// ============================================================
// bedside/sedation.js
// PROCEDURAL SEDATION — agents + reversal, drugs.json-backed.
// ============================================================
// Pulls in shared side-effect (window._EM) in case anything else needs it.
import './shared.js';
function d(wt, mgPerKg, max) { var v = Math.round(wt * mgPerKg * 100) / 100; return max ? Math.min(v, max) : v; }
// Fallback inline data — mirrors drugs.json sedation section. The first
// table's rows group by drug (Ketamine has both IV + IM lines), hence the
// display vs name split. `reverses` marks the final 2 rows as reversal
// agents shown in a separate table.
var SED_FALLBACK = [
{ name: 'Ketamine IV', display: 'Ketamine', dose_mg_per_kg_low: 1.5, dose_mg_per_kg_high: 2, max_mg_low: 100, max_mg_high: 150, unit: 'mg', route: 'IV', onset: '1 min', duration: '15-30 min', notes: 'Dissociative. Preserves airway reflexes.' },
{ name: 'Ketamine IM', display: '', dose_mg_per_kg_low: 4, dose_mg_per_kg_high: 5, max_mg_low: 300, max_mg_high: 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', dose_mg_per_kg_low: 0.05, dose_mg_per_kg_high: 0.1, max_mg_low: 2, max_mg_high: 5, unit: 'mg', route: 'IV', onset: '2-3 min', duration: '30-60 min', notes: 'Anxiolysis. Titrate q3-5 min.' },
{ name: 'Midazolam IN/PO', display: '', dose_mg_per_kg: 0.5, max_mg: 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', dose_mg_per_kg: 1, max_mg: 40, unit: 'mg', route: 'IV', onset: '30 sec', duration: '5-10 min', notes: 'Short procedures. Causes apnea — manage airway.' },
{ name: 'Fentanyl IV', display: 'Fentanyl', dose_mg_per_kg: 1, max_mg: 100, unit: 'mcg', route: 'IV', onset: '2-3 min', duration: '30-60 min', notes: 'Analgesic. Often combined with midazolam.' },
{ name: 'Fentanyl IN', display: '', dose_mg_per_kg: 2, max_mg: 100, unit: 'mcg', route: 'IN', onset: '5-10 min', duration: '30-60 min', notes: 'Intranasal.' },
{ name: 'Nitrous oxide', display: 'Nitrous oxide', dose_display: '50:50 or 70:30 mix', unit: 'mix', route: 'Inhaled',onset: '2-5 min', duration: '5 min off', notes: 'Self-administered via demand valve. Anxiolysis + mild analgesia.' },
{ name: 'Dexmedetomidine IN', display: 'Dexmedetomidine', dose_mg_per_kg_low: 2, dose_mg_per_kg_high: 3, max_mg_low: 100, max_mg_high: null, unit: 'mcg', route: 'IN', onset: '15-30 min', duration: '60-90 min', notes: 'Intranasal. No respiratory depression. Good for imaging.' },
{ name: 'Naloxone', display: 'Naloxone', dose_mg_per_kg: 0.1, max_mg: 2, unit: 'mg', route: 'IV/IM/IN', reverses: 'Opioids (fentanyl, morphine)', notes: 'Max 2 mg. Repeat q2-3 min. Duration shorter than opioids — monitor for re-sedation.' },
{ name: 'Flumazenil', display: 'Flumazenil', dose_mg_per_kg: 0.01, max_mg: 0.2, unit: 'mg', route: 'IV', reverses: 'Benzodiazepines (midazolam)', notes: 'Max 0.2 mg single dose. Repeat q1 min to max 1 mg total. Risk of seizures — use cautiously.' }
];
function sedDrugs() {
var s = window._DRUGS && window._DRUGS.sections && window._DRUGS.sections.sedation;
if (s && s.drugs && s.drugs.length) {
return s.drugs.map(function(dg) {
var fb = SED_FALLBACK.filter(function(x) { return x.name === dg.name; })[0] || {};
return Object.assign({}, fb, dg);
});
}
return SED_FALLBACK;
}
// perKg footer that matches the original inline format exactly.
function sedPerKg(lo, hi, unit) {
unit = unit || 'mg';
return ' (' + lo + (hi != null ? '-' + hi : '') + ' ' + unit + '/kg)';
}
// Build the Dose cell text for a sedation drug (supports low/high range
// and single-dose entries; honors custom dose_display for fixed doses).
function sedDoseCell(wt, dg) {
if (dg.dose_display) return dg.dose_display;
var unitLabel = dg.unit === 'mcg' ? ' mcg' : (dg.unit === 'mix' ? '' : ' mg');
var perKgUnit = dg.unit === 'mcg' ? 'mcg' : 'mg';
if (dg.dose_mg_per_kg_low != null) {
var lo = d(wt, dg.dose_mg_per_kg_low, dg.max_mg_low);
if (dg.dose_mg_per_kg_high != null) {
var hi = d(wt, dg.dose_mg_per_kg_high, dg.max_mg_high);
return lo + '-' + hi + unitLabel + sedPerKg(dg.dose_mg_per_kg_low, dg.dose_mg_per_kg_high, perKgUnit);
}
return lo + unitLabel + sedPerKg(dg.dose_mg_per_kg_low, null, perKgUnit);
}
if (dg.dose_mg_per_kg != null) {
var v = d(wt, dg.dose_mg_per_kg, dg.max_mg);
return v + unitLabel + sedPerKg(dg.dose_mg_per_kg, null, perKgUnit);
}
return '';
}
function sedRow(wt, dg, showReverses) {
var displayName = dg.display == null ? dg.name : dg.display;
var nameCell = displayName
? '| ' + displayName + ' | '
: ' | ';
var dose = sedDoseCell(wt, dg);
if (showReverses) {
return '' + nameCell + '| ' + dose + ' | ' + dg.route + ' | ' + (dg.reverses || '') + ' | ' + dg.notes + ' |
';
}
return '' + nameCell + '| ' + dose + ' | ' + dg.route + ' | ' + (dg.onset || '') + ' | ' + (dg.duration || '') + ' | ' + dg.notes + ' |
';
}
function calcSedation() {
var wt = parseFloat(document.getElementById('sed-weight').value);
var resultDiv = document.getElementById('sed-result');
if (!wt) { resultDiv.innerHTML = 'Enter weight (kg).
'; return; }
var all = sedDrugs();
var agents = all.filter(function(dg) { return !dg.reverses; });
var reversals = all.filter(function(dg) { return !!dg.reverses; });
var html = 'Procedural Sedation — ' + wt + ' kg patient
';
// Sedation agents
html += 'Sedation Agents
';
html += '| Drug | Dose | Route | Onset | Duration | Notes |
|---|
';
html += agents.map(function(dg) { return sedRow(wt, dg, false); }).join('');
html += '
Reversal Agents
';
html += '| Drug | Dose | Route | Reverses | Notes |
|---|
';
html += reversals.map(function(dg) { return sedRow(wt, dg, true); }).join('');
html += '
Pre-sedation checklist: NPO status (2h clear liquids, 6h solids), consent, monitoring equipment (pulse ox, capnography, BP), resuscitation equipment at bedside, suction ready, IV access. Minimum monitoring: continuous SpO2, HR, capnography. Provider capable of managing airway must be present.
';
html += 'AAP Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation. ASA Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.
';
resultDiv.innerHTML = html;
}
export function init() {
document.addEventListener('click', function(e) {
if (e.target.id === 'btn-sed-calc' || e.target.closest('#btn-sed-calc')) calcSedation();
});
}