+
+
+++++
a|
* Brain Meninges: increased signal
intensity along the falx cereberi and the
@@ -79,7 +84,12 @@ cerebri and tentorium cerebelli likely
subarachinoid bleeders.
a| Day of admission (second day after injury)
-a| image:tbi-0/dai-ct-2.png[CT,width="",height=""]
+a|
+++++
+
+ 
+
+++++
a|
* Calvaria: right side frontoparietal
swelling likely subgaleal hematoma.
@@ -113,7 +123,19 @@ a|
a| Unremarkable findings.
a| Last day from admission day
-a| image:tbi-0/dai-us-1.png[US-1,width="",height=""] image:tbi-0/dai-us-2.png[US-2,width="",height=""]
+a|
+++++
+
+ 
+
+++++
+
+++++
+
+ 
+
+++++
+
a|
* Impression:
** Hepatic focal lesion at the hepatic
@@ -383,19 +405,35 @@ Liver and renal function tests and the total creatine kinase levels are highly s
== Thumbnails:
-image:tbi-0/gcs-score-table.png[gcs-1,width="",height=""]
+++++
+
+ 
+
+++++
[.subtitle]
[[Fig-1.1]] Fig-1.1 - Prognosis Reclaiming from the GCS-P Score (GCS-PA Charts), a simple graphical tool in the 3-dimensional vector-space.
-image:tbi-0/gcs-score-table-2.png[gcs-2,width="",height=""]
+++++
+
+ 
+
+++++
[.subtitle]
[[Fig-1.2]] Fig-1.2 - GCS-PA combined with brain CT findings.
-image:tbi-0/red-nucleus.png[red,width="",height=""]
+++++
+
+ 
+
+++++
[.subtitle]
[[Fig-2]] Fig-2 - The red nucleus cortical, spinal and cerebellar connections.
-image:tbi-0/oculo-sympathetic-pathway.png[pathway,width="",height=""]
+++++
+
+ 
+
+++++
[.subtitle]
[[Fig-3]] Fig-3 - The oculo-sympathetic pathway.
diff --git a/modules/COMPANION/assets/dot/atls_xabcde_algorithm.dot b/modules/COMPANION/assets/dot/atls_xabcde_algorithm.dot
new file mode 100644
index 0000000..3f9e34e
--- /dev/null
+++ b/modules/COMPANION/assets/dot/atls_xabcde_algorithm.dot
@@ -0,0 +1,869 @@
+/**
+ * ATLS 11th Edition — xABCDE Primary Survey Algorithm
+ * Three-Column Layout:
+ * LEFT → Sequential algorithm nodes (brief, decision-flow)
+ * MIDDLE → Detailed breakdown of each maneuver
+ * RIGHT → Image placeholder template for each step
+ *
+ * Render with:
+ * dot -Tsvg atls_xabcde_algorithm.dot -o atls_xabcde_algorithm.svg
+ * dot -Tpdf atls_xabcde_algorithm.dot -o atls_xabcde_algorithm.pdf
+ *
+ * Editing notes:
+ * • Each PRIMARY step has a matching DETAIL node (suffix _d) and IMAGE node (suffix _i)
+ * • Column membership is controlled by invisible rank-constraining edges
+ * • Colors follow ATLS severity convention:
+ * Red → Immediate life-threat
+ * Orange → Urgent maneuver
+ * Yellow → Assessment / evaluation
+ * Green → Completed / stable
+ * Blue → Adjunct / monitoring
+ * Gray → Image placeholder
+ */
+
+digraph ATLS_xABCDE {
+
+ /* ─────────────────────────────────────────────
+ GLOBAL GRAPH SETTINGS
+ ───────────────────────────────────────────── */
+ graph [
+ rankdir = TB
+ splines = spline
+ nodesep = 0.55
+ ranksep = 0.70
+ fontname = "Helvetica Neue"
+ fontsize = 11
+ pad = 0.5
+ bgcolor = "#FAFAFA"
+ label = "ATLS® 11th Edition | Primary Survey: xABCDE Algorithm\nAmerican College of Surgeons Committee on Trauma"
+ labelloc = t
+ labeljust = c
+ fontsize = 16
+ ]
+
+ node [
+ fontname = "Helvetica Neue"
+ fontsize = 10
+ style = "filled,rounded"
+ penwidth = 1.5
+ margin = "0.20,0.12"
+ ]
+
+ edge [
+ fontname = "Helvetica Neue"
+ fontsize = 9
+ color = "#444444"
+ arrowsize = 0.8
+ ]
+
+ /* ═══════════════════════════════════════════════════════════════════
+ COLUMN HEADER NODES
+ ═══════════════════════════════════════════════════════════════════ */
+
+ subgraph cluster_headers {
+ rank = same
+ style = invis
+
+ hdr_L [
+ label = "SEQUENTIAL ALGORITHM\n(Primary Survey Flow)"
+ shape = rect
+ style = "filled"
+ fillcolor = "#1A1A2E"
+ fontcolor = white
+ fontsize = 12
+ fontname = "Helvetica Neue Bold"
+ width = 3.2
+ ]
+
+ hdr_M [
+ label = "MANEUVER DETAIL\n(Assessment & Intervention)"
+ shape = rect
+ style = "filled"
+ fillcolor = "#16213E"
+ fontcolor = white
+ fontsize = 12
+ fontname = "Helvetica Neue Bold"
+ width = 4.5
+ ]
+
+ hdr_R [
+ label = "ILLUSTRATION TEMPLATE\n(Clinical Image Placeholder)"
+ shape = rect
+ style = "filled"
+ fillcolor = "#0F3460"
+ fontcolor = white
+ fontsize = 12
+ fontname = "Helvetica Neue Bold"
+ width = 3.0
+ ]
+ }
+
+ /* ═══════════════════════════════════════════════════════════════════
+ STEP 0 — SCENE SAFETY & PREPARATION
+ ═══════════════════════════════════════════════════════════════════ */
+
+ /* ── LEFT ── */
+ S0 [
+ label = "PREPARATION\n& SCENE SAFETY"
+ shape = octagon
+ fillcolor = "#2D4A22"
+ fontcolor = white
+ fontsize = 11
+ fontname = "Helvetica Neue Bold"
+ width = 3.0
+ ]
+
+ /* ── MIDDLE ── */
+ S0_d [
+ label = <| PREPARATION & PPE |
|
+ • Don PPE: gloves, gown, eye/face protection + • Prearrival huddle — assign team roles + • Activate trauma team notification + • Assess available resources (blood, OR, ICU) + • Review mechanism via MIST handover tool + • Airway cart, IV access, monitoring ready + • Activate MTP/MHP if major hemorrhage likely + • Designate team leader and scribe + |
| x — EXSANGUINATION CONTROL |
|
+ Assess: Visible life-threatening external bleeding + ↳ Extremity wounds, scalp, junctional zones + + Interventions (apply immediately): + • Direct pressure — first-line for all wounds + • Tourniquet (TQ) — proximal extremity; note time + • Wound packing with hemostatic gauze (junctional) + • Pelvic binder — suspected pelvic ring disruption + • Sutures/clips — scalp lacerations + • Resuscitative Endovascular Balloon Occlusion + of the Aorta (REBOA) — if available, Zone III/I + + Key principle: Control exsanguination BEFORE + airway management in actively bleeding patients + |
| A — AIRWAY MANAGEMENT |
|
+ Assessment: + • Talk to patient — if they respond clearly, airway intact + • Look: agitation, cyanosis, accessory muscle use + • Listen: stridor, gurgling, silence (apnea) + • Check: blood, vomit, teeth, foreign body, facial trauma + • Thermal/inhalation injury signs + + Basic maneuvers (C-spine in-line): + • Chin lift / jaw thrust (avoid head-tilt in trauma) + • Suction — clear oropharynx + • Oropharyngeal airway (OPA) — unconscious, no gag + • Nasopharyngeal airway (NPA) — conscious/semi + • Supraglottic device (LMA) — bridge/rescue + + Definitive airway indications: + • GCS ≤8 / apnea / airway not maintainable + • Anticipated loss (burns, expanding hematoma) + • Orotracheal RSI — preferred method + • Video laryngoscopy — recommended + • Bougie — have immediately available + • Surgical airway (cricothyrotomy) — cannot intubate + + C-Spine: Maintain in-line stabilisation throughout + Post-intubation: confirm with ETCO2 + CXR + |
| B — BREATHING ASSESSMENT & MANAGEMENT |
|
+ Assessment (LOOK / LISTEN / FEEL): + • Expose chest fully — compare both sides + • RR: normal 12–20 /min; tachypnea >20 = concern + • SpO2 — target ≥94% (trauma); 88–92% in COPD + • Percussion: hyper-resonance (PTX) / dullness (HTX) + • Auscultate: equal air entry bilaterally + • Tracheal position, JVD, chest wall motion/symmetry + + Immediate life-threats — treat when found: + 1. Tension Pneumothorax + → Needle decompression 2nd ICS MCL (or 4th ICS AAL) + → Finger/tube thoracostomy; CXD tube 4th ICS + 2. Open (Sucking) Chest Wound + → 3-sided occlusive dressing; later chest drain + 3. Massive Haemothorax + → Large-bore chest drain 4th/5th ICS; IV access + 4. Flail Chest + Pulmonary Contusion + → Oxygenation, analgesia, consider NIV/intubation + + Ventilated patients: + • Confirm ETCO2 waveform post-intubation + • Low ETCO2 = hypovolaemia / displaced ETT + • Tidal volume 6–8 mL/kg IBW; avoid barotrauma + |
| C — CIRCULATION ASSESSMENT & RESUSCITATION |
|
+ Signs of shock: + • HR >100, RR >20, CRT >2s, cool/clammy + • SBP <90 = LATE sign; don't wait for hypotension + • Altered mentation, decreased pulse pressure + • Urinary output <0.5 mL/kg/hr + + Haemorrhage Classification (approximate): + Class I : <750 mL (<15%) — minimal signs + Class II : 750–1500 mL (15–30%) — tachycardia + Class III: 1500–2000 mL (30–40%)— hypotension + Class IV : >2000 mL (>40%) — life-threatening + + Source identification ("5 Boxes"): + Chest | Abdomen | Pelvis | Long bones | "Floor" + → eFAST, Pelvis XR, Long bone XR + + Resuscitation — Damage Control: + • 2 large-bore IVs (14–16G) or IO access + • Balanced haemostatic resus: pRBC:FFP:PLT = 1:1:1 + • Whole blood preferred if available + • TXA ≤3 hr from injury: 1g IV over 10 min loading + • Permissive hypotension: SBP 80–90 mmHg (no TBI) + • Activate MTP early; avoid crystalloid excess + • Calcium supplementation with massive transfusion + + Source control options: + • External: TQ, packing, pelvic binder + • OR: damage control laparotomy/thoracotomy + • IR: angioembolisation (pelvic, solid organ) + • REBOA as bridge to definitive control + + Non-haemorrhagic shock: + Tension PTX → decompress | Tamponade → FAST → EDEP + Neurogenic → fluids + vasopressors after excluding bleed + |
| D — DISABILITY: NEUROLOGICAL ASSESSMENT |
|
+ Rapid neuro exam (AVPU → GCS): + A — Alert; V — Voice; P — Pain; U — Unresponsive + + Glasgow Coma Scale (GCS) 3–15: + Eyes: 4-Spontaneous / 3-Voice / 2-Pain / 1-None + Verbal: 5-Oriented / 4-Confused / 3-Words / 2-Sounds / 1-None + Motor: 6-Obeys / 5-Localises / 4-Withdraws / 3-Flexion + 2-Extension / 1-None + Motor GCS <6 = unable to follow commands (field triage) + + Pupil exam: + • Size, symmetry, reactivity bilaterally + • Unilateral fixed dilated = herniation until proven otherwise + + Lateralising signs: + • Asymmetric limb movement / posturing + • Indicates structural CNS injury + + Management priorities: + • Prevent secondary brain injury (hypoxia + hypotension) + • Maintain SpO2 ≥94%, SBP ≥110 mmHg in isolated TBI + • GCS ≤8 → definitive airway (if not already secured) + • Hyperventilation ONLY for impending herniation (transient) + • Blood glucose check — correct hypoglycaemia + • Avoid hyperglycaemia + • Neurosurgery activation: GCS drop, haematoma on imaging + |
| E — EXPOSURE & ENVIRONMENT |
|
+ Exposure: + • Remove all clothing (cut if necessary) + • Log-roll with C-spine control → inspect back + • Perineum, axillae, gluteal folds examined + • "The Floor" — check beneath patient for hidden bleeding + • Remove penetrating objects only in controlled setting + + Environmental control (prevent hypothermia): + • Core temp target: >35°C (lethal triad: coagulopathy + + acidosis + hypothermia) + • Warm blankets immediately after exam + • Warmed IV fluids and blood products + • Convection warming devices (Bair Hugger) + • Warm ambient room temperature + • Active rewarming for T <32°C + + Log-roll technique: + • Minimum 3 people + leader controlling head/C-spine + • Spine board removed once safe to do so + |
| ADJUNCTS TO PRIMARY SURVEY |
|
+ Monitoring (continuous): + • ECG — arrhythmia, blunt cardiac injury + • Pulse oximetry (SpO2) + • Capnography (ETCO2) — post-intubation + • Blood pressure (arterial line preferred in instability) + • Temperature + • Urinary catheter — UO 0.5 mL/kg/hr target + • Gastric decompression — NG or OG tube + + Imaging: + • CXR — haemo/pneumothorax, mediastinum, lines + • Pelvis XR — pelvic ring disruption + • eFAST — pericardial, peritoneal, pleural fluid + • CECT whole body ("pan-scan") when stabilised + + Lab: + • ABG — pH, lactate, base deficit, PaO2 + • FBC, coagulation (PT, APTT, fibrinogen), TEG/ROTEM + • Type & crossmatch / group & screen + • β-hCG (all reproductive-age females) + • BMP, troponin, toxicology screen + |
| REEVALUATION — CRITICAL STEP |
|
+ Reevaluate continuously throughout primary survey + + • Repeat full xABCDE when clinical status changes + • Deterioration may indicate new/missed injury + • Serial GCS, vital signs, lactate clearance + • Reassess response to resuscitation + • Update team with huddle/time-out + • If condition worsens → return to "x" (haemorrhage) + + Specific reevaluation triggers: + • Failure to respond to fluid resuscitation + • Sudden haemodynamic deterioration + • Worsening GCS or new pupil changes + • Increasing ventilatory requirements + • Rising airway pressures in ventilated patient + |
| SECONDARY SURVEY |
|
+ Initiate ONLY after primary survey stabilisation + + History — SAMPLE: + S — Symptoms / Signs + A — Allergies + M — Medications (anticoagulants, steroids) + P — Past medical/surgical history + L — Last meal (aspiration risk) + E — Events leading to injury / mechanism + + Head-to-toe physical exam: + Head → Face → Neck → Chest → Abdomen + → Pelvis → Perineum → Extremities → Back + + Transfer decision: + • Consider if injuries exceed institutional capability + • Use S-xABCDE-BAR handover tool for communication + • Arrange definitive care (OR / ICU / neurosurgery) + |
+
+++++
+[.subtite]
+[[Fig-1.1]] The ATLS Algorithm based on the ACP 11^th^ edition.
\ No newline at end of file
diff --git a/scripts/build.sh b/scripts/build.sh
index cac89e5..056698d 100644
--- a/scripts/build.sh
+++ b/scripts/build.sh
@@ -1,3 +1,8 @@
#!/bin/sh
+cached_work_dir=$(pwd)
+cd ./modules/COMPANION/assets
+dot -Tsvg ./dot/atls_xabcde_algorithm.dot -o ./images/xabcde/atls.svg
+cd $cached_work_dir
+
npx antora antora-playbook.yml
diff --git a/scripts/install.sh b/scripts/install.sh
index b011619..e9e06e4 100644
--- a/scripts/install.sh
+++ b/scripts/install.sh
@@ -10,3 +10,5 @@ export NVM_DIR="$([ -z "${XDG_CONFIG_HOME-}" ] && printf %s "${HOME}/.nvm" || pr
nvm install node
npm i -g antora
+
+npm install asciidoctor asciidoctor-kroki
\ No newline at end of file
diff --git a/ui-bundle/css/site.css b/ui-bundle/css/site.css
index 470b2a1..8debea0 100644
--- a/ui-bundle/css/site.css
+++ b/ui-bundle/css/site.css
@@ -9,4 +9,12 @@
padding-left: 20px;
padding-top: -10px;
}
+.zoom-img {
+ transition: transform 0.3s ease, box-shadow 0.3s ease;
+}
+
+.zoom-img:hover {
+ transform: scale(1.08) translateY(-5px);
+ box-shadow: 0 10px 25px rgba(0,0,0,0.3);
+}
/*! Adapted from the GitHub style by Vasily Polovnyov