2742a2a130
Split the Bedside clinical reference section out of calculators.js (~1220 lines) into 20 focused ES modules under public/js/bedside/. Each module owns one clinical topic (cardiac, seizure, sepsis, burns, etc.) and exports an init() wired up by bedside/index.js. Shared helpers live in shared.js and also set window._EM for back-compat with the 4 remaining call sites in calculators.js. Load order: classic defer calculators.js first, then module script bedside/index.js. Handlers bind at DOM-ready; runtime _EM lookups resolve after both are evaluated. Makes bedside content editable per-section, shrinks calculators.js from 4111 to 2891 lines, and keeps the existing Playwright smoke suite (e2e/tests/bedside-smoke.spec.js) as the behavioral contract.
112 lines
8.9 KiB
JavaScript
112 lines
8.9 KiB
JavaScript
// ============================================================
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// bedside/sedation.js
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// PROCEDURAL SEDATION — agents + reversal, drugs.json-backed.
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// ============================================================
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// Pulls in shared side-effect (window._EM) in case anything else needs it.
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import './shared.js';
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function d(wt, mgPerKg, max) { var v = Math.round(wt * mgPerKg * 100) / 100; return max ? Math.min(v, max) : v; }
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// Fallback inline data — mirrors drugs.json sedation section. The first
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// table's rows group by drug (Ketamine has both IV + IM lines), hence the
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// display vs name split. `reverses` marks the final 2 rows as reversal
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// agents shown in a separate table.
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var SED_FALLBACK = [
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{ 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.' },
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{ 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.' },
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{ 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.' },
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{ 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).' },
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{ 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.' },
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{ 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.' },
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{ 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.' },
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{ 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.' },
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{ 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.' },
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{ 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.' },
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{ 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.' }
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];
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function sedDrugs() {
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var s = window._DRUGS && window._DRUGS.sections && window._DRUGS.sections.sedation;
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if (s && s.drugs && s.drugs.length) {
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return s.drugs.map(function(dg) {
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var fb = SED_FALLBACK.filter(function(x) { return x.name === dg.name; })[0] || {};
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return Object.assign({}, fb, dg);
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});
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}
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return SED_FALLBACK;
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}
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// perKg footer that matches the original inline format exactly.
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function sedPerKg(lo, hi, unit) {
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unit = unit || 'mg';
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return ' <span style="color:var(--g500);font-size:11px;">(' + lo + (hi != null ? '-' + hi : '') + ' ' + unit + '/kg)</span>';
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}
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// Build the Dose cell text for a sedation drug (supports low/high range
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// and single-dose entries; honors custom dose_display for fixed doses).
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function sedDoseCell(wt, dg) {
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if (dg.dose_display) return dg.dose_display;
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var unitLabel = dg.unit === 'mcg' ? ' mcg' : (dg.unit === 'mix' ? '' : ' mg');
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var perKgUnit = dg.unit === 'mcg' ? 'mcg' : 'mg';
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if (dg.dose_mg_per_kg_low != null) {
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var lo = d(wt, dg.dose_mg_per_kg_low, dg.max_mg_low);
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if (dg.dose_mg_per_kg_high != null) {
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var hi = d(wt, dg.dose_mg_per_kg_high, dg.max_mg_high);
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return lo + '-' + hi + unitLabel + sedPerKg(dg.dose_mg_per_kg_low, dg.dose_mg_per_kg_high, perKgUnit);
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}
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return lo + unitLabel + sedPerKg(dg.dose_mg_per_kg_low, null, perKgUnit);
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}
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if (dg.dose_mg_per_kg != null) {
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var v = d(wt, dg.dose_mg_per_kg, dg.max_mg);
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return v + unitLabel + sedPerKg(dg.dose_mg_per_kg, null, perKgUnit);
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}
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return '';
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}
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function sedRow(wt, dg, showReverses) {
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var displayName = dg.display == null ? dg.name : dg.display;
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var nameCell = displayName
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? '<td style="font-weight:600;">' + displayName + '</td>'
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: '<td></td>';
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var dose = sedDoseCell(wt, dg);
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if (showReverses) {
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return '<tr>' + nameCell + '<td>' + dose + '</td><td>' + dg.route + '</td><td>' + (dg.reverses || '') + '</td><td style="font-size:12px;color:var(--g500);">' + dg.notes + '</td></tr>';
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}
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return '<tr>' + nameCell + '<td>' + dose + '</td><td>' + dg.route + '</td><td>' + (dg.onset || '') + '</td><td>' + (dg.duration || '') + '</td><td style="font-size:12px;color:var(--g500);">' + dg.notes + '</td></tr>';
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}
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function calcSedation() {
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var wt = parseFloat(document.getElementById('sed-weight').value);
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var resultDiv = document.getElementById('sed-result');
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if (!wt) { resultDiv.innerHTML = '<p style="color:var(--red);font-size:13px;">Enter weight (kg).</p>'; return; }
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var all = sedDrugs();
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var agents = all.filter(function(dg) { return !dg.reverses; });
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var reversals = all.filter(function(dg) { return !!dg.reverses; });
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var html = '<div style="padding:10px 14px;border-radius:8px;background:var(--purple-light);border:1.5px solid var(--purple);margin-bottom:12px;"><span style="font-size:14px;font-weight:700;color:var(--purple);">Procedural Sedation — ' + wt + ' kg patient</span></div>';
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// Sedation agents
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html += '<h4 style="font-size:14px;font-weight:700;color:var(--g800);margin:0 0 8px;">Sedation Agents</h4>';
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html += '<div style="overflow-x:auto;-webkit-overflow-scrolling:touch;margin-bottom:16px;"><table style="width:100%;min-width:640px;border-collapse:collapse;font-size:13px;"><thead><tr style="background:var(--g100);"><th style="text-align:left;padding:6px 8px;">Drug</th><th style="padding:6px 8px;">Dose</th><th style="padding:6px 8px;">Route</th><th style="padding:6px 8px;">Onset</th><th style="padding:6px 8px;">Duration</th><th style="padding:6px 8px;">Notes</th></tr></thead><tbody>';
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html += agents.map(function(dg) { return sedRow(wt, dg, false); }).join('');
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html += '</tbody></table></div>';
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// Reversal agents
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html += '<h4 style="font-size:14px;font-weight:700;color:var(--red);margin:0 0 8px;"><i class="fas fa-rotate-left"></i> Reversal Agents</h4>';
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html += '<div style="overflow-x:auto;-webkit-overflow-scrolling:touch;"><table style="width:100%;min-width:560px;border-collapse:collapse;font-size:13px;"><thead><tr style="background:#fee2e2;"><th style="text-align:left;padding:6px 8px;">Drug</th><th style="padding:6px 8px;">Dose</th><th style="padding:6px 8px;">Route</th><th style="padding:6px 8px;">Reverses</th><th style="padding:6px 8px;">Notes</th></tr></thead><tbody>';
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html += reversals.map(function(dg) { return sedRow(wt, dg, true); }).join('');
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html += '</tbody></table></div>';
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html += '<div style="margin-top:12px;padding:10px 12px;background:var(--amber-light);border-radius:6px;font-size:12px;color:#92400e;"><strong>Pre-sedation checklist:</strong> 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.</div>';
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html += '<p style="font-size:11px;color:var(--g400);margin:8px 0 0;">AAP Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation. ASA Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.</p>';
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resultDiv.innerHTML = html;
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}
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export function init() {
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document.addEventListener('click', function(e) {
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if (e.target.id === 'btn-sed-calc' || e.target.closest('#btn-sed-calc')) calcSedation();
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});
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}
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