoral.`,normal:`Symmetric, no delay`},{label:`Blood pressure`,method:`Measure BP with appropriately sized cuff. If elevated, check both arms and one leg.`,normal:`Age-appropriate (< 120/80 roughly by 10+ years)`}],abnormalHints:[`Exertional syncope — HOCM, arrhythmia, LQTS`,`BP differential — coarctation`,`Displaced apex — cardiomegaly`]},{name:`Auscultation`,steps:[{label:`All 5 classic points`,method:`See APTM diagram. A → P → E → T → M with diaphragm and bell.`,normal:`S1, S2 clear with physiologic split at P, no added sounds`},{label:`Grade any murmur`,method:`Levine 1–6 (see scales above); characterise timing, location, radiation.`,normal:`No murmur, or innocent flow murmur meeting all 7 S criteria`},{label:`Innocent vs pathologic`,method:`Apply 7 S criteria; compare to innocent-murmur panel.`,normal:`Innocent murmur (if present) clearly fits all 7 S features`},{label:`Dynamic maneuvers`,method:`Standing: HOCM louder; most others soften. Valsalva: HOCM louder.`,normal:`Murmur (if any) softens on standing and Valsalva`}],abnormalHints:[`Murmur louder with Valsalva / standing — HOCM (sports disqualification considerations)`,`Any diastolic murmur`,`Murmur ≥ grade 3, radiating, or with thrill`]}]}},adolescent:{label:`Adolescent (12–21 years)`,msk:{overview:`Sports-related injuries, adolescent scoliosis, apophyseal overuse, hypermobility screening.`,components:[{name:`Scoliosis screen`,steps:[{label:`Standing inspection`,method:`Patient undressed to waist (keep privacy); compare shoulders, iliac crests, scapular heights`,normal:`Symmetric shoulders and pelvis`},{label:`Forward bend (Adam)`,method:`Feet together, bend forward, arms hanging palms together`,normal:`Symmetric paraspinal contour`},{label:`Scoliometer`,method:`Place across thoracic and lumbar regions at maximum prominence`,normal:`ATR <5°; 5–6° monitor; ≥7° refer`},{label:`Plumb line check`,method:`Drop plumb from C7; note where it falls`,normal:`Passes through gluteal cleft (compensated)`},{label:`Leg lengths`,method:`Supine; ASIS to medial malleolus each side`,normal:`Within 1cm`}],abnormalHints:[`Rib/lumbar hump`,`ATR ≥7°`,`Decompensation (plumb off gluteal cleft)`,`Leg-length discrepancy driving apparent curve`]},{name:`Back pain evaluation (if complaint)`,steps:[{label:`Inspect and palpate`,method:`Spinous processes, paraspinal muscles, SI joints`,normal:`Non-tender`},{label:`Range of motion`,method:`Flex, extend, lateral bend, rotate`,normal:`Full painless range`},{label:`Single-leg hyperextension (stork)`,method:`Stand on one foot, extend back — each side`,normal:`No pain (negative for spondylolysis)`},{label:`Straight-leg raise`,method:`Supine, lift straight leg to 70°+`,normal:`No radicular pain to 70°`},{label:`SI joint tests`,method:`FABER, SI compression`,normal:`No pain`}],abnormalHints:[`Spondylolysis (positive stork test)`,`Radicular pain (disc herniation)`,`SI joint pathology`,`Inflammatory back pain pattern`]},{name:`Joint stability — sports-specific`,steps:[{label:`Knee — Lachman`,method:`Knee 20° flexion, stabilize femur, pull tibia anteriorly`,normal:`Firm endpoint, no laxity (ACL intact)`},{label:`Knee — anterior drawer`,method:`Knee 90°, pull tibia forward`,normal:`No excess anterior translation`},{label:`Knee — varus/valgus stress`,method:`Stress at 0 and 30° flexion`,normal:`No gap opening (LCL/MCL intact)`},{label:`Knee — McMurray`,method:`Flex, rotate tibia while extending`,normal:`No pain or click`},{label:`Shoulder — apprehension`,method:`Abduct and externally rotate`,normal:`No apprehension`},{label:`Shoulder — Neer/Hawkins`,method:`Passive flexion with internal rotation`,normal:`No pain`},{label:`Ankle — anterior drawer`,method:`Pull heel forward with tibia stabilized`,normal:`No laxity`},{label:`Ankle — talar tilt`,method:`Invert heel with tibia stabilized`,normal:`No excess tilt`}],abnormalHints:[`ACL/PCL tear`,`MCL/LCL laxity`,`Meniscal injury`,`Shoulder instability/impingement`,`Ankle ligament laxity`]},{name:`Apophysitis and overuse screen`,steps:[{label:`Tibial tubercle`,method:`Palpate with knee flexed`,normal:`Non-tender`},{label:`Calcaneal apophysis`,method:`Palpate posterior calcaneus`,normal:`Non-tender`},{label:`Iliac apophyses`,method:`Palpate ASIS, AIIS, iliac crest`,normal:`Non-tender`},{label:`Rotator cuff`,method:`Empty-can (Jobe) test`,normal:`No pain or weakness`}],abnormalHints:[`Osgood-Schlatter (tibial tubercle tender)`,`Sever (calcaneal tender)`,`Iliac apophysitis`,`Rotator cuff tendinopathy`]},{name:`Hypermobility screen (Beighton)`,steps:[{label:`Fifth finger extension`,method:`Passive extension of fifth MCP to >90°`,normal:`No hyperextension (1 pt each side if positive)`},{label:`Thumb to forearm`,method:`Passive flexion of thumb to touch forearm`,normal:`Does not reach (1 pt each side if positive)`},{label:`Elbow hyperextension`,method:`Hyperextension >10°`,normal:`No hyperextension (1 pt each side if positive)`},{label:`Knee hyperextension`,method:`Hyperextension >10°`,normal:`No hyperextension (1 pt each side if positive)`},{label:`Palms to floor`,method:`Feet together, bend forward, palms flat on floor with knees straight`,normal:`Cannot reach (1 pt if positive)`}],abnormalHints:[`Beighton ≥5/9 suggests hypermobility spectrum (hEDS workup if with other features)`]},{name:`Alignment and gait`,steps:[{label:`Standing alignment`,method:`View knees, feet`,normal:`Neutral alignment, medial arch`},{label:`Normal gait`,method:`Walk 20 feet`,normal:`Symmetric, smooth`},{label:`Functional movements`,method:`Squat, single-leg stance, hop`,normal:`Full symmetric function`}],abnormalHints:[`Antalgic gait`,`Trendelenburg`,`Asymmetric squat`]}]},neuro:{overview:`Full adult-pattern neuro exam across six pillars: mental status, cranial nerves, motor, reflexes, sensory, coordination/gait. In adolescents, screen concussion sequelae if sports-active; frontal release signs must be absent.`,components:[{name:`Mental status`,significance:`Detects cognitive change (concussion, substance use, mood disorder, rare neurodegenerative disease).`,pearl:`Attention precedes memory. A patient who can't attend (serial 7s, months backward) will fail memory even with intact hippocampus — distinguish before calling it a memory problem.`,steps:[{label:`Orientation`,method:`Name, age, date, location, situation`,normal:`Oriented x 4`},{label:`Attention`,method:`Count backward from 100 by 7s (serial 7s) or months of year backward`,normal:`Intact`},{label:`Short-term memory`,method:`3-item registration and recall at 5 min`,normal:`3/3 recall`},{label:`Language`,method:`Object naming; sentence repetition; reading; writing`,normal:`Fluent, no paraphasia, comprehends written and spoken`},{label:`Executive function`,method:`Similarities (apple/orange); interpret proverb`,normal:`Abstract, age-appropriate`}],abnormalHints:[`Post-concussion cognitive changes`,`Mood or personality changes`,`Subtle executive dysfunction`,`Word-finding difficulty`]},{name:`Cranial nerves (II–XII, full formal exam)`,significance:`Localises brainstem, base-of-skull, and specific nerve pathology. Subtle deficits (RAPD, mild facial weakness, Horner) are easily missed — exam discipline matters.`,pearl:`The fastest screen for a CN deficit is asking the patient to speak, smile, look around, and swallow water. What's preserved in everyday function tells you what's likely intact — then examine formally to confirm and to catch the subtle.`,steps:[{label:`CN I (if indicated)`,method:`Coffee or cinnamon each nostril separately`,normal:`Identifies both`},{label:`CN II — acuity`,method:`Snellen at 20ft each eye; corrective lenses if worn`,normal:`20/20 or baseline`},{label:`CN II — fields`,method:`Confrontation, 4 quadrants each eye`,normal:`Full fields`},{label:`CN II — fundoscopy`,method:`Direct ophthalmoscopy — disc, vessels, macula`,normal:`Sharp disc, normal cup/disc, no papilledema`},{label:`CN II, III — pupils`,method:`Direct, consensual, swinging flashlight, accommodation`,normal:`PERRLA, no RAPD`},{label:`CN III, IV, VI — EOM`,method:`H pattern, convergence, note nystagmus or ptosis`,normal:`Full conjugate movement, no nystagmus, convergence intact`},{label:`CN V — sensation`,method:`Light touch V1, V2, V3 each side`,normal:`Intact, symmetric`},{label:`CN V — motor`,method:`Clench jaw, palpate masseter/temporalis; lateral jaw movement`,normal:`Symmetric strength and bulk`},{label:`CN V — corneal reflex (if indicated)`,method:`Cotton wisp to cornea`,normal:`Blinks bilaterally`},{label:`CN VII`,method:`Wrinkle forehead, close eyes against resistance, smile/bare teeth, puff cheeks`,normal:`Symmetric all four movements`},{label:`CN VIII — hearing`,method:`Finger rub each ear; Weber (midline) + Rinne (air > bone) if deficit`,normal:`Equal bilaterally`},{label:`CN IX, X`,method:`Palate elevation with "ahh"; uvula midline; voice; gag (if indicated)`,normal:`Symmetric palate, uvula midline, normal voice`},{label:`CN XI`,method:`Shoulder shrug and head turn against resistance`,normal:`5/5 SCM and trapezius bilaterally`},{label:`CN XII`,method:`Tongue protrusion, side to side; inspect for fasciculations/atrophy`,normal:`Midline, no atrophy or fasciculations, full movement`}],abnormalHints:[`Any focal cranial nerve deficit`,`Papilledema`,`RAPD`,`Nystagmus`,`Facial asymmetry`,`Tongue deviation`]},{name:`Motor — bulk, tone, strength`,significance:`Localises lesion to UMN vs LMN vs muscle vs junction. Pattern of weakness (proximal vs distal, symmetric vs focal) narrows differential.`,pearl:`Pronator drift is the most sensitive screen for subtle UMN weakness — a normal-feeling arm that drifts down with eyes closed still has corticospinal tract dysfunction. Always do it even when formal strength is 5/5.`,steps:[{label:`Bulk inspection`,method:`Inspect shoulders, biceps, thighs, calves, dorsal interossei (between metacarpals) of hands.`,normal:`Symmetric bulk; no atrophy, no pseudohypertrophy`},{label:`Tone — upper`,method:`Passive flex-extend elbow and pronate-supinate wrist at slow then quick speeds. Then pronator drift: arms outstretched, palms up, eyes closed for 10 s.`,normal:`Smooth passive range; no drift, no pronation of the outstretched hand`},{label:`Tone — lower`,method:`Passive knee flexion-extension; quick ankle dorsiflexion to check for catch. Heel-slap test: roll thigh and watch for ankle swing.`,normal:`Normal resistance, no catch, symmetric`},{label:`Strength — deltoid (C5)`,method:`Patient abducts both arms to 90°. Examiner pushes down on each arm just above the elbow while patient resists. Compare sides.`,normal:`Holds against full resistance — MRC 5/5 bilaterally`},{label:`Strength — biceps (C5–C6)`,method:`Elbow flexed 90°, supinated. Examiner grasps wrist and pulls to extend while patient resists.`,normal:`Holds against full resistance — 5/5`},{label:`Strength — triceps (C7)`,method:`Elbow flexed 90°. Examiner pushes wrist toward shoulder while patient extends against resistance.`,normal:`Extends against full resistance — 5/5`},{label:`Strength — wrist extension (C6–C7)`,method:`Patient makes fist, extends wrist. Examiner pushes down on knuckles while patient holds wrist up.`,normal:`Holds against full resistance — 5/5`},{label:`Strength — finger flexion / grip (C8)`,method:`Patient grips two of examiner's crossed fingers as hard as possible. Compare sides.`,normal:`Strong symmetric grip — 5/5`},{label:`Strength — finger abduction (T1)`,method:`Patient spreads fingers wide. Examiner squeezes index and little fingers together while patient resists.`,normal:`Holds fingers apart — 5/5`},{label:`Strength — hip flexion (L2–L3)`,method:`Supine. Patient lifts straight leg 30° off table. Examiner pushes down on thigh just above knee while patient resists.`,normal:`Holds thigh up against full resistance — 5/5`},{label:`Strength — knee extension (L3–L4)`,method:`Sitting, knee 90°. Patient straightens knee while examiner pushes distal shin down.`,normal:`Extends against full resistance — 5/5`},{label:`Strength — ankle dorsiflexion (L4–L5)`,method:`Patient pulls toes and foot up toward shin. Examiner pushes foot down at the dorsum.`,normal:`Holds dorsiflexion against full resistance — 5/5; preserved heel-walk`},{label:`Strength — great toe extension (L5)`,method:`Patient extends great toe up while examiner pushes it down with thumb.`,normal:`Holds against full resistance — 5/5 (classic L5 test)`},{label:`Strength — ankle plantarflexion (S1)`,method:`Patient pushes foot down against examiner's hand at the ball. OR ask patient to toe-walk 10 steps (more sensitive — unilateral plantarflexion weakness shows immediately).`,normal:`Full power; toe-walks symmetrically — 5/5`}],abnormalHints:[`Focal weakness → localise by myotome`,`Pronator drift (subtle UMN, always check even with 5/5)`,`Spasticity / catch (UMN)`,`Atrophy (LMN, disuse)`,`Fasciculations (MND, ALS)`,`Pseudohypertrophy of calves (DMD in a young male)`]},{name:`Deep tendon reflexes`,significance:`Reflex pattern (increased, decreased, asymmetric) localises UMN vs LMN vs root vs peripheral nerve. Inexpensive and fast, but asymmetry is the most informative finding.`,pearl:`A reinforced reflex is still a reflex. If you can't elicit it initially, use Jendrassik (teeth clench or pull interlocked fingers apart) to boost — absent reflexes without reinforcement aren't truly absent.`,steps:[{label:`Biceps (C5–C6)`,method:`Patient's arm relaxed across lap. Examiner places thumb firmly on biceps tendon at the cubital fossa, strikes thumb with reflex hammer. Compare both sides sequentially.`,normal:`2+ symmetric — visible contraction of biceps, slight elbow flexion`},{label:`Brachioradialis (C5–C6)`,method:`Arm relaxed. Strike the distal radius about 3 cm proximal to the wrist, on its radial (thumb) side.`,normal:`2+ symmetric — elbow flexion and slight forearm supination`},{label:`Triceps (C7)`,method:`Support the patient's arm at the wrist with elbow at 90°. Strike the triceps tendon just above the olecranon.`,normal:`2+ symmetric — triceps contraction, slight elbow extension`},{label:`Finger flexors — Hoffmann sign`,method:`Grasp the middle finger's distal phalanx, flick it downward quickly and release. Watch the thumb and index finger.`,normal:`Negative — no thumb flexion, no index flexion (positive = corticospinal tract dysfunction)`},{label:`Patellar (L3–L4)`,method:`Patient sits with knees hanging freely off the table. Strike the patellar tendon just below the patella.`,normal:`2+ symmetric — quadriceps contraction with knee extension`},{label:`Achilles (S1)`,method:`Patient's knee slightly flexed and leg externally rotated, or kneeling on a chair. Slightly dorsiflex the foot and strike the Achilles tendon.`,normal:`2+ symmetric — plantar flexion of the foot`},{label:`Plantar response (Babinski)`,method:`Stroke the lateral aspect of the sole firmly from the heel toward the little toe, then curve across the ball of the foot.`,normal:`Toes flex downward (plantar flexion, "down-going") bilaterally in anyone ≥ 2 years`},{label:`Ankle clonus`,method:`Knee slightly bent. Support the shin with one hand, quickly and sharply dorsiflex the foot with the other, hold in dorsiflexion.`,normal:`≤ 3 non-sustained beats is acceptable; sustained rhythmic oscillation = pathological clonus (UMN)`}],abnormalHints:[`Hyperreflexia + sustained clonus = UMN (MS, myelopathy, cord lesion, stroke)`,`Symmetric hyporeflexia = peripheral polyneuropathy, GBS, myopathy, hypothyroid, B12 deficiency`,`Asymmetric hyporeflexia = radiculopathy at that segment`,`Hoffmann positive = corticospinal tract dysfunction at cervical cord or above`,`Up-going Babinski after age 2 = UMN (always abnormal)`]},{name:`Sensory`,steps:[{label:`Light touch — upper`,method:`Cotton wisp, dorsum of hands, eyes closed`,normal:`Intact, symmetric`},{label:`Light touch — lower`,method:`Dorsum of feet`,normal:`Intact, symmetric`},{label:`Pain — upper`,method:`Broken Q-tip sharp end, hands`,normal:`Intact, symmetric`},{label:`Pain — lower`,method:`Same on feet`,normal:`Intact, symmetric`},{label:`Temperature (if indicated)`,method:`Cold tuning fork each area`,normal:`Intact`},{label:`Vibration`,method:`128 Hz tuning fork at distal IP of great toes; count seconds to fade`,normal:`Feels vibration; appropriate duration`},{label:`Proprioception`,method:`Move great toe up/down with eyes closed`,normal:`Identifies direction correctly`},{label:`Two-point discrimination (if indicated)`,method:`Blunt calipers on fingertip`,normal:`<5mm on fingertip`},{label:`Stereognosis (if indicated)`,method:`Identify coin/key in hand with eyes closed`,normal:`Correct identification`}],abnormalHints:[`Dermatomal loss (nerve root)`,`Stocking-glove loss (length-dependent neuropathy)`,`Dorsal column loss (B12, tabes, MS — positive Romberg, vibration loss)`,`Cortical deficit (astereognosis, impaired 2-pt)`]},{name:`Coordination`,steps:[{label:`Finger-nose-finger`,method:`Alternate examiner's finger and own nose; examiner moves target`,normal:`Smooth, accurate bilaterally`},{label:`Heel-to-shin`,method:`Supine: heel down opposite shin and back`,normal:`Smooth, accurate`},{label:`Rapid alternating (Dysdiadochokinesis)`,method:`Supinate/pronate hand rapidly on thigh`,normal:`Rhythmic, symmetric`},{label:`Finger tapping`,method:`Thumb to each finger in sequence rapidly`,normal:`Rhythmic, smooth, symmetric`}],abnormalHints:[`Dysmetria (cerebellar)`,`Intention tremor`,`Dysdiadochokinesia`,`Decomposed movement`]},{name:`Gait and Romberg`,steps:[{label:`Normal gait`,method:`Walk 20 feet`,normal:`Narrow-based, smooth, reciprocal arm swing`},{label:`Heel walk`,method:`Walk on heels only`,normal:`Able without difficulty`},{label:`Toe walk`,method:`Walk on toes only`,normal:`Able without difficulty`},{label:`Tandem`,method:`Heel-to-toe along a line, 10+ steps`,normal:`Minimal deviation`},{label:`Romberg`,method:`Feet together, eyes open then closed, 30s`,normal:`Stable — no significant sway or fall with eyes closed`},{label:`Single-leg stance`,method:`10s each side, eyes open`,normal:`Stable without drift`}],abnormalHints:[`Ataxic (wide-based — cerebellar)`,`Steppage (peripheral neuropathy / foot drop)`,`Circumduction (UMN hemiparesis)`,`Scissoring`,`Romberg positive (dorsal column)`]},{name:`Frontal release / primitive reflexes`,steps:[{label:`Grasp reflex`,method:`Stroke palm`,normal:`Absent`},{label:`Snout reflex`,method:`Tap upper lip`,normal:`No lip pucker`},{label:`Glabellar tap`,method:`Tap between eyebrows — should habituate after 3–4 taps`,normal:`Habituates (no sustained blink)`},{label:`Palmomental`,method:`Stroke thenar eminence`,normal:`No ipsilateral chin twitch`}],abnormalHints:[`Presence suggests frontal lobe pathology, neurodegenerative disease, or severe TBI — rare in adolescence but relevant in post-concussion workup`]}]},resp:{overview:`Systematic respiratory exam: inspection → palpation → percussion → auscultation → special maneuvers. Always start from observation — rate, pattern, work of breathing, and audible sounds (stridor, grunting) can be diagnostic before the stethoscope touches the chest.`,components:[{name:`Inspection — observation before touching`,significance:`Detects respiratory distress and localises the level of airway compromise before any equipment is used. High yield: RR, WOB, audible sounds, chest shape, colour.`,pearl:`Audible stridor at rest from across the room = upper-airway obstruction, often urgent. Grunting in an infant = significant distress — never dismiss as fussiness.`,steps:[{label:`Respiratory rate`,method:`Count over a full 60 seconds (not 15×4) — children normally breathe irregularly. Count while the patient is calm, before any interaction.`,normal:`Within age-appropriate range (see scales card above)`},{label:`Respiratory pattern`,method:`Observe depth, regularity, and inspiration:expiration ratio. Watch for prolonged expiration, paradoxical chest-abdominal movement, or apneas.`,normal:`Regular, I:E ratio ~1:2, no pauses > 10 s in an infant`},{label:`Work of breathing`,method:`Inspect for nasal flaring, suprasternal/intercostal/subcostal retractions, accessory muscle use (SCM, abdominals), tripod positioning, head-bobbing in infants.`,normal:`No retractions; breathing effortless`},{label:`Audible sounds (no stethoscope)`,method:`Listen at the bedside without the stethoscope. Grunting? Stridor? Wheezing audible across the room? Hoarse voice?`,normal:`No audible stridor, grunting, or wheeze`},{label:`Chest shape and symmetry`,method:`Inspect from front and lateral. Note AP-to-transverse diameter, pectus excavatum/carinatum, chest wall asymmetry.`,normal:`AP:transverse ~1:2 (not barrel-chested); symmetric`},{label:`Colour and perfusion`,method:`Inspect lips, tongue, nail beds for central cyanosis. Check peripheral perfusion (capillary refill, mottling).`,normal:`Pink, cap refill < 2 s, no cyanosis`},{label:`Clubbing`,method:`Inspect fingernails: Schamroth sign (reverse a finger against its mirror — normal forms a diamond-shaped window, clubbed does not).`,normal:`Normal nail angle, Schamroth window present`}],abnormalHints:[`Audible stridor — upper airway (croup, epiglottitis, foreign body, laryngomalacia)`,`Grunting in infant — significant distress`,`Tripod positioning, accessory muscle use — severe distress`,`Barrel chest — chronic air-trapping (asthma, CF)`,`Central cyanosis — significant hypoxemia`,`Clubbing in a child — cystic fibrosis, chronic hypoxemia, bronchiectasis, cyanotic CHD`]},{name:`Palpation`,significance:`Localises pathology: consolidation increases tactile fremitus; pneumothorax/effusion decreases it. Trachea deviates AWAY from expanding lesions and TOWARD collapsing ones.`,pearl:`Tracheal deviation is one of the fastest bedside clues to mediastinal shift — tension pneumothorax pushes it away, lobar collapse pulls it toward. Palpate with the middle finger in the suprasternal notch.`,steps:[{label:`Tracheal position`,method:`Patient sitting upright, neck slightly extended. Place middle finger in the suprasternal notch, check equal distance to each SCM.`,normal:`Midline`},{label:`Chest expansion — symmetry`,method:`Hands on lateral chest wall with thumbs meeting at the spine (posterior) or xiphoid (anterior). Patient takes a deep breath. Watch thumbs separate symmetrically.`,normal:`Symmetric 3–5 cm separation`},{label:`Tactile fremitus`,method:`Ulnar surface of hand on chest wall. Ask patient to say "ninety-nine" repeatedly. Move hand systematically across each zone, comparing sides.`,normal:`Equal mild vibration bilaterally over lung fields`},{label:`Chest wall tenderness`,method:`Palpate ribs, costochondral junctions, sternum, and intercostal spaces.`,normal:`No tenderness`},{label:`Subcutaneous emphysema`,method:`Gentle palpation along clavicles, neck, chest wall.`,normal:`No crepitus under skin`}],abnormalHints:[`Tracheal deviation — tension pneumothorax, large pleural effusion (away); upper lobe collapse (toward)`,`Asymmetric expansion — pneumothorax, large effusion, lobar collapse, phrenic palsy`,`Increased fremitus — consolidation (pneumonia), lobar pneumonia`,`Decreased/absent fremitus — pleural effusion, pneumothorax, obstruction`,`Costochondral tenderness — costochondritis, trauma`,`Subcutaneous emphysema — pneumothorax, tracheobronchial injury`]},{name:`Percussion`,significance:`Differentiates air (hyper-resonant), fluid (dull), and consolidated lung (dull) without imaging. Well-performed percussion detects a pleural effusion > 300 mL or a pneumothorax with ~90% sensitivity.`,pearl:`Pleximeter fingertip must be flat against the chest wall — lift other fingers off. The "feel" of a percussion note is as informative as the sound: dullness has a dense, reflected quality; hyper-resonance feels hollow and springy.`,steps:[{label:`Technique`,method:`Place middle finger of non-dominant hand (pleximeter) flat on chest wall; strike distal IP joint with tip of dominant middle finger (plexor) using a quick wrist flick.`,normal:`N/A — technique step`},{label:`Systematic zones`,method:`Percuss from apex to base, comparing side-to-side at each level. Include anterior, lateral (mid-axillary), and posterior fields.`,normal:`Resonant throughout lung fields`},{label:`Cardiac dullness`,method:`Percuss from resonant lung toward the heart border. Left sternal border dullness starts at the 3rd–5th ICS.`,normal:`Dullness beginning at the expected cardiac border`},{label:`Hepatic dullness`,method:`Right 5th–6th ICS mid-clavicular line transitions from resonant to dull.`,normal:`Liver edge dullness at expected level`},{label:`Diaphragmatic excursion`,method:`Patient inhales fully then exhales fully; mark level of dullness at each end. Difference is diaphragm excursion.`,normal:`3–5 cm excursion bilaterally`}],abnormalHints:[`Hyper-resonant — pneumothorax, emphysematous bulla, severe asthma attack`,`Dull — consolidation, pleural effusion (stony dull), atelectasis, pleural thickening, large mass`,`Raised diaphragm (loss of excursion) — effusion, paralysis, subdiaphragmatic pathology`]},{name:`Auscultation — normal breath sounds`,significance:`Breath sound quality varies by location. Bronchial sounds heard peripherally = consolidation; absent breath sounds = pneumothorax, effusion, obstruction.`,pearl:`Always compare corresponding points side-to-side sequentially — your ear calibrates to "normal" one side and immediately hears asymmetry. Listen through a full respiratory cycle at each zone.`,steps:[{label:`Technique`,method:`Diaphragm of stethoscope directly on skin (not over clothing). Patient breathes slowly and deeply through an open mouth.`,normal:`N/A — technique`},{label:`Vesicular sounds (peripheral)`,method:`Listen over lung fields away from the sternum. Play the "Normal vesicular" sample above for reference.`,normal:`Soft, low-pitched, inspiration > expiration in length and loudness`},{label:`Bronchovesicular (over main bronchi)`,method:`Listen at the 1st–2nd ICS anteriorly and between scapulae posteriorly.`,normal:`Intermediate pitch, inspiration = expiration`},{label:`Bronchial (over trachea)`,method:`Listen directly over the manubrium or trachea.`,normal:`Harsh, high-pitched, expiration > inspiration`},{label:`Systematic comparison`,method:`Six zones anteriorly (upper/mid/lower × L/R), four lateral, six posterior. Compare side-to-side at each zone.`,normal:`Symmetric breath sounds at every paired zone`}],abnormalHints:[`Bronchial sounds heard peripherally — consolidation (pneumonia)`,`Absent/diminished breath sounds — pneumothorax, effusion, severe obstruction, obesity / muscular chest`,`Prolonged expiration — lower airway obstruction (asthma, bronchiolitis)`]},{name:`Auscultation — adventitious sounds`,significance:`Adventitious (added) sounds are the key diagnostic finding. Timing (inspiratory vs expiratory vs biphasic), character (continuous vs discontinuous), and location are all informative.`,pearl:`Ask the patient to cough and re-listen. Secretions (rhonchi, some coarse crackles) clear or change; fine crackles of fibrosis or early pneumonia do not. The cough test separates two differential groups in one maneuver.`,steps:[{label:`Listen for wheeze`,method:`Continuous musical sounds, typically expiratory. Use the "Wheeze" sample for reference.`,normal:`No wheeze`},{label:`Listen for crackles — fine`,method:`Short, high-pitched, discontinuous "Velcro" sounds. Typically end-inspiratory, bibasilar. Use the "Fine crackles" sample.`,normal:`No crackles`},{label:`Listen for crackles — coarse`,method:`Longer, lower-pitched, louder than fine. Use the "Coarse crackles" sample.`,normal:`No crackles`},{label:`Listen for rhonchi`,method:`Low-pitched, continuous, snore-like. Often change with cough. Use the "Rhonchi" sample.`,normal:`No rhonchi`},{label:`Listen for pleural rub`,method:`Grating, creaky, biphasic, does NOT clear with cough. Use the "Pleural rub" sample.`,normal:`No pleural rub`},{label:`Listen at the neck (for stridor)`,method:`Place stethoscope over the anterior neck. Stridor is loudest here and differentiates from wheeze (loudest over chest). Use the "Stridor" sample.`,normal:`No stridor`},{label:`Listen for expiratory grunting (infants)`,method:`Often audible without a stethoscope at the bedside — short, low-pitched sound at the end of each expiration (glottal closure against exhaled air).`,normal:`No grunting`},{label:`Cough re-listen`,method:`Have patient cough forcefully; re-listen to any abnormal area. Note if the sound clears or changes.`,normal:`Any secretion-based sound should clear or change with cough`}],abnormalHints:[`Wheeze — asthma, bronchiolitis, foreign body (localised), anaphylaxis`,`Fine crackles — pulmonary edema, interstitial lung disease, early pneumonia`,`Coarse crackles — bronchitis, pneumonia, bronchiectasis, aspiration`,`Rhonchi — large-airway secretions`,`Pleural rub — pleurisy, PE, pneumonia with pleural involvement`,`Stridor — upper airway obstruction (croup, epiglottitis, FB)`]},{name:`Special maneuvers — transmitted voice sounds`,significance:`Vocal resonance tests detect consolidation (increased transmission) and effusion/pneumothorax (decreased). Useful when auscultation suggests asymmetry.`,pearl:`Whispered pectoriloquy is the most sensitive of the three — whispered words transmitted clearly through consolidated lung. If "one, two, three" whispered becomes clearly audible over one lung zone, there is consolidation underneath.`,steps:[{label:`Bronchophony`,method:`Patient says "ninety-nine" in normal voice. Listen at each lung zone with the stethoscope.`,normal:`Muffled, indistinct sound`},{label:`Egophony`,method:`Patient says "ee" continuously. Listen over any suspicious area.`,normal:`"Ee" sounds like "ee" (no change)`},{label:`Whispered pectoriloquy`,method:`Patient whispers "one, two, three" or "ninety-nine". Listen over each zone.`,normal:`Whisper is faint and indistinct`}],abnormalHints:[`Bronchophony increased — consolidation`,`Egophony positive ("ee" → "A" / "ay") — consolidation, sometimes top of an effusion`,`Whispered pectoriloquy positive (whisper clearly audible) — consolidation`]}]},cv:{overview:`Systematic cardiovascular exam: inspection → palpation → auscultation at the five classic points → peripheral vascular exam. Always palpate the apex BEFORE auscultating — knowing where the apex lies tells you where to put the stethoscope and flags cardiomegaly immediately.`,components:[{name:`Inspection`,significance:`Detects obvious precordial activity, chest-wall signs of congenital heart disease, and systemic markers (cyanosis, clubbing, dysmorphic features).`,pearl:`Clubbing + central cyanosis in a well-appearing adolescent = cyanotic congenital heart disease until proven otherwise. Inspect the fingernails before reaching for the stethoscope.`,steps:[{label:`General appearance`,method:`Observe body habitus, features suggesting syndromic CHD (Turner, Down, Marfan, Williams).`,normal:`No dysmorphic features, appropriate growth`},{label:`Central cyanosis`,method:`Inspect lips, tongue, and oral mucosa for bluish discoloration.`,normal:`Pink oral mucosa, no cyanosis`},{label:`Peripheral cyanosis / clubbing`,method:`Inspect nail beds; do Schamroth's window (oppose nails of 4th fingers — normally forms a diamond-shaped window).`,normal:`Pink nail beds, Schamroth window present`},{label:`Precordial bulge`,method:`Inspect anterior chest wall tangentially for asymmetric prominence over the heart.`,normal:`Symmetric chest, no bulge`},{label:`Visible apex beat`,method:`Inspect for a visible cardiac impulse at the 5th ICS mid-clavicular line.`,normal:`Apex may be visible in thin patients; should not be displaced`},{label:`Neck veins (JVP)`,method:`Patient reclined 45°, head turned slightly left. Observe the right internal jugular pulsation; measure vertical height above the sternal angle.`,normal:`≤ 4 cm above sternal angle (≤ 9 cm H₂O from right atrium)`}],abnormalHints:[`Central cyanosis — right-to-left shunt, severe hypoxemia`,`Clubbing — cyanotic CHD, chronic hypoxemia`,`Precordial bulge — long-standing cardiomegaly (grew during skeletal growth)`,`Visible apex displaced lateral/inferior — cardiomegaly`,`Elevated JVP — right-heart failure, fluid overload, cardiac tamponade`]},{name:`Palpation`,significance:`Localises the apex (confirms cardiac size), detects thrills (loud murmurs), and identifies a parasternal heave (RV hypertrophy).`,pearl:`If you feel a thrill, the murmur is at least grade 4/6 — grade your murmur as ≥4 even if it sounds less impressive. Thrill = loud, palpable turbulence.`,steps:[{label:`Apex beat — localise`,method:`Feel with the tips of the fingers at the 5th ICS mid-clavicular line. If not found, roll the patient to the left lateral decubitus position.`,normal:`Located at 5th ICS, mid-clavicular line, less than 2 cm in diameter`},{label:`Apex character`,method:`Describe: tapping (normal), heaving (pressure overload, e.g. AS/HTN), thrusting (volume overload, e.g. AR/MR), dyskinetic (MI/aneurysm).`,normal:`Brief tapping quality`},{label:`Parasternal heave`,method:`Place the heel of the hand along the left sternal border. Sustained outward movement with each systole = heave.`,normal:`No heave`},{label:`Thrills`,method:`Use the palmar aspect of the hand at each of the 5 auscultation areas (A, P, E, T, M). A thrill = palpable turbulence.`,normal:`No thrills`},{label:`Peripheral pulses — upper`,method:`Palpate radial pulses bilaterally, then brachial. Note rate, rhythm, volume, and symmetry.`,normal:`Symmetric 2+ pulses, regular rhythm, age-appropriate rate`},{label:`Peripheral pulses — lower`,method:`Palpate femoral pulses. Compare to brachial — radio-femoral or brachio-femoral delay suggests coarctation of the aorta.`,normal:`Femoral pulses 2+ symmetric, no delay relative to radial`}],abnormalHints:[`Apex displaced laterally/inferiorly — cardiomegaly`,`Heaving apex — pressure overload (AS, HTN)`,`Thrusting apex — volume overload (AR, MR)`,`Thrill over precordium — always pathological; at least grade 4/6 murmur`,`Parasternal heave — RV hypertrophy (pulmonary HTN, pulmonary stenosis, VSD with Eisenmenger)`,`Radio-femoral delay — coarctation of the aorta (always check in a hypertensive adolescent)`]},{name:`Auscultation — approach`,significance:`Systematic technique ensures every relevant finding is detected. Listen at all 5 points, with both diaphragm and bell, in supine/sitting/left-lateral positions as needed.`,pearl:`Time every murmur by simultaneously palpating the carotid pulse with the fingers of your free hand. Pulse = systole. Murmur heard during the pulse = systolic; in between pulses = diastolic.`,steps:[{label:`Positioning`,method:`Patient supine, head of bed at 30°. Exam room quiet, patient relaxed. Warm the stethoscope first.`,normal:`N/A — technique`},{label:`Diaphragm technique`,method:`Firm contact with skin. Detects HIGH-pitched sounds: S1, S2, systolic ejection murmurs, AR, MR.`,normal:`N/A — technique`},{label:`Bell technique`,method:`Very light contact — enough to make a seal but not stretch the skin. Detects LOW-pitched sounds: S3, S4, mitral stenosis rumble.`,normal:`N/A — technique`},{label:`Listen at each of the 5 points`,method:`A → P → E → T → M in order, each with diaphragm then bell. Spend a full cycle at each zone.`,normal:`S1 crisp, S2 clear (splits physiologically on inspiration at P), no added sounds, no murmur`},{label:`Left lateral decubitus position`,method:`If apex murmur suspected. Roll patient to left side. Listen at the apex with the BELL for mitral stenosis rumble or S3/S4.`,normal:`No added sounds, no diastolic rumble`},{label:`Sitting forward, held expiration`,method:`Patient leans forward, exhales fully, holds. Listen at left lower sternal border and Erb's point with the DIAPHRAGM for aortic regurgitation (soft early diastolic decrescendo).`,normal:`No early-diastolic murmur`}],abnormalHints:[`Fixed split S2 (no change with respiration) — ASD`,`Loud S2 at pulmonic area — pulmonary HTN`,`S3 — volume overload, CHF (can be normal in young athletes)`,`S4 — stiff ventricle (HTN, HCM, ischemia)`,`Audible opening snap — mitral stenosis (rare in children)`]},{name:`Auscultation — heart sounds and murmurs`,significance:`Characterising a murmur by timing, location, radiation, pitch, quality, and dynamic maneuvers narrows the differential.`,pearl:`Innocent murmurs in children share 7 "S" features: Soft (≤ grade 2), Systolic, Short, Single (no added S3/S4), Small (localised, non-radiating), Sweet (musical), Sensitive to position/respiration (louder supine, softer standing). Anything breaking this pattern deserves workup.`,steps:[{label:`S1`,method:`Listen at the apex (mitral). Coincides with the carotid pulse upstroke. Mitral + tricuspid closure.`,normal:`Single, crisp, single-component sound`},{label:`S2`,method:`Listen at the pulmonic area in HELD INSPIRATION and HELD EXPIRATION. Note whether S2 splits physiologically (wider in inspiration, narrower/absent in expiration).`,normal:`Physiologic split (widens on inspiration, narrows on expiration)`},{label:`S3 / S4 gallops`,method:`Bell at the apex in left lateral decubitus. S3 = early diastole (after S2), low-pitched. S4 = late diastole (just before S1).`,normal:`Absent in adults; S3 can be normal in young athletes under age 30`},{label:`Identify murmur — timing`,method:`Time vs carotid pulse. Systolic (during pulse) vs diastolic (between pulses) vs continuous.`,normal:`No murmur, or only soft innocent flow murmur`},{label:`Identify murmur — location + radiation`,method:`Where loudest? Does it radiate? AS → carotids. MR → axilla. Coarctation → back.`,normal:`N/A — characterise only if murmur present`},{label:`Identify murmur — character`,method:`Crescendo-decrescendo (ejection) vs holosystolic (plateau) vs decrescendo early-diastolic (AR, PR) vs mid-diastolic rumble (MS, TS).`,normal:`N/A — characterise only if murmur present`},{label:`Grade intensity`,method:`Levine 1–6 scale (see scales card above).`,normal:`No murmur, or grade ≤ 2 soft innocent flow murmur`},{label:`Dynamic maneuvers`,method:`Standing: ↑HOCM, ↑MVP click (earlier). Squatting: opposite. Valsalva: ↑HOCM, most others decrease.`,normal:`No significant change with posture`}],abnormalHints:[`Holosystolic murmur at apex → axilla — mitral regurgitation`,`Holosystolic at lower left sternal border (LLSB) — VSD, tricuspid regurgitation`,`Systolic ejection at upper right sternal border → carotids — aortic stenosis`,`Systolic ejection at upper left sternal border — pulmonary stenosis`,`Continuous "machinery" below left clavicle — PDA`,`Early diastolic at Erb's point, leaning forward — aortic regurgitation`,`Diastolic rumble at apex, bell in left-lateral — mitral stenosis`,`Fixed split S2 + systolic flow murmur — ASD`]},{name:`Peripheral vascular exam`,significance:`Coarctation of the aorta hides until BP and pulses are checked in all four extremities. Differential diagnosis of a hypertensive adolescent should include this in the first 60 seconds.`,pearl:`Four-limb BP measurement is mandatory in any adolescent with hypertension or a murmur. Upper-extremity BP > lower-extremity BP (or brachio-femoral delay) = coarctation until excluded.`,steps:[{label:`Four-limb blood pressure`,method:`Measure BP in right arm, left arm, and at least one leg. Use appropriately sized cuff (bladder width 40% of limb circumference, length 80–100%).`,normal:`Arm BPs within 10 mmHg of each other; leg systolic within 20 mmHg of arm systolic (may be higher)`},{label:`Radial pulses`,method:`Palpate both radials simultaneously — note any delay or asymmetry.`,normal:`Simultaneous, symmetric, 2+`},{label:`Radio-femoral delay`,method:`Palpate radial and femoral simultaneously. Feel the femoral as clearly "after" the radial = delay.`,normal:`No delay`},{label:`Femoral pulses`,method:`Palpate both femoral pulses at the mid-inguinal point. Compare amplitude to radials.`,normal:`Symmetric 2+ pulses, equal amplitude to radial`},{label:`Dorsalis pedis + posterior tibialis`,method:`Palpate in both feet.`,normal:`2+ pulses bilaterally`},{label:`Capillary refill`,method:`Press and release the nail bed; time to normal colour.`,normal:`< 2 sec`}],abnormalHints:[`Asymmetric upper-extremity BP (> 10 mmHg) — subclavian stenosis or coarctation at the origin`,`Upper >> lower-extremity BP — coarctation of the aorta`,`Diminished or absent femoral pulses with brachio-femoral delay — coarctation`,`Bounding pulses with wide pulse pressure — AR, PDA, arteriovenous fistula, thyrotoxicosis, anemia`,`Weak thready pulses — low output state (heart failure, shock, hypovolemia)`,`Prolonged capillary refill — dehydration, shock, cold stress`]}]}}},u={mrc:{title:`MRC strength grade (0–5)`,icon:`fa-hand-fist`,rows:[[`5`,`Normal power — holds against full resistance`],[`4`,`Reduced — moves against gravity + some resistance`],[`3`,`Moves against gravity only (no added resistance)`],[`2`,`Full range with gravity eliminated (horizontal plane)`],[`1`,`Flicker / trace contraction, no joint movement`],[`0`,`No contraction`]]},dtr:{title:`Deep-tendon reflex grade (0–4+)`,icon:`fa-circle-dot`,rows:[[`0`,`Absent`],[`1+`,`Hypoactive — trace, only with reinforcement`],[`2+`,`Normal`],[`3+`,`Brisk — may still be normal in anxious patients`],[`4+`,`Hyperactive with sustained clonus — always abnormal`]]},plantar:{title:`Plantar response (Babinski)`,icon:`fa-shoe-prints`,rows:[[`Down-going`,`Normal in anyone ≥ 2 years`],[`Up-going`,`Normal < 2 years; abnormal after — UMN lesion`],[`Asymmetric`,`Always abnormal at any age`]]},beighton:{title:`Beighton hypermobility score (0–9)`,icon:`fa-hands`,rows:[[`≤ 3`,`Normal flexibility`],[`4`,`Borderline — consider in context`],[`≥ 5`,`Hypermobility spectrum; screen for hEDS if other features present`]]},atr:{title:`Scoliometer — angle of trunk rotation`,icon:`fa-ruler`,rows:[[`< 5°`,`Normal, no follow-up`],[`5–6°`,`Borderline — re-check at each visit`],[`≥ 7°`,`Refer for PA/lateral spine x-ray + orthopedic evaluation`]]},rr:{title:`Respiratory rate — upper limit by age (awake)`,icon:`fa-lungs`,rows:[[`Newborn`,`≤ 60 /min`],[`< 2 months`,`≤ 60 /min (WHO tachypnea cutoff)`],[`2–12 months`,`≤ 50 /min (WHO tachypnea cutoff)`],[`1–5 years`,`≤ 40 /min (WHO tachypnea cutoff)`],[`6–11 years`,`≤ 30 /min`],[`≥ 12 years`,`≤ 20 /min (adult pattern)`]]},spo2:{title:`Pulse oximetry (SpO₂) — at room air`,icon:`fa-heart-pulse`,rows:[[`≥ 95%`,`Normal`],[`92–94%`,`Mild hypoxemia — investigate cause`],[`< 92%`,`Moderate hypoxemia — supplemental O₂`],[`< 88%`,`Severe — urgent intervention; target ≥ 90% acutely`]]},silverman:{title:`Silverman–Andersen retraction score (neonatal, 0–10)`,icon:`fa-baby`,rows:[[`0`,`No respiratory distress`],[`1–3`,`Mild — close observation`],[`4–6`,`Moderate distress — consider CPAP / support`],[`7–10`,`Severe — imminent respiratory failure, intubate`]]},westley:{title:`Westley croup severity score`,icon:`fa-stethoscope`,rows:[[`≤ 2`,`Mild — home management, cool mist, oral dexamethasone`],[`3–5`,`Moderate — nebulised epinephrine + dexamethasone`],[`6–11`,`Severe — admit, continuous monitoring`],[`≥ 12`,`Impending respiratory failure — ICU / airway management`]]},murmurGrade:{title:`Heart-murmur grading (Levine 1–6)`,icon:`fa-wave-square`,rows:[[`1/6`,`Very faint — heard only with concentration`],[`2/6`,`Soft but readily heard`],[`3/6`,`Moderately loud, no thrill`],[`4/6`,`Loud WITH a palpable thrill`],[`5/6`,`Very loud; audible with stethoscope just off the chest`],[`6/6`,`Audible without the stethoscope touching the chest`]]},pulseAmp:{title:`Pulse amplitude grade (0–4)`,icon:`fa-heart-pulse`,rows:[[`0`,`Absent`],[`1+`,`Diminished, thready`],[`2+`,`Normal`],[`3+`,`Bounding`],[`4+`,`Bounding with visible pulsation (e.g., aortic regurgitation)`]]},capRefill:{title:`Capillary refill time`,icon:`fa-hand`,rows:[[`< 2 sec`,`Normal`],[`2–3 sec`,`Borderline — consider hydration / perfusion`],[`≥ 3 sec`,`Delayed — dehydration, shock, low cardiac output`]]}},d={msk:[`atr`,`beighton`],neuro:[`mrc`,`dtr`,`plantar`],resp:[`rr`,`spo2`,`silverman`,`westley`],cv:[`murmurGrade`,`pulseAmp`,`capRefill`]},f=[{letter:`A`,color:`#dc2626`,title:`Aortic area`,location:`2nd ICS, right sternal border`,listen:`S2 (aortic component), aortic stenosis, aortic regurgitation`},{letter:`P`,color:`#2563eb`,title:`Pulmonic area`,location:`2nd ICS, left sternal border`,listen:`S2 (pulmonic component), pulmonic stenosis, PDA, physiologic split of S2`,innocent:`Pulmonary flow murmur (children, adolescents) — upper left sternal border`},{letter:`E`,color:`#059669`,title:`Erb's point`,location:`3rd ICS, left sternal border`,listen:`Aortic regurgitation (best here), transitional zone murmurs`,innocent:`Still's murmur classically radiates to Erb's / LLSB`},{letter:`T`,color:`#d97706`,title:`Tricuspid area`,location:`4th–5th ICS, lower left sternal border`,listen:`Tricuspid regurgitation, VSD, S3/S4, holosystolic murmurs`,innocent:`Still's murmur — vibratory, musical, age 3–7 y (loudest between LLSB and apex)`},{letter:`M`,color:`#7c3aed`,title:`Mitral area (apex)`,location:`5th ICS, mid-clavicular line`,listen:`S1, mitral regurgitation, mitral stenosis (with bell, left-lateral decubitus)`}],p=[{name:`Still's (vibratory) murmur`,age:`3–7 y (most common in children)`,location:`LLSB, radiating to apex`,character:`Low-frequency vibratory / musical systolic, grade 2–3/6, mid-systolic, "twanging-string" quality`,confirm:`Louder supine, softer or disappears on standing or Valsalva. No radiation to neck/back. Normal S2.`},{name:`Pulmonary flow murmur`,age:`School-age and adolescents, thin chest`,location:`Upper left sternal border (2nd–3rd ICS)`,character:`Soft blowing early systolic ejection, grade 1–2/6, higher-pitched`,confirm:`No ejection click. Physiologic split of S2. Louder supine, softer on standing. No radiation.`},{name:`Venous hum`,age:`Ages 3–8, disappears by adolescence`,location:`Supraclavicular or infraclavicular area, usually right`,character:`Soft continuous hum, louder in diastole. Only innocent continuous murmur.`,confirm:`Disappears when supine OR when jugular vein is gently compressed (key maneuver). Turning head to opposite side also alters it.`},{name:`Carotid bruit / supraclavicular bruit`,age:`Children and adolescents`,location:`Supraclavicular fossa, right > left; may radiate to carotid`,character:`Brief early systolic, grade 2–3/6, higher-pitched than Still's`,confirm:`Softer or disappears with hyperextension of the shoulders. Normal cardiac exam otherwise. No radiation below the clavicles.`},{name:`Peripheral pulmonary stenosis (PPS, neonatal)`,age:`Newborns and infants < 6–12 months`,location:`Upper LSB, radiates to BOTH axillae and the back`,character:`Soft systolic ejection murmur, grade 1–2/6`,confirm:`Typical age + radiation to back/axillae. Resolves by age 1 as branch pulmonary arteries grow. Persistence or louder grade warrants echo.`}],m=[{key:`normal`,src:`/audio/respiratory/normal-vesicular.ogg`,title:`Normal vesicular breath sounds`,where:`Peripheral lung fields`,features:`Soft, rustling. Inspiration louder and longer than expiration.`,clinical:`Baseline — deviation elsewhere is what you listen for.`},{key:`wheeze`,src:`/audio/respiratory/wheeze.ogg`,title:`Wheeze`,where:`Diffuse in asthma; localised in foreign body`,features:`Continuous, high-pitched, musical. Usually expiratory; biphasic if severe.`,clinical:`Lower-airway narrowing — asthma, bronchiolitis, foreign body, bronchomalacia. 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Does NOT clear with cough.`,clinical:`Pleural inflammation — pleuritis, pulmonary embolism, pneumonia with pleural involvement, viral pleurisy.`}],h=[{key:`normal`,src:`/audio/cardiac/normal.ogg`,title:`Normal heart sounds (S1, S2)`,where:`All four classic auscultation points`,rate:`~61 bpm reference`,features:`"lub-dub": S1 (closure of mitral + tricuspid) louder at apex; S2 (closure of aortic + pulmonic) louder at base. Physiologic S2 split on inspiration.`,clinical:`Reference for rhythm, rate, and the normal S1–S2 interval. Listen for what's changed — not just what's added.`},{key:`infant-normal`,src:`/audio/cardiac/infant-normal.ogg`,title:`Infant normal heart sounds`,where:`Infant chest — rate will be higher than adult`,rate:`Pediatric reference (120–160 bpm range)`,features:`Same S1–S2 pattern, faster rate. Short diastole makes murmurs easier to miss — careful auscultation needed.`,clinical:`Reference for neonatal/infant rhythm. Any murmur in the first 72 h should prompt pre/postductal sat screening.`},{key:`vsd`,src:`/audio/cardiac/vsd.wav`,title:`Ventricular septal defect (VSD)`,where:`Lower left sternal border (4th ICS)`,features:`Harsh, blowing, holosystolic (pansystolic) murmur — plateau shape through all of systole. Often accompanied by a thrill if large.`,clinical:`Most common congenital heart defect. Small VSD: loud murmur, usually asymptomatic, may close spontaneously. Large VSD: softer murmur (less pressure gradient) but signs of heart failure, pulmonary hypertension.`},{key:`mvp`,src:`/audio/cardiac/mitral-prolapse.wav`,title:`Mitral valve prolapse (MVP) — click + late systolic murmur`,where:`Apex (5th ICS, mid-clavicular line)`,features:`Mid-systolic click followed by a late-systolic crescendo murmur. Timing of click changes with maneuvers: earlier with standing or Valsalva, later with squatting.`,clinical:`Often benign, especially in thin young women. 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gap-3`,children:R.components.map((t,r)=>(0,g.jsx)(E,{age:e,sys:n,idx:r,comp:t,getStatus:e=>N[e]??null,setStatus:(e,t)=>P(n=>({...n,[e]:t}))},r))})]}),(0,g.jsxs)(`section`,{className:_,"data-testid":`pe-generate`,children:[(0,g.jsx)(`h2`,{className:`text-lg font-semibold`,children:`Generate Exam Report`}),(0,g.jsx)(`p`,{className:`text-sm text-muted-foreground`,children:`Uses the statuses above + optional patient context.`}),(0,g.jsxs)(`div`,{className:`grid grid-cols-1 md:grid-cols-3 gap-3`,children:[(0,g.jsx)(`input`,{className:x,placeholder:`Patient age (e.g. 3y)`,value:D,onChange:e=>O(e.target.value)}),(0,g.jsx)(`input`,{className:x,placeholder:`Patient gender (optional)`,value:k,onChange:e=>A(e.target.value)}),(0,g.jsxs)(`select`,{className:x,value:j,onChange:e=>M(e.target.value),children:[(0,g.jsx)(`option`,{value:`narrative`,children:`Narrative`}),(0,g.jsx)(`option`,{value:`list`,children:`List`})]})]}),(0,g.jsxs)(`div`,{className:`flex items-center gap-3`,children:[(0,g.jsx)(`button`,{type:`button`,className:y,onClick:U,disabled:z.isPending||W===0,"data-testid":`btn-pe-generate`,children:z.isPending?`Generating…`:`Generate Exam Report`}),W===0&&(0,g.jsx)(`span`,{className:`text-xs text-muted-foreground`,children:`Mark at least one step before generating.`})]}),F&&(0,g.jsx)(`div`,{className:`rounded-md border border-border bg-muted/40 p-3 whitespace-pre-wrap text-sm`,"data-testid":`pe-narrative`,children:F})]})]})}export{D as default}; \ No newline at end of file diff --git a/public/app/assets/Recorder-DdXTjnSC.js b/public/app/assets/Recorder-DdXTjnSC.js new file mode 100644 index 0000000..8937d7f --- /dev/null +++ b/public/app/assets/Recorder-DdXTjnSC.js @@ -0,0 +1 @@ +import{i as e,n as t,t as n}from"./jsx-runtime-ByY1xr43.js";var r=e(t(),1),i=class{mediaRecorder=null;chunks=[];stream=null;start(){return this.chunks=[],navigator.mediaDevices.getUserMedia({audio:{channelCount:1,sampleRate:16e3,echoCancellation:!0,noiseSuppression:!0}}).then(e=>{this.stream=e;let t=MediaRecorder.isTypeSupported(`audio/webm;codecs=opus`)?`audio/webm;codecs=opus`:`audio/webm`;this.mediaRecorder=new MediaRecorder(e,{mimeType:t,audioBitsPerSecond:32e3}),this.mediaRecorder.ondataavailable=e=>{e.data.size>0&&this.chunks.push(e.data)},this.mediaRecorder.start(1e3)})}stop(){return new Promise(e=>{if(!this.mediaRecorder||this.mediaRecorder.state===`inactive`){e(null);return}this.mediaRecorder.onstop=()=>{let t=new Blob(this.chunks,{type:this.mediaRecorder.mimeType});this.stream&&this.stream.getTracks().forEach(e=>e.stop()),e(t)},this.mediaRecorder.stop()})}pause(){if(this.mediaRecorder&&typeof this.mediaRecorder.pause==`function`&&this.mediaRecorder.state===`recording`)try{this.mediaRecorder.pause()}catch{}}resume(){if(this.mediaRecorder)try{if(typeof this.mediaRecorder.resume==`function`&&this.mediaRecorder.state===`paused`)this.mediaRecorder.resume();else if(this.mediaRecorder.state===`inactive`&&this.stream&&this.stream.active){let e=MediaRecorder.isTypeSupported(`audio/webm;codecs=opus`)?`audio/webm;codecs=opus`:`audio/webm`;this.mediaRecorder=new MediaRecorder(this.stream,{mimeType:e,audioBitsPerSecond:32e3}),this.mediaRecorder.ondataavailable=e=>{e.data.size>0&&this.chunks.push(e.data)},this.mediaRecorder.start(1e3)}}catch{}}},a=null;async function o(){try{let e=await(await fetch(`/api/transcribe/status`,{credentials:`include`})).json();a=!!e.available,e.provider}catch{a=!1}}function s(){return a}async function c(e,t=`encounter`){if(a===null&&await o(),a===!1)return{success:!1,noProvider:!0,error:`No transcription API configured — using live transcript`};let n=new FormData;n.append(`audio`,e,`audio.webm`);try{let r=await(await 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a=n.transaction(d,`readwrite`).objectStore(d).add({blob:e,module:t,timestamp:Date.now(),size:e.size,mimeType:e.type});a.onsuccess=()=>r(a.result),a.onerror=()=>i(Error(`Failed to save audio backup`))})).catch(()=>null)}var h=`ped_web_speech_enabled`;function g(){if(typeof window>`u`)return null;let e=window;return e.SpeechRecognition||e.webkitSpeechRecognition||null}function _(){try{return localStorage.getItem(h)===`1`||localStorage.getItem(h)===`true`}catch{return!1}}function v(e){let t=g();if(!t)return null;let n=null,r=!1;function i(){let n=new t;return n.continuous=!0,n.interimResults=!0,n.lang=`en-US`,n.maxAlternatives=1,n.onresult=t=>{let n=``;for(let r=t.resultIndex;r{t.error===`no-speech`||t.error===`aborted`||e.onError?.(t.error)},n.onend=()=>{if(r)try{n.start()}catch{}},n}return{start:()=>{r=!0,n=i();try{n.start()}catch{}},stop:()=>{if(r=!1,n)try{n.stop()}catch{}}}}function y(e,t){if(!e||!t)return e;let n=e.trim();if(!n||t.trimEnd().endsWith(n))return``;let r=n.split(/\s+/);if(r.length>=3){if(t.trimEnd().split(/\s+/).slice(-r.length).join(` `)===n)return``;let e=Math.ceil(r.length/2),i=r.slice(0,e).join(` `);if(t.trimEnd().endsWith(i))return r.slice(e).join(` `)+` `}return e}var b=n(),x=`inline-flex items-center gap-2 px-4 py-2 rounded-md text-sm font-semibold border transition-colors`;function S({module:e,onTranscript:t,onInterim:n,onError:a,disabled:l}){let u=(0,r.useRef)(null),d=(0,r.useRef)(null),f=(0,r.useRef)(``),p=(0,r.useRef)(null),m=(0,r.useRef)(0),h=(0,r.useRef)(0),g=(0,r.useRef)(0),[S,C]=(0,r.useState)(`idle`),[w,T]=(0,r.useState)(0);(0,r.useEffect)(()=>{s()===null&&o()},[]),(0,r.useEffect)(()=>()=>{p.current&&window.clearInterval(p.current),d.current&&d.current.stop(),u.current&&u.current.stop().catch(()=>{})},[]);function E(){p.current&&window.clearInterval(p.current),p.current=window.setInterval(()=>{T(Math.floor((Date.now()-m.current-h.current)/1e3))},1e3)}function D(){p.current&&=(window.clearInterval(p.current),null)}async function O(){if(S===`idle`){f.current=``,h.current=0,T(0);try{let e=new i;if(await e.start(),u.current=e,m.current=Date.now(),E(),C(`recording`),_()){let e=v({onFinal:e=>{let t=y(e,f.current);f.current+=t,n?.(f.current)},onInterim:e=>n?.(f.current+e),onError:()=>{}});d.current=e,e?.start()}}catch{a?.(`Microphone permission denied`),C(`idle`)}}}function k(){S===`recording`&&(u.current?.pause(),d.current?.stop(),g.current=Date.now(),D(),C(`paused`))}function A(){S===`paused`&&(u.current?.resume(),h.current+=Date.now()-g.current,E(),_()&&!d.current&&(d.current=v({onFinal:e=>{let t=y(e,f.current);f.current+=t,n?.(f.current)},onInterim:e=>n?.(f.current+e)})),d.current?.start(),C(`recording`))}async function j(){if(S!==`recording`&&S!==`paused`)return;let n=f.current.trim();d.current?.stop(),d.current=null,D();let r=w;C(`transcribing`);try{let i=await u.current.stop();if(u.current=null,!i||i.size===0){n&&t(n,{durationSec:r,appended:!0}),C(`idle`);return}if(i.size>24*1024*1024){a?.(`Recording too large for AI transcription — using live transcript`),n&&t(n,{durationSec:r,appended:!0}),C(`idle`);return}let o=await c(i,e);o.success&&o.text?t(o.text,{provider:o.provider,durationSec:r,appended:!1}):o.noProvider?n?t(n,{durationSec:r,appended:!0}):a?.(`No transcription API configured`):n?t(n,{durationSec:r,appended:!0}):a?.(o.error||`Transcription failed`)}catch(e){a?.(e.message)}finally{C(`idle`)}}let M=String(Math.floor(w/60)).padStart(2,`0`),N=String(w%60).padStart(2,`0`);return(0,b.jsxs)(`div`,{className:`flex flex-wrap items-center gap-2`,"data-testid":`recorder-`+e,children:[S===`idle`&&(0,b.jsx)(`button`,{type:`button`,onClick:O,disabled:l,className:x+` bg-destructive text-white border-destructive hover:bg-red-700`,"data-testid":`recorder-start`,children:`🎙 Start recording`}),(S===`recording`||S===`paused`)&&(0,b.jsxs)(b.Fragment,{children:[(0,b.jsx)(`button`,{type:`button`,onClick:S===`recording`?k:A,className:x+` bg-amber-500 text-white border-amber-500 hover:bg-amber-600`,"data-testid":`recorder-pause`,children:S===`recording`?`⏸ Pause`:`▶ Resume`}),(0,b.jsx)(`button`,{type:`button`,onClick:j,className:x+` bg-slate-800 text-white border-slate-800 hover:bg-slate-900`,"data-testid":`recorder-stop`,children:`⏹ Stop`}),(0,b.jsxs)(`span`,{className:`inline-flex items-center gap-1.5 text-sm text-destructive font-mono`,"data-testid":`recorder-timer`,children:[(0,b.jsx)(`span`,{className:S===`recording`?`animate-pulse`:`opacity-50`,children:`●`}),S===`paused`?`paused `:``,M,`:`,N]})]}),S===`transcribing`&&(0,b.jsx)(`span`,{className:`text-sm text-muted-foreground`,"data-testid":`recorder-transcribing`,children:`⌛ Transcribing…`})]})}export{S as t}; \ No newline at end of file diff --git a/public/app/assets/ResetPassword-pLQAcaAT.js b/public/app/assets/ResetPassword-CVgOn7wd.js similarity index 97% rename from public/app/assets/ResetPassword-pLQAcaAT.js rename to public/app/assets/ResetPassword-CVgOn7wd.js index f18ef8a..3e7f010 100644 --- a/public/app/assets/ResetPassword-pLQAcaAT.js +++ b/public/app/assets/ResetPassword-CVgOn7wd.js @@ -1 +1 @@ -import{i as e,n as t,t as n}from"./jsx-runtime-ByY1xr43.js";import{i as r,o as i,s as a}from"./index-BuU36CvS.js";var o=e(t(),1),s=n(),c=`rounded-2xl border border-border bg-card p-6 shadow-lg space-y-4 w-full max-w-md`,l=`w-full rounded-md bg-primary text-primary-foreground px-4 py-3 text-sm font-semibold disabled:opacity-60`,u=`w-full rounded-md border border-input bg-background px-3 py-2.5 text-sm outline-none focus:ring-2 focus:ring-ring`,d=`block text-xs font-semibold text-muted-foreground mb-1`,f=`rounded-md bg-green-50 dark:bg-green-950/30 border border-green-200 dark:border-green-900 p-3 text-sm text-green-800 dark:text-green-100`,p=`rounded-md bg-red-50 dark:bg-red-950/30 border border-red-200 dark:border-red-900 p-3 text-sm text-red-800 dark:text-red-100`,m=`rounded-md bg-amber-50 dark:bg-amber-950/30 border border-amber-200 dark:border-amber-900 p-3 text-sm text-amber-900 dark:text-amber-100`;function h(){let[e]=a(),t=i(),n=e.get(`token`)||``,[h,g]=(0,o.useState)(``),[_,v]=(0,o.useState)(``),[y,b]=(0,o.useState)(``),[x,S]=(0,o.useState)(``),[C,w]=(0,o.useState)(``),[T,E]=(0,o.useState)(!1);async function D(e){if(e.preventDefault(),b(``),S(``),w(``),!n){b(`Missing reset token. Open the reset link from your email.`);return}if(h.length<8){b(`Password must be 8+ characters`);return}if(h!==_){b(`Passwords do not match`);return}E(!0);try{let e=await r.post(`/api/auth/reset-password`,{token:n,newPassword:h});S(`Password reset. You can now sign in.`),e.passwordWarning&&w(e.passwordWarning),setTimeout(()=>t(`/auth`,{replace:!0}),2500)}catch(e){b(e.message||`Reset failed. The link may have expired.`)}finally{E(!1)}}return(0,s.jsx)(`div`,{className:`min-h-screen bg-gradient-to-br from-blue-50 via-white to-indigo-50 dark:from-slate-900 dark:via-slate-950 dark:to-slate-900 flex items-center justify-center p-4`,children:(0,s.jsxs)(`div`,{className:c,children:[(0,s.jsxs)(`header`,{className:`text-center space-y-1`,children:[(0,s.jsx)(`div`,{className:`text-4xl`,children:`🔑`}),(0,s.jsx)(`h1`,{className:`text-xl font-bold`,children:`Set a new password`}),(0,s.jsx)(`p`,{className:`text-xs text-muted-foreground`,children:`Choose a password at least 8 characters long.`})]}),y&&(0,s.jsx)(`div`,{className:p,children:y}),x&&(0,s.jsx)(`div`,{className:f,children:x}),C&&(0,s.jsx)(`div`,{className:m,children:C}),(0,s.jsxs)(`form`,{onSubmit:D,className:`space-y-3`,"data-testid":`reset-password-form`,children:[(0,s.jsxs)(`div`,{children:[(0,s.jsx)(`label`,{className:d,children:`New password`}),(0,s.jsx)(`input`,{type:`password`,required:!0,minLength:8,className:u,value:h,onChange:e=>g(e.target.value),autoFocus:!0,"data-testid":`reset-new`})]}),(0,s.jsxs)(`div`,{children:[(0,s.jsx)(`label`,{className:d,children:`Confirm new password`}),(0,s.jsx)(`input`,{type:`password`,required:!0,minLength:8,className:u,value:_,onChange:e=>v(e.target.value),"data-testid":`reset-confirm`})]}),(0,s.jsx)(`button`,{type:`submit`,className:l,disabled:T||!n,"data-testid":`reset-submit`,children:T?`Resetting…`:`Reset password`})]})]})})}export{h as default}; \ No newline at end of file +import{i as e,n as t,t as n}from"./jsx-runtime-ByY1xr43.js";import{i as r,o as i,s as a}from"./index-C9wKWOAN.js";var o=e(t(),1),s=n(),c=`rounded-2xl border border-border bg-card p-6 shadow-lg space-y-4 w-full max-w-md`,l=`w-full rounded-md bg-primary text-primary-foreground px-4 py-3 text-sm font-semibold disabled:opacity-60`,u=`w-full rounded-md border border-input bg-background px-3 py-2.5 text-sm outline-none focus:ring-2 focus:ring-ring`,d=`block text-xs font-semibold text-muted-foreground mb-1`,f=`rounded-md bg-green-50 dark:bg-green-950/30 border border-green-200 dark:border-green-900 p-3 text-sm text-green-800 dark:text-green-100`,p=`rounded-md bg-red-50 dark:bg-red-950/30 border border-red-200 dark:border-red-900 p-3 text-sm text-red-800 dark:text-red-100`,m=`rounded-md bg-amber-50 dark:bg-amber-950/30 border border-amber-200 dark:border-amber-900 p-3 text-sm text-amber-900 dark:text-amber-100`;function h(){let[e]=a(),t=i(),n=e.get(`token`)||``,[h,g]=(0,o.useState)(``),[_,v]=(0,o.useState)(``),[y,b]=(0,o.useState)(``),[x,S]=(0,o.useState)(``),[C,w]=(0,o.useState)(``),[T,E]=(0,o.useState)(!1);async function D(e){if(e.preventDefault(),b(``),S(``),w(``),!n){b(`Missing reset token. Open the reset link from your email.`);return}if(h.length<8){b(`Password must be 8+ characters`);return}if(h!==_){b(`Passwords do not match`);return}E(!0);try{let e=await r.post(`/api/auth/reset-password`,{token:n,newPassword:h});S(`Password reset. You can now sign in.`),e.passwordWarning&&w(e.passwordWarning),setTimeout(()=>t(`/auth`,{replace:!0}),2500)}catch(e){b(e.message||`Reset failed. The link may have expired.`)}finally{E(!1)}}return(0,s.jsx)(`div`,{className:`min-h-screen bg-gradient-to-br from-blue-50 via-white to-indigo-50 dark:from-slate-900 dark:via-slate-950 dark:to-slate-900 flex items-center justify-center p-4`,children:(0,s.jsxs)(`div`,{className:c,children:[(0,s.jsxs)(`header`,{className:`text-center space-y-1`,children:[(0,s.jsx)(`div`,{className:`text-4xl`,children:`🔑`}),(0,s.jsx)(`h1`,{className:`text-xl font-bold`,children:`Set a new password`}),(0,s.jsx)(`p`,{className:`text-xs text-muted-foreground`,children:`Choose a password at least 8 characters long.`})]}),y&&(0,s.jsx)(`div`,{className:p,children:y}),x&&(0,s.jsx)(`div`,{className:f,children:x}),C&&(0,s.jsx)(`div`,{className:m,children:C}),(0,s.jsxs)(`form`,{onSubmit:D,className:`space-y-3`,"data-testid":`reset-password-form`,children:[(0,s.jsxs)(`div`,{children:[(0,s.jsx)(`label`,{className:d,children:`New password`}),(0,s.jsx)(`input`,{type:`password`,required:!0,minLength:8,className:u,value:h,onChange:e=>g(e.target.value),autoFocus:!0,"data-testid":`reset-new`})]}),(0,s.jsxs)(`div`,{children:[(0,s.jsx)(`label`,{className:d,children:`Confirm new password`}),(0,s.jsx)(`input`,{type:`password`,required:!0,minLength:8,className:u,value:_,onChange:e=>v(e.target.value),"data-testid":`reset-confirm`})]}),(0,s.jsx)(`button`,{type:`submit`,className:l,disabled:T||!n,"data-testid":`reset-submit`,children:T?`Resetting…`:`Reset password`})]})]})})}export{h as default}; \ No newline at end of file diff --git a/public/app/assets/Settings-CnDpQmnm.js b/public/app/assets/Settings-B_mY7MfB.js similarity index 99% rename from public/app/assets/Settings-CnDpQmnm.js rename to public/app/assets/Settings-B_mY7MfB.js index bf2deac..68425af 100644 --- a/public/app/assets/Settings-CnDpQmnm.js +++ b/public/app/assets/Settings-B_mY7MfB.js @@ -1,4 +1,4 @@ -import{i as e,n as t,t as n}from"./jsx-runtime-ByY1xr43.js";import{c as r,i,l as a,u as o}from"./index-BuU36CvS.js";import{t as s}from"./ConfirmModal-zYA0ebt6.js";var c=e(t(),1),l=n(),u=`rounded-lg border border-border bg-card p-5 space-y-3`,d=`w-full rounded-md border border-input bg-background px-3 py-2 text-sm`,f=`rounded-md bg-primary text-primary-foreground px-3 py-2 text-sm font-medium disabled:opacity-50`,p=`rounded-md border border-border px-3 py-2 text-sm disabled:opacity-50`,m=`rounded-md bg-destructive text-white px-3 py-2 text-sm font-medium disabled:opacity-50`;function h({msg:e}){return e?(0,l.jsx)(`div`,{className:`text-sm `+(e.kind===`ok`?`text-green-600`:e.kind===`err`?`text-destructive`:`text-muted-foreground`),children:e.text}):null}function g(e){let t=Math.floor((Date.now()-new Date(e).getTime())/1e3);return t<60?`just now`:t<3600?Math.floor(t/60)+`m ago`:t<86400?Math.floor(t/3600)+`h ago`:Math.floor(t/86400)+`d ago`}function _(){let e=o(),[t,n]=(0,c.useState)(``),[a,s]=(0,c.useState)(``),[p,m]=(0,c.useState)(``),[g,_]=(0,c.useState)(null),v=r({mutationFn:e=>i.post(`/api/auth/change-password`,e),onSuccess:t=>{_({text:t.message||`Password changed`,kind:`ok`}),n(``),s(``),m(``),e.invalidateQueries({queryKey:[`sessions`]}),t.passwordWarning&&setTimeout(()=>_({text:t.passwordWarning,kind:`info`}),2e3)},onError:e=>_({text:e.message,kind:`err`})});function y(e){if(e.preventDefault(),_(null),!t||!a)return _({text:`Fill in all fields`,kind:`err`});if(a.length<8)return _({text:`New password must be 8+ characters`,kind:`err`});if(a!==p)return _({text:`Passwords do not match`,kind:`err`});v.mutate({currentPassword:t,newPassword:a})}return(0,l.jsxs)(`section`,{className:u,"data-testid":`change-password-section`,children:[(0,l.jsx)(`h3`,{className:`text-base font-semibold`,children:`Change Password`}),(0,l.jsxs)(`form`,{onSubmit:y,className:`space-y-2 max-w-sm`,children:[(0,l.jsx)(`input`,{type:`password`,className:d,placeholder:`Current password`,value:t,onChange:e=>n(e.target.value),"data-testid":`pw-current`}),(0,l.jsx)(`input`,{type:`password`,className:d,placeholder:`New password (8+ characters)`,minLength:8,value:a,onChange:e=>s(e.target.value),"data-testid":`pw-new`}),(0,l.jsx)(`input`,{type:`password`,className:d,placeholder:`Confirm new password`,minLength:8,value:p,onChange:e=>m(e.target.value),"data-testid":`pw-confirm`}),(0,l.jsxs)(`div`,{className:`flex items-center gap-3`,children:[(0,l.jsx)(`button`,{type:`submit`,disabled:v.isPending,className:f,"data-testid":`btn-change-password`,children:v.isPending?`Changing…`:`Change Password`}),(0,l.jsx)(h,{msg:g})]})]})]})}function v({codes:e,onClose:t}){return(0,l.jsx)(`div`,{role:`dialog`,"aria-modal":`true`,className:`fixed inset-0 z-50 flex items-center justify-center bg-black/40 p-4`,children:(0,l.jsxs)(`div`,{className:`w-full max-w-md rounded-lg border border-border bg-background p-5 shadow-lg space-y-3`,children:[(0,l.jsx)(`h3`,{className:`text-base font-semibold`,children:`Save your backup codes`}),(0,l.jsx)(`p`,{className:`text-sm text-muted-foreground`,children:`Each code can be used once if you lose access to your authenticator. 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