Anesthesia (v2.4.0 — Clinical Precision & Emergency Resilience) is a universal, zero-latency clinical decision support and point-of-care medical suite for physicians, residents, intensivists, and healthcare professionals across all specialties.
Built with Next.js 16 (App Router with Turbopack), Tailwind CSS 4, and Dexie IndexedDB, it unifies disparate bedside tools—traditionally fragmented across MDCalc, Epocrates, ASRA Coags, UpToDate, and ultrasound carts—into a single, privacy-first, 100% offline-capable Progressive Web Application (PWA) that runs directly in the browser with zero cloud round-trips.
Core Clinical Pillars & Capabilities
1. 🧮 Universal Clinical Risk Scores & Lab Interpreters (MDCalc Benchmark)
- Cardiovascular & VTE: Wells Score for DVT & Pulmonary Embolism (with integrated PERC rule-out), CHA₂DS₂-VASc (annual stroke risk & anticoagulation threshold), HAS-BLED (anticoagulation bleeding risk), and HEART Score (emergency department chest pain & 6-week MACE stratification).
- Critical Care & Sepsis: CURB-65 & Pneumonia Severity Index (PSI), qSOFA bedside screening & full 6-organ SOFA trajectory scoring.
- Neurology & Stroke: Glasgow Coma Scale (GCS & GCS-P with pupil reactivity), NIH Stroke Scale (NIHSS) with IV Tenecteplase / Alteplase thrombolysis contraindication checklist.
- Hepatology & Nephrology: MELD-Na (UNOS-capped bounds) and Child-Pugh surgical mortality risk; race-free CKD-EPI 2021 eGFR equation with anesthetic drug handling recommendations.
- Gastroenterology & Hemodynamics: Glasgow-Blatchford Bleeding Score (GBS) for upper GI hemorrhage triage; Shock Index (SI) & Modified Shock Index (MSI) to detect occult hypoperfusion before overt hypotension.
- Point-of-Care Lab Engines: 4-Step ABG Analyzer (with Winter’s compensation & delta-delta ratio for mixed disorders), Katz/Hillier hyperglycemia-corrected sodium, and potassium repletion boundaries.
2. 📡 Point-of-Care Ultrasound (POCUS) Diagnostic Station
- Interactive 36-Case Reference Atlas: Pre-cached cine-loops across eFAST (RUQ Morison’s pouch, LUQ splenorenal, suprapubic, subxiphoid pericardium, thoracic sliding), Lung BLUE protocol (Bat sign, A/B-lines, lung point, shred sign), Focused Cardiac Ultrasound (PLAX, PSAX, A4C, IVC long axis), RUSH shock protocol, and Lower Extremity DVT 2-point compression.
- 2D SVG Anatomical Mannequin: Interactive touch/pointer tracking with acoustic window lock, probe orientation marker, and real-time rotation dial ($0^\circ\text{–}90^\circ$).
- Live Hardware Feed & DICOM Review: Direct UVC video capture (
getUserMedia) connecting ultrasound carts via HDMI-to-USB cards; on-canvas 2-point distance calipers, elliptical area measurement, 3-axis automated bladder volume, real-time double-buffered M-mode column extractor, and client-side offline DICOM parser (dicom-parser).
3. 🛡️ ASRA Coags Regional Anticoagulation Matrix (ASRA Benchmark)
- American Society of Regional Anesthesia (ASRA 5th Consensus) guidelines for spinal, epidural, deep plexus, and superficial peripheral nerve blocks.
- Washout hold times, catheter pull intervals, and post-procedure restart schedules across 14 antithrombotic drugs (LMWH, UFH, Apixaban, Rivaroxaban, Dabigatran with CrCl adjustments, Warfarin with target $\text{INR} \le 1.4$, P2Y12 inhibitors, and Aspirin).
4. ⚡ Vasoactive Syringe Pump Infusion Titrator (50 mL) (Vargo Benchmark)
- Continuous infusion syringe titrator with 10 gold-standard ICU/OR protocols (Norepinephrine, Epinephrine, Vasopressin, Phenylephrine, Nicardipine, Propofol 1%/2% TIVA, Remifentanil TIVA, Dexmedetomidine, Dopamine, Dobutamine).
- Real-time bidirectional rate converter ($\mu\text{g/kg/min} \leftrightarrow \text{mL/hr}$), active patient weight synchronization, and auto-generated 6-step titration reference ladders.
5. 👶 Pediatric & Neonatal Growth Suite
- WHO Child Growth Standards (0–5 Years): Piecewise LMS curves calculating exact Z-scores (SD) and percentiles for Weight-for-Age, Height-for-Age, and BMI-for-Age.
- Age-Stratified Vital Sign Norms: Reference ranges (50th & 95th percentiles) across 7 developmental stages (Preterm, Term Neonate, Infant, Toddler, Preschool, School Age, Adolescent).
- Neonatal Scoring: Interactive 1- and 5-minute APGAR scores and Silverman-Anderson Respiratory Distress Index for newborns.
6. 💊 100% Offline Drug Interaction Safety Matrix (Epocrates Benchmark)
- 50+ critical drug-pair and pharmacodynamic class rules running client-side in $<2\text{ ms}$ with zero network reliance.
- Catches fatal combinations (MAOI + Pethidine/Tramadol, PDE5-i + Nitrates, Epinephrine 1:1,000 IV), anesthesia risks (Opioid + Benzo respiratory depression, Suxamethonium + Hyperkalemia), and acute care risks (Triple Whammy AKI: ACEi + Diuretic + NSAID; Linezolid Serotonin Syndrome; QT prolongation).
7. 📝 Structured Clinical Documentation (SOAP & SBAR)
- 1-tap compiler generating complete Subjective, Objective, Assessment, Plan (SOAP) clinical progress notes and Bedside Rounds SBAR handoff sheets with embedded risk scores, active labs, and emergency standby parameters for direct copy-pasting into hospital EHR/HIS.
8. 🚨 Acute Crisis Resuscitation Tray
- Interactive ACLS/PALS 2-minute CPR cycle metronome ($110\text{ bpm}$ via Web Audio API) with audio alarms and shockable vs non-shockable branches.
- Pediatric Broselow tape emergency estimator (9 color zones + endotracheal tube / airway sizing).
- Multi-route Anaphylaxis protocols (Thigh IM vs Monitored OR/ICU Push-Dose vs Continuous Infusion).