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teste2
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Files changed (3) hide show
  1. README.md +7 -5
  2. index.html +855 -19
  3. prompts.txt +1 -0
README.md CHANGED
@@ -1,10 +1,12 @@
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  ---
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- title: Teste2
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- emoji: 🐢
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- colorFrom: green
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- colorTo: pink
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  sdk: static
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  pinned: false
 
 
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  ---
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- Check out the configuration reference at https://huggingface.co/docs/hub/spaces-config-reference
 
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  ---
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+ title: teste2
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+ emoji: 🐳
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+ colorFrom: yellow
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+ colorTo: gray
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  sdk: static
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  pinned: false
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+ tags:
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+ - deepsite
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  ---
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+ Check out the configuration reference at https://huggingface.co/docs/hub/spaces-config-reference
index.html CHANGED
@@ -1,19 +1,855 @@
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- <!doctype html>
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- <html>
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- <head>
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- <meta charset="utf-8" />
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- <meta name="viewport" content="width=device-width" />
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- <title>My static Space</title>
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- <link rel="stylesheet" href="style.css" />
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- </head>
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- <body>
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- <div class="card">
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- <h1>Welcome to your static Space!</h1>
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- <p>You can modify this app directly by editing <i>index.html</i> in the Files and versions tab.</p>
13
- <p>
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- Also don't forget to check the
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- <a href="https://huggingface.co/docs/hub/spaces" target="_blank">Spaces documentation</a>.
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- </p>
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- </div>
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- </body>
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- </html>
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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+ <!DOCTYPE html>
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+ <html lang="pt-BR">
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+ <head>
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+ <meta charset="UTF-8">
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+ <meta name="viewport" content="width=device-width, initial-scale=1.0">
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+ <title>Anestesia em Pacientes Hepáticos - Dr. Cyro Vieira</title>
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+ <script src="https://cdn.tailwindcss.com"></script>
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+ <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.4.0/css/all.min.css">
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+ <style>
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+ .slide {
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+ display: none;
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+ min-height: 100vh;
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+ padding: 2rem;
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+ }
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+ .active {
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+ display: block;
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+ }
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+ .progress-container {
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+ width: 100%;
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+ height: 8px;
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+ background: #e0e0e0;
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+ }
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+ .progress-bar {
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+ height: 8px;
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+ background: #3b82f6;
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+ width: 0%;
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+ }
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+ .chart-container {
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+ width: 100%;
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+ height: 300px;
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+ margin: 20px auto;
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+ }
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+ .flowchart {
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+ display: flex;
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+ flex-direction: column;
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+ align-items: center;
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+ }
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+ .flow-step {
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+ padding: 15px;
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+ border: 2px solid #3b82f6;
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+ border-radius: 8px;
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+ margin: 10px;
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+ width: 80%;
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+ text-align: center;
45
+ background-color: #f8fafc;
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+ }
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+ .flow-arrow {
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+ font-size: 24px;
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+ color: #3b82f6;
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+ }
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+ @keyframes fadeIn {
52
+ from { opacity: 0; }
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+ to { opacity: 1; }
54
+ }
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+ .fade-in {
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+ animation: fadeIn 0.5s ease-in;
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+ }
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+ </style>
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+ </head>
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+ <body class="bg-gray-100 font-sans">
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+ <div class="progress-container fixed top-0 left-0 z-50">
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+ <div class="progress-bar" id="progressBar"></div>
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+ </div>
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+
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+ <div class="fixed bottom-10 right-10 z-50 flex space-x-4">
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+ <button onclick="prevSlide()" class="bg-blue-500 hover:bg-blue-700 text-white font-bold py-3 px-4 rounded-full shadow-lg transition duration-300">
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+ <i class="fas fa-arrow-left"></i>
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+ </button>
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+ <button onclick="nextSlide()" class="bg-blue-500 hover:bg-blue-700 text-white font-bold py-3 px-4 rounded-full shadow-lg transition duration-300">
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+ <i class="fas fa-arrow-right"></i>
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+ </button>
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+ </div>
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+
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+ <!-- Slides -->
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+ <div class="slides-container">
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+ <!-- Slide 1 - Title -->
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+ <div class="slide active fade-in">
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+ <div class="flex flex-col items-center justify-center h-full bg-gradient-to-br from-blue-50 to-indigo-100 rounded-xl p-8 shadow-xl">
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+ <img src="https://img.icons8.com/color/96/000000/liver.png" alt="Liver Icon" class="mb-6">
80
+ <h1 class="text-5xl font-bold text-blue-800 mb-6 text-center">Anestesia em Pacientes Hepáticos</h1>
81
+ <h2 class="text-3xl font-semibold text-gray-700 mb-8 text-center">Protocolos e Abordagens no HUWC-HSC</h2>
82
+ <div class="bg-white p-6 rounded-lg shadow-md w-full max-w-2xl">
83
+ <p class="text-xl text-gray-700 mb-2"><i class="fas fa-user-md text-blue-500 mr-2"></i> <span class="font-semibold">Apresentação:</span> Dr. Cyro Vieira</p>
84
+ <p class="text-xl text-gray-700"><i class="fas fa-calendar-alt text-blue-500 mr-2"></i> <span class="font-semibold">Data:</span> <span id="currentDate"></span></p>
85
+ </div>
86
+ </div>
87
+ </div>
88
+
89
+ <!-- Slide 2 - Objectives -->
90
+ <div class="slide fade-in">
91
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
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+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center border-b-2 border-blue-200 pb-4">Objetivos da Apresentação</h2>
93
+ <div class="grid grid-cols-1 md:grid-cols-2 gap-8">
94
+ <div class="bg-blue-50 p-6 rounded-lg shadow">
95
+ <h3 class="text-2xl font-semibold text-blue-700 mb-4 flex items-center">
96
+ <i class="fas fa-bullseye mr-3"></i> Objetivos Gerais
97
+ </h3>
98
+ <ul class="space-y-3 text-gray-700 text-lg">
99
+ <li class="flex items-start"><i class="fas fa-check-circle text-blue-500 mr-2 mt-1"></i> Compreender a fisiopatologia hepática relevante para anestesia</li>
100
+ <li class="flex items-start"><i class="fas fa-check-circle text-blue-500 mr-2 mt-1"></i> Avaliar riscos anestésicos em pacientes hepáticos</li>
101
+ <li class="flex items-start"><i class="fas fa-check-circle text-blue-500 mr-2 mt-1"></i> Conhecer as particularidades do manejo perioperatório</li>
102
+ </ul>
103
+ </div>
104
+ <div class="bg-indigo-50 p-6 rounded-lg shadow">
105
+ <h3 class="text-2xl font-semibold text-indigo-700 mb-4 flex items-center">
106
+ <i class="fas fa-clipboard-list mr-3"></i> Objetivos Específicos
107
+ </h3>
108
+ <ul class="space-y-3 text-gray-700 text-lg">
109
+ <li class="flex items-start"><i class="fas fa-check-circle text-indigo-500 mr-2 mt-1"></i> Protocolos de avaliação pré-operatória</li>
110
+ <li class="flex items-start"><i class="fas fa-check-circle text-indigo-500 mr-2 mt-1"></i> Escolha de agentes anestésicos</li>
111
+ <li class="flex items-start"><i class="fas fa-check-circle text-indigo-500 mr-2 mt-1"></i> Monitorização intraoperatória</li>
112
+ <li class="flex items-start"><i class="fas fa-check-circle text-indigo-500 mr-2 mt-1"></i> Cuidados pós-operatórios</li>
113
+ </ul>
114
+ </div>
115
+ </div>
116
+ </div>
117
+ </div>
118
+
119
+ <!-- Slide 3 - Epidemiology -->
120
+ <div class="slide fade-in">
121
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
122
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Epidemiologia das Doenças Hepáticas</h2>
123
+
124
+ <div class="grid grid-cols-1 lg:grid-cols-2 gap-8 mb-8">
125
+ <div>
126
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
127
+ <i class="fas fa-chart-line text-blue-500 mr-3"></i> Prevalência Global
128
+ </h3>
129
+ <div class="bg-gray-50 p-4 rounded-lg shadow">
130
+ <p class="text-gray-700 mb-4">As doenças hepáticas afetam aproximadamente 844 milhões de pessoas mundialmente, com cirrose sendo responsável por mais de 1 milhão de mortes anualmente.</p>
131
+ <div class="chart-container">
132
+ <canvas id="epidemiologyChart"></canvas>
133
+ </div>
134
+ </div>
135
+ </div>
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+
137
+ <div>
138
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
139
+ <i class="fas fa-procedures text-blue-500 mr-3"></i> Implicações Anestésicas
140
+ </h3>
141
+ <div class="bg-gray-50 p-4 rounded-lg shadow">
142
+ <ul class="space-y-3 text-gray-700">
143
+ <li class="flex items-start"><i class="fas fa-exclamation-triangle text-yellow-500 mr-2 mt-1"></i> 8-10% dos pacientes cirróticos necessitam de cirurgia anualmente</li>
144
+ <li class="flex items-start"><i class="fas fa-exclamation-triangle text-yellow-500 mr-2 mt-1"></i> Mortalidade perioperatória pode chegar a 50% em Child C</li>
145
+ <li class="flex items-start"><i class="fas fa-exclamation-triangle text-yellow-500 mr-2 mt-1"></i> Complicações em até 30% dos casos</li>
146
+ </ul>
147
+ <div class="mt-4 p-4 bg-blue-50 rounded-lg">
148
+ <p class="text-blue-800 font-semibold"><i class="fas fa-lightbulb text-blue-500 mr-2"></i> A avaliação cuidadosa é essencial para reduzir morbimortalidade</p>
149
+ </div>
150
+ </div>
151
+ </div>
152
+ </div>
153
+ </div>
154
+ </div>
155
+
156
+ <!-- Slide 4 - Liver Functions -->
157
+ <div class="slide fade-in">
158
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
159
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Funções Hepáticas Relevantes para Anestesia</h2>
160
+
161
+ <div class="grid grid-cols-1 md:grid-cols-2 lg:grid-cols-3 gap-6">
162
+ <div class="bg-gradient-to-b from-blue-50 to-blue-100 p-6 rounded-xl shadow hover:shadow-lg transition duration-300">
163
+ <div class="text-blue-600 text-4xl mb-4">
164
+ <i class="fas fa-pills"></i>
165
+ </div>
166
+ <h3 class="text-xl font-bold text-blue-800 mb-3">Metabolismo de Drogas</h3>
167
+ <p class="text-gray-700">O fígado metaboliza a maioria dos agentes anestésicos através das enzimas do citocromo P450.</p>
168
+ </div>
169
+
170
+ <div class="bg-gradient-to-b from-green-50 to-green-100 p-6 rounded-xl shadow hover:shadow-lg transition duration-300">
171
+ <div class="text-green-600 text-4xl mb-4">
172
+ <i class="fas fa-tint"></i>
173
+ </div>
174
+ <h3 class="text-xl font-bold text-green-800 mb-3">Síntese de Proteínas</h3>
175
+ <p class="text-gray-700">Produz albumina e fatores de coagulação (II, V, VII, IX, X), essenciais para ligação de drogas e hemostasia.</p>
176
+ </div>
177
+
178
+ <div class="bg-gradient-to-b from-purple-50 to-purple-100 p-6 rounded-xl shadow hover:shadow-lg transition duration-300">
179
+ <div class="text-purple-600 text-4xl mb-4">
180
+ <i class="fas fa-filter"></i>
181
+ </div>
182
+ <h3 class="text-xl font-bold text-purple-800 mb-3">Desintoxicação</h3>
183
+ <p class="text-gray-700">Remove amônia, bilirrubina e outras toxinas que podem afetar a função cerebral.</p>
184
+ </div>
185
+
186
+ <div class="bg-gradient-to-b from-yellow-50 to-yellow-100 p-6 rounded-xl shadow hover:shadow-lg transition duration-300">
187
+ <div class="text-yellow-600 text-4xl mb-4">
188
+ <i class="fas fa-sugar-lump"></i>
189
+ </div>
190
+ <h3 class="text-xl font-bold text-yellow-800 mb-3">Metabolismo Energético</h3>
191
+ <p class="text-gray-700">Gliconeogênese, armazenamento de glicogênio e metabolismo lipídico.</p>
192
+ </div>
193
+
194
+ <div class="bg-gradient-to-b from-red-50 to-red-100 p-6 rounded-xl shadow hover:shadow-lg transition duration-300">
195
+ <div class="text-red-600 text-4xl mb-4">
196
+ <i class="fas fa-water"></i>
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+ </div>
198
+ <h3 class="text-xl font-bold text-red-800 mb-3">Volume Sanguíneo</h3>
199
+ <p class="text-gray-700">Armazena ~10% do volume sanguíneo total e regula o fluxo portal.</p>
200
+ </div>
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+
202
+ <div class="bg-gradient-to-b from-indigo-50 to-indigo-100 p-6 rounded-xl shadow hover:shadow-lg transition duration-300">
203
+ <div class="text-indigo-600 text-4xl mb-4">
204
+ <i class="fas fa-shield-alt"></i>
205
+ </div>
206
+ <h3 class="text-xl font-bold text-indigo-800 mb-3">Função Imune</h3>
207
+ <p class="text-gray-700">Células de Kupffer filtram bactérias e endotoxinas da circulação portal.</p>
208
+ </div>
209
+ </div>
210
+ </div>
211
+ </div>
212
+
213
+ <!-- Slide 5 - Child-Pugh Classification -->
214
+ <div class="slide fade-in">
215
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
216
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Classificação de Child-Pugh</h2>
217
+
218
+ <div class="bg-blue-50 p-6 rounded-lg shadow mb-8">
219
+ <p class="text-blue-800 text-lg mb-4"><i class="fas fa-info-circle text-blue-500 mr-2"></i> Sistema de escore que avalia a gravidade da doença hepática e prediz mortalidade perioperatória.</p>
220
+
221
+ <div class="overflow-x-auto">
222
+ <table class="min-w-full bg-white rounded-lg overflow-hidden shadow">
223
+ <thead class="bg-blue-600 text-white">
224
+ <tr>
225
+ <th class="py-3 px-4 text-left">Parâmetro</th>
226
+ <th class="py-3 px-4 text-center">1 ponto</th>
227
+ <th class="py-3 px-4 text-center">2 pontos</th>
228
+ <th class="py-3 px-4 text-center">3 pontos</th>
229
+ </tr>
230
+ </thead>
231
+ <tbody class="divide-y divide-gray-200">
232
+ <tr class="hover:bg-gray-50">
233
+ <td class="py-3 px-4 font-medium">Bilirrubina (mg/dL)</td>
234
+ <td class="py-3 px-4 text-center">&lt;2</td>
235
+ <td class="py-3 px-4 text-center">2-3</td>
236
+ <td class="py-3 px-4 text-center">&gt;3</td>
237
+ </tr>
238
+ <tr class="hover:bg-gray-50">
239
+ <td class="py-3 px-4 font-medium">Albumina (g/dL)</td>
240
+ <td class="py-3 px-4 text-center">&gt;3.5</td>
241
+ <td class="py-3 px-4 text-center">2.8-3.5</td>
242
+ <td class="py-3 px-4 text-center">&lt;2.8</td>
243
+ </tr>
244
+ <tr class="hover:bg-gray-50">
245
+ <td class="py-3 px-4 font-medium">INR</td>
246
+ <td class="py-3 px-4 text-center">&lt;1.7</td>
247
+ <td class="py-3 px-4 text-center">1.7-2.3</td>
248
+ <td class="py-3 px-4 text-center">&gt;2.3</td>
249
+ </tr>
250
+ <tr class="hover:bg-gray-50">
251
+ <td class="py-3 px-4 font-medium">Ascite</td>
252
+ <td class="py-3 px-4 text-center">Ausente</td>
253
+ <td class="py-3 px-4 text-center">Leve-moderada</td>
254
+ <td class="py-3 px-4 text-center">Refratária</td>
255
+ </tr>
256
+ <tr class="hover:bg-gray-50">
257
+ <td class="py-3 px-4 font-medium">Encefalopatia</td>
258
+ <td class="py-3 px-4 text-center">Ausente</td>
259
+ <td class="py-3 px-4 text-center">Grau I-II</td>
260
+ <td class="py-3 px-4 text-center">Grau III-IV</td>
261
+ </tr>
262
+ </tbody>
263
+ </table>
264
+ </div>
265
+ </div>
266
+
267
+ <div class="grid grid-cols-1 md:grid-cols-3 gap-6">
268
+ <div class="bg-green-50 p-4 rounded-lg shadow text-center">
269
+ <h3 class="text-xl font-bold text-green-800 mb-2">Child A (5-6 pontos)</h3>
270
+ <p class="text-gray-700">Mortalidade perioperatória: 10%</p>
271
+ <p class="text-gray-700">Sobrevida em 1 ano: 100%</p>
272
+ </div>
273
+ <div class="bg-yellow-50 p-4 rounded-lg shadow text-center">
274
+ <h3 class="text-xl font-bold text-yellow-800 mb-2">Child B (7-9 pontos)</h3>
275
+ <p class="text-gray-700">Mortalidade perioperatória: 30%</p>
276
+ <p class="text-gray-700">Sobrevida em 1 ano: 80%</p>
277
+ </div>
278
+ <div class="bg-red-50 p-4 rounded-lg shadow text-center">
279
+ <h3 class="text-xl font-bold text-red-800 mb-2">Child C (10-15 pontos)</h3>
280
+ <p class="text-gray-700">Mortalidade perioperatória: 50-80%</p>
281
+ <p class="text-gray-700">Sobrevida em 1 ano: 45%</p>
282
+ </div>
283
+ </div>
284
+ </div>
285
+ </div>
286
+
287
+ <!-- Slide 6 - MELD Score -->
288
+ <div class="slide fade-in">
289
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
290
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Escore MELD (Model for End-Stage Liver Disease)</h2>
291
+
292
+ <div class="bg-indigo-50 p-6 rounded-lg shadow mb-8">
293
+ <p class="text-indigo-800 text-lg mb-4"><i class="fas fa-calculator text-indigo-500 mr-2"></i> MELD = 3,78 × ln(bilirrubina [mg/dL]) + 11,2 × ln(INR) + 9,57 × ln(creatinina [mg/dL]) + 6,43</p>
294
+
295
+ <div class="grid grid-cols-1 md:grid-cols-2 gap-8">
296
+ <div>
297
+ <h3 class="text-xl font-semibold text-gray-700 mb-4">Interpretação do MELD</h3>
298
+ <div class="space-y-4">
299
+ <div class="flex items-start">
300
+ <div class="bg-green-500 text-white rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">1</div>
301
+ <div>
302
+ <p class="font-medium text-gray-800">MELD &lt;10</p>
303
+ <p class="text-gray-600">Baixo risco perioperatório (mortalidade ~5%)</p>
304
+ </div>
305
+ </div>
306
+ <div class="flex items-start">
307
+ <div class="bg-yellow-500 text-white rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">2</div>
308
+ <div>
309
+ <p class="font-medium text-gray-800">MELD 10-15</p>
310
+ <p class="text-gray-600">Risco intermediário (mortalidade ~15%)</p>
311
+ </div>
312
+ </div>
313
+ <div class="flex items-start">
314
+ <div class="bg-orange-500 text-white rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">3</div>
315
+ <div>
316
+ <p class="font-medium text-gray-800">MELD 16-20</p>
317
+ <p class="text-gray-600">Alto risco (mortalidade ~25%)</p>
318
+ </div>
319
+ </div>
320
+ <div class="flex items-start">
321
+ <div class="bg-red-500 text-white rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">4</div>
322
+ <div>
323
+ <p class="font-medium text-gray-800">MELD &gt;20</p>
324
+ <p class="text-gray-600">Risco muito alto (mortalidade &gt;50%)</p>
325
+ </div>
326
+ </div>
327
+ </div>
328
+ </div>
329
+
330
+ <div>
331
+ <h3 class="text-xl font-semibold text-gray-700 mb-4">Vantagens do MELD</h3>
332
+ <ul class="space-y-3 text-gray-700">
333
+ <li class="flex items-start"><i class="fas fa-check-circle text-green-500 mr-2 mt-1"></i> Objetivo (baseado em exames laboratoriais)</li>
334
+ <li class="flex items-start"><i class="fas fa-check-circle text-green-500 mr-2 mt-1"></i> Melhor preditor de mortalidade em 3 meses</li>
335
+ <li class="flex items-start"><i class="fas fa-check-circle text-green-500 mr-2 mt-1"></i> Útil para priorização de transplante</li>
336
+ <li class="flex items-start"><i class="fas fa-check-circle text-green-500 mr-2 mt-1"></i> Não depende de achados subjetivos</li>
337
+ </ul>
338
+
339
+ <div class="mt-6 p-4 bg-blue-100 rounded-lg">
340
+ <p class="text-blue-800"><i class="fas fa-exclamation-triangle text-blue-500 mr-2"></i> <strong>Limitação:</strong> Não considera hipertensão portal ou encefalopatia</p>
341
+ </div>
342
+ </div>
343
+ </div>
344
+ </div>
345
+
346
+ <div class="bg-white p-6 rounded-lg shadow border border-blue-200">
347
+ <h3 class="text-xl font-semibold text-blue-700 mb-4">Recomendações Baseadas no MELD</h3>
348
+ <div class="flowchart">
349
+ <div class="flow-step">MELD &lt;10 → Procedimento geralmente seguro</div>
350
+ <div class="flow-arrow">↓</div>
351
+ <div class="flow-step">MELD 10-15 → Avaliar risco-benefício cuidadosamente</div>
352
+ <div class="flow-arrow">↓</div>
353
+ <div class="flow-step">MELD &gt;15 → Considerar adiar cirurgia eletiva</div>
354
+ <div class="flow-arrow">↓</div>
355
+ <div class="flow-step">MELD &gt;25 → Evitar cirurgias eletivas</div>
356
+ </div>
357
+ </div>
358
+ </div>
359
+ </div>
360
+
361
+ <!-- Slide 7 - Preoperative Evaluation -->
362
+ <div class="slide fade-in">
363
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
364
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Avaliação Pré-Operatória</h2>
365
+
366
+ <div class="grid grid-cols-1 lg:grid-cols-2 gap-8">
367
+ <div>
368
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
369
+ <i class="fas fa-clipboard-check text-blue-500 mr-3"></i> Componentes Essenciais
370
+ </h3>
371
+ <div class="bg-gray-50 p-6 rounded-lg shadow">
372
+ <ul class="space-y-4 text-gray-700">
373
+ <li class="flex items-start">
374
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">1</span>
375
+ <span>História completa e exame físico (buscar sinais de hipertensão portal, encefalopatia)</span>
376
+ </li>
377
+ <li class="flex items-start">
378
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">2</span>
379
+ <span>Classificação Child-Pugh e cálculo do MELD</span>
380
+ </li>
381
+ <li class="flex items-start">
382
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">3</span>
383
+ <span>Exames laboratoriais: hemograma, coagulograma, função hepática, eletrólitos, creatinina</span>
384
+ </li>
385
+ <li class="flex items-start">
386
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">4</span>
387
+ <span>Avaliação cardiovascular (ECG, ecocardiograma se indicado)</span>
388
+ </li>
389
+ <li class="flex items-start">
390
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">5</span>
391
+ <span>Avaliação pulmonar (gasometria, espirometria se cirrose)</span>
392
+ </li>
393
+ <li class="flex items-start">
394
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">6</span>
395
+ <span>Endoscopia digestiva alta (rastreio de varizes)</span>
396
+ </li>
397
+ </ul>
398
+ </div>
399
+ </div>
400
+
401
+ <div>
402
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
403
+ <i class="fas fa-exclamation-triangle text-red-500 mr-3"></i> Fatores de Alto Risco
404
+ </h3>
405
+ <div class="bg-red-50 p-6 rounded-lg shadow">
406
+ <div class="space-y-4">
407
+ <div class="flex items-start">
408
+ <div class="bg-red-100 text-red-800 rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">
409
+ <i class="fas fa-skull-crossbones"></i>
410
+ </div>
411
+ <div>
412
+ <p class="font-bold text-red-800">Child-Pugh C ou MELD &gt;15</p>
413
+ <p class="text-gray-700">Mortalidade perioperatória significativamente aumentada</p>
414
+ </div>
415
+ </div>
416
+
417
+ <div class="flex items-start">
418
+ <div class="bg-red-100 text-red-800 rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">
419
+ <i class="fas fa-tint"></i>
420
+ </div>
421
+ <div>
422
+ <p class="font-bold text-red-800">Hiponatremia &lt;130 mEq/L</p>
423
+ <p class="text-gray-700">Preditor independente de mortalidade</p>
424
+ </div>
425
+ </div>
426
+
427
+ <div class="flex items-start">
428
+ <div class="bg-red-100 text-red-800 rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">
429
+ <i class="fas fa-brain"></i>
430
+ </div>
431
+ <div>
432
+ <p class="font-bold text-red-800">Encefalopatia hepática</p>
433
+ <p class="text-gray-700">Aumenta risco de complicações neurológicas</p>
434
+ </div>
435
+ </div>
436
+
437
+ <div class="flex items-start">
438
+ <div class="bg-red-100 text-red-800 rounded-full w-8 h-8 flex items-center justify-center mr-3 mt-1">
439
+ <i class="fas fa-heartbeat"></i>
440
+ </div>
441
+ <div>
442
+ <p class="font-bold text-red-800">Cardiomiopatia cirrótica</p>
443
+ <p class="text-gray-700">Risco aumentado de insuficiência cardíaca</p>
444
+ </div>
445
+ </div>
446
+ </div>
447
+
448
+ <div class="mt-6 p-4 bg-white rounded-lg border border-red-200">
449
+ <p class="text-red-800 font-semibold"><i class="fas fa-lightbulb text-red-500 mr-2"></i> Pacientes com estes fatores exigem avaliação multidisciplinar e otimização pré-operatória</p>
450
+ </div>
451
+ </div>
452
+ </div>
453
+ </div>
454
+ </div>
455
+ </div>
456
+
457
+ <!-- Slide 8 - Preoperative Optimization -->
458
+ <div class="slide fade-in">
459
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
460
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Otimização Pré-Operatória</h2>
461
+
462
+ <div class="grid grid-cols-1 md:grid-cols-2 gap-8">
463
+ <div>
464
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
465
+ <i class="fas fa-flask text-green-500 mr-3"></i> Correção de Anormalidades Laboratoriais
466
+ </h3>
467
+ <div class="bg-green-50 p-6 rounded-lg shadow">
468
+ <ul class="space-y-4 text-gray-700">
469
+ <li class="flex items-start">
470
+ <span class="bg-green-100 text-green-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">1</span>
471
+ <span><strong>Coagulopatia:</strong> Vitamina K (5-10mg IV), FFP (10-15mL/kg), PCC se INR&gt;1.5</span>
472
+ </li>
473
+ <li class="flex items-start">
474
+ <span class="bg-green-100 text-green-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">2</span>
475
+ <span><strong>Trombocitopenia:</strong> Transfusão de plaquetas se &lt;50.000/mm³</span>
476
+ </li>
477
+ <li class="flex items-start">
478
+ <span class="bg-green-100 text-green-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">3</span>
479
+ <span><strong>Anemia:</strong> Transfusão se Hb&lt;7-8g/dL (avaliar risco de sobrecarga volêmica)</span>
480
+ </li>
481
+ <li class="flex items-start">
482
+ <span class="bg-green-100 text-green-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">4</span>
483
+ <span><strong>Hiponatremia:</strong> Correção lenta (não mais que 6-8 mEq/L/dia)</span>
484
+ </li>
485
+ <li class="flex items-start">
486
+ <span class="bg-green-100 text-green-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">5</span>
487
+ <span><strong>Hipoalbuminemia:</strong> Albumina humana 20% se &lt;2,5g/dL</span>
488
+ </li>
489
+ </ul>
490
+ </div>
491
+ </div>
492
+
493
+ <div>
494
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
495
+ <i class="fas fa-procedures text-blue-500 mr-3"></i> Manejo de Complicações da Cirrose
496
+ </h3>
497
+ <div class="bg-blue-50 p-6 rounded-lg shadow">
498
+ <ul class="space-y-4 text-gray-700">
499
+ <li class="flex items-start">
500
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">1</span>
501
+ <span><strong>Ascite:</strong> Paracentese pré-operatória se volumosa (associada a albumina 6-8g/L removido)</span>
502
+ </li>
503
+ <li class="flex items-start">
504
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">2</span>
505
+ <span><strong>Encefalopatia:</strong> Lactulose e rifaximina, evitar sedativos</span>
506
+ </li>
507
+ <li class="flex items-start">
508
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">3</span>
509
+ <span><strong>Varizes:</strong> Beta-bloqueadores não seletivos (propranolol, carvedilol)</span>
510
+ </li>
511
+ <li class="flex items-start">
512
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">4</span>
513
+ <span><strong>Infecção:</strong> Antibioticoprofilaxia em cirurgias de alto risco</span>
514
+ </li>
515
+ <li class="flex items-start">
516
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">5</span>
517
+ <span><strong>Desnutrição:</strong> Suplementação nutricional (35-40 kcal/kg/dia, 1,2-1,5g proteína/kg/dia)</span>
518
+ </li>
519
+ </ul>
520
+ </div>
521
+ </div>
522
+ </div>
523
+
524
+ <div class="mt-8 bg-yellow-50 p-6 rounded-lg shadow">
525
+ <h3 class="text-2xl font-semibold text-yellow-800 mb-4 flex items-center">
526
+ <i class="fas fa-clock text-yellow-500 mr-3"></i> Timing Cirúrgico
527
+ </h3>
528
+ <div class="grid grid-cols-1 md:grid-cols-3 gap-4">
529
+ <div class="bg-white p-4 rounded-lg shadow text-center">
530
+ <p class="font-bold text-green-600">Eletiva</p>
531
+ <p class="text-gray-700">Apenas após otimização completa (Child A/B, MELD&lt;15)</p>
532
+ </div>
533
+ <div class="bg-white p-4 rounded-lg shadow text-center">
534
+ <p class="font-bold text-orange-600">Urgente</p>
535
+ <p class="text-gray-700">Avaliar risco-benefício, otimizar no perioperatório</p>
536
+ </div>
537
+ <div class="bg-white p-4 rounded-lg shadow text-center">
538
+ <p class="font-bold text-red-600">Emergência</p>
539
+ <p class="text-gray-700">Manejo agressivo das complicações durante cirurgia</p>
540
+ </div>
541
+ </div>
542
+ </div>
543
+ </div>
544
+ </div>
545
+
546
+ <!-- Slide 9 - Anesthetic Considerations -->
547
+ <div class="slide fade-in">
548
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
549
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Considerações Anestésicas em Pacientes Hepáticos</h2>
550
+
551
+ <div class="grid grid-cols-1 lg:grid-cols-2 gap-8">
552
+ <div>
553
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
554
+ <i class="fas fa-syringe text-purple-500 mr-3"></i> Farmacologia Anestésica Alterada
555
+ </h3>
556
+ <div class="bg-purple-50 p-6 rounded-lg shadow">
557
+ <div class="mb-6">
558
+ <h4 class="text-lg font-bold text-purple-800 mb-2">Alterações Farmacocinéticas</h4>
559
+ <ul class="space-y-2 text-gray-700">
560
+ <li class="flex items-start"><i class="fas fa-arrow-right text-purple-500 mr-2 mt-1"></i> ↑ Volume de distribuição (↓ albumina, ascite)</li>
561
+ <li class="flex items-start"><i class="fas fa-arrow-right text-purple-500 mr-2 mt-1"></i> ↓ Ligação proteica (↑ fração livre de drogas)</li>
562
+ <li class="flex items-start"><i class="fas fa-arrow-right text-purple-500 mr-2 mt-1"></i> ↓ Metabolismo hepático (↓ atividade enzimática)</li>
563
+ <li class="flex items-start"><i class="fas fa-arrow-right text-purple-500 mr-2 mt-1"></i> ↓ Clearance (↓ fluxo sanguíneo hepático)</li>
564
+ </ul>
565
+ </div>
566
+
567
+ <div>
568
+ <h4 class="text-lg font-bold text-purple-800 mb-2">Alterações Farmacodinâmicas</h4>
569
+ <ul class="space-y-2 text-gray-700">
570
+ <li class="flex items-start"><i class="fas fa-brain text-purple-500 mr-2 mt-1"></i> ↑ Sensibilidade a sedativos (encefalopatia)</li>
571
+ <li class="flex items-start"><i class="fas fa-heart text-purple-500 mr-2 mt-1"></i> ↓ Resposta cardiovascular (cardiomiopatia cirrótica)</li>
572
+ <li class="flex items-start"><i class="fas fa-lungs text-purple-500 mr-2 mt-1"></i> ↑ Shunt pulmonar (HPS)</li>
573
+ </ul>
574
+ </div>
575
+ </div>
576
+ </div>
577
+
578
+ <div>
579
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
580
+ <i class="fas fa-heartbeat text-red-500 mr-3"></i> Considerações Hemodinâmicas
581
+ </h3>
582
+ <div class="bg-red-50 p-6 rounded-lg shadow">
583
+ <div class="mb-6">
584
+ <h4 class="text-lg font-bold text-red-800 mb-2">Circulação Hiperdinâmica</h4>
585
+ <ul class="space-y-2 text-gray-700">
586
+ <li class="flex items-start"><i class="fas fa-tachometer-alt text-red-500 mr-2 mt-1"></i> ↑ Débito cardíaco (2-3x normal)</li>
587
+ <li class="flex items-start"><i class="fas fa-water text-red-500 mr-2 mt-1"></i> ↓ Resistência vascular sistêmica</li>
588
+ <li class="flex items-start"><i class="fas fa-vial text-red-500 mr-2 mt-1"></i> ↓ Pressão de perfusão hepática</li>
589
+ <li class="flex items-start"><i class="fas fa-exchange-alt text-red-500 mr-2 mt-1"></i> ↑ Shunt portossistêmico</li>
590
+ </ul>
591
+ </div>
592
+
593
+ <div>
594
+ <h4 class="text-lg font-bold text-red-800 mb-2">Implicações Anestésicas</h4>
595
+ <ul class="space-y-2 text-gray-700">
596
+ <li class="flex items-start"><i class="fas fa-exclamation-triangle text-red-500 mr-2 mt-1"></i> Hipotensão marcada com indução</li>
597
+ <li class="flex items-start"><i class="fas fa-exclamation-triangle text-red-500 mr-2 mt-1"></i> Resposta exagerada a vasopressores</li>
598
+ <li class="flex items-start"><i class="fas fa-exclamation-triangle text-red-500 mr-2 mt-1"></i> Risco de isquemia hepática</li>
599
+ </ul>
600
+ </div>
601
+ </div>
602
+ </div>
603
+ </div>
604
+
605
+ <div class="mt-8 bg-blue-50 p-6 rounded-lg shadow">
606
+ <h3 class="text-2xl font-semibold text-blue-800 mb-4 flex items-center">
607
+ <i class="fas fa-balance-scale text-blue-500 mr-3"></i> Princípios Gerais de Manejo
608
+ </h3>
609
+ <div class="grid grid-cols-1 md:grid-cols-3 gap-4">
610
+ <div class="bg-white p-4 rounded-lg shadow">
611
+ <h4 class="font-bold text-blue-700 mb-2">Doses</h4>
612
+ <p class="text-gray-700">Reduzir doses de indutores e opioides em 30-50%</p>
613
+ </div>
614
+ <div class="bg-white p-4 rounded-lg shadow">
615
+ <h4 class="font-bold text-blue-700 mb-2">Monitorização</h4>
616
+ <p class="text-gray-700">Considerar acesso arterial e cateter venoso central</p>
617
+ </div>
618
+ <div class="bg-white p-4 rounded-lg shadow">
619
+ <h4 class="font-bold text-blue-700 mb-2">Hidratação</h4>
620
+ <p class="text-gray-700">Balancear risco de sobrecarga x hipoperfusão hepática</p>
621
+ </div>
622
+ </div>
623
+ </div>
624
+ </div>
625
+ </div>
626
+
627
+ <!-- Slide 10 - Anesthetic Agents -->
628
+ <div class="slide fade-in">
629
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
630
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Agentes Anestésicos em Pacientes Hepáticos</h2>
631
+
632
+ <div class="grid grid-cols-1 lg:grid-cols-2 gap-8 mb-8">
633
+ <div>
634
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
635
+ <i class="fas fa-prescription-bottle-alt text-green-500 mr-3"></i> Indutores Intravenosos
636
+ </h3>
637
+ <div class="bg-green-50 p-6 rounded-lg shadow">
638
+ <table class="min-w-full bg-white rounded-lg overflow-hidden">
639
+ <thead class="bg-green-600 text-white">
640
+ <tr>
641
+ <th class="py-2 px-4 text-left">Droga</th>
642
+ <th class="py-2 px-4 text-left">Considerações</th>
643
+ <th class="py-2 px-4 text-left">Dose</th>
644
+ </tr>
645
+ </thead>
646
+ <tbody class="divide-y divide-gray-200">
647
+ <tr class="hover:bg-gray-50">
648
+ <td class="py-2 px-4 font-medium">Propofol</td>
649
+ <td class="py-2 px-4">Metabolismo hepático, mas clearance bem preservado</td>
650
+ <td class="py-2 px-4">↓ 30-50%</td>
651
+ </tr>
652
+ <tr class="hover:bg-gray-50">
653
+ <td class="py-2 px-4 font-medium">Etomidato</td>
654
+ <td class="py-2 px-4">Boa estabilidade hemodinâmica, mas risco de supressão adrenal</td>
655
+ <td class="py-2 px-4">↓ 20-30%</td>
656
+ </tr>
657
+ <tr class="hover:bg-gray-50">
658
+ <td class="py-2 px-4 font-medium">Tiopental</td>
659
+ <td class="py-2 px-4">Metabolismo hepático, longa duração</td>
660
+ <td class="py-2 px-4">↓ 50%</td>
661
+ </tr>
662
+ <tr class="hover:bg-gray-50">
663
+ <td class="py-2 px-4 font-medium">Ketamina</td>
664
+ <td class="py-2 px-4">Pode aumentar pressão portal, útil em hipovolemia</td>
665
+ <td class="py-2 px-4">Dose padrão</td>
666
+ </tr>
667
+ </tbody>
668
+ </table>
669
+ </div>
670
+ </div>
671
+
672
+ <div>
673
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
674
+ <i class="fas fa-gas-pump text-blue-500 mr-3"></i> Anestésicos Inalatórios
675
+ </h3>
676
+ <div class="bg-blue-50 p-6 rounded-lg shadow">
677
+ <table class="min-w-full bg-white rounded-lg overflow-hidden">
678
+ <thead class="bg-blue-600 text-white">
679
+ <tr>
680
+ <th class="py-2 px-4 text-left">Droga</th>
681
+ <th class="py-2 px-4 text-left">Considerações</th>
682
+ <th class="py-2 px-4 text-left">Recomendação</th>
683
+ </tr>
684
+ </thead>
685
+ <tbody class="divide-y divide-gray-200">
686
+ <tr class="hover:bg-gray-50">
687
+ <td class="py-2 px-4 font-medium">Isoflurano</td>
688
+ <td class="py-2 px-4">↓ Fluxo sanguíneo hepático, risco de hepatotoxicidade</td>
689
+ <td class="py-2 px-4">Evitar</td>
690
+ </tr>
691
+ <tr class="hover:bg-gray-50">
692
+ <td class="py-2 px-4 font-medium">Sevoflurano</td>
693
+ <td class="py-2 px-4">Menos efeito no fluxo hepático, metabolismo mínimo</td>
694
+ <td class="py-2 px-4">Droga de escolha</td>
695
+ </tr>
696
+ <tr class="hover:bg-gray-50">
697
+ <td class="py-2 px-4 font-medium">Desflurano</td>
698
+ <td class="py-2 px-4">Metabolismo mínimo, mas pode causar taquicardia</td>
699
+ <td class="py-2 px-4">Alternativa</td>
700
+ </tr>
701
+ <tr class="hover:bg-gray-50">
702
+ <td class="py-2 px-4 font-medium">Óxido Nitroso</td>
703
+ <td class="py-2 px-4">Risco de embolia gasosa em shunts portossistêmicos</td>
704
+ <td class="py-2 px-4">Evitar</td>
705
+ </tr>
706
+ </tbody>
707
+ </table>
708
+ </div>
709
+ </div>
710
+ </div>
711
+
712
+ <div class="grid grid-cols-1 lg:grid-cols-2 gap-8">
713
+ <div>
714
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
715
+ <i class="fas fa-pills text-purple-500 mr-3"></i> Relaxantes Musculares
716
+ </h3>
717
+ <div class="bg-purple-50 p-6 rounded-lg shadow">
718
+ <table class="min-w-full bg-white rounded-lg overflow-hidden">
719
+ <thead class="bg-purple-600 text-white">
720
+ <tr>
721
+ <th class="py-2 px-4 text-left">Droga</th>
722
+ <th class="py-2 px-4 text-left">Considerações</th>
723
+ <th class="py-2 px-4 text-left">Recomendação</th>
724
+ </tr>
725
+ </thead>
726
+ <tbody class="divide-y divide-gray-200">
727
+ <tr class="hover:bg-gray-50">
728
+ <td class="py-2 px-4 font-medium">Rocurônio</td>
729
+ <td class="py-2 px-4">Excreção biliar, duração prolongada</td>
730
+ <td class="py-2 px-4">↓ Dose ou usar sugammadex</td>
731
+ </tr>
732
+ <tr class="hover:bg-gray-50">
733
+ <td class="py-2 px-4 font-medium">Vecurônio</td>
734
+ <td class="py-2 px-4">Excreção biliar, duração muito prolongada</td>
735
+ <td class="py-2 px-4">Evitar</td>
736
+ </tr>
737
+ <tr class="hover:bg-gray-50">
738
+ <td class="py-2 px-4 font-medium">Cisatracúrio</td>
739
+ <td class="py-2 px-4">Hofmann elimination, independente do fígado</td>
740
+ <td class="py-2 px-4">Droga de escolha</td>
741
+ </tr>
742
+ <tr class="hover:bg-gray-50">
743
+ <td class="py-2 px-4 font-medium">Atracúrio</td>
744
+ <td class="py-2 px-4">Hofmann elimination, mas libera laudanosine</td>
745
+ <td class="py-2 px-4">Alternativa</td>
746
+ </tr>
747
+ </tbody>
748
+ </table>
749
+ </div>
750
+ </div>
751
+
752
+ <div>
753
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
754
+ <i class="fas fa-prescription-bottle text-red-500 mr-3"></i> Analgésicos Opioides
755
+ </h3>
756
+ <div class="bg-red-50 p-6 rounded-lg shadow">
757
+ <table class="min-w-full bg-white rounded-lg overflow-hidden">
758
+ <thead class="bg-red-600 text-white">
759
+ <tr>
760
+ <th class="py-2 px-4 text-left">Droga</th>
761
+ <th class="py-2 px-4 text-left">Considerações</th>
762
+ <th class="py-2 px-4 text-left">Dose</th>
763
+ </tr>
764
+ </thead>
765
+ <tbody class="divide-y divide-gray-200">
766
+ <tr class="hover:bg-gray-50">
767
+ <td class="py-2 px-4 font-medium">Fentanil</td>
768
+ <td class="py-2 px-4">Metabolismo hepático, mas curta duração</td>
769
+ <td class="py-2 px-4">↓ 30%</td>
770
+ </tr>
771
+ <tr class="hover:bg-gray-50">
772
+ <td class="py-2 px-4 font-medium">Remifentanil</td>
773
+ <td class="py-2 px-4">Metabolismo por esterases plasmáticas</td>
774
+ <td class="py-2 px-4">Dose padrão</td>
775
+ </tr>
776
+ <tr class="hover:bg-gray-50">
777
+ <td class="py-2 px-4 font-medium">Morfina</td>
778
+ <td class="py-2 px-4">Metabolismo hepático, glicuronidação</td>
779
+ <td class="py-2 px-4">↓ 50%</td>
780
+ </tr>
781
+ <tr class="hover:bg-gray-50">
782
+ <td class="py-2 px-4 font-medium">Buprenorfina</td>
783
+ <td class="py-2 px-4">Metabolismo hepático, mas alto clearance</td>
784
+ <td class="py-2 px-4">↓ 30%</td>
785
+ </tr>
786
+ </tbody>
787
+ </table>
788
+ </div>
789
+ </div>
790
+ </div>
791
+ </div>
792
+ </div>
793
+
794
+ <!-- Slide 11 - Monitoring -->
795
+ <div class="slide fade-in">
796
+ <div class="bg-white rounded-xl p-8 h-full shadow-xl">
797
+ <h2 class="text-3xl font-bold text-blue-800 mb-8 text-center">Monitorização em Pacientes Hepáticos</h2>
798
+
799
+ <div class="grid grid-cols-1 lg:grid-cols-2 gap-8">
800
+ <div>
801
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
802
+ <i class="fas fa-heartbeat text-red-500 mr-3"></i> Monitorização Básica
803
+ </h3>
804
+ <div class="bg-red-50 p-6 rounded-lg shadow">
805
+ <ul class="space-y-4 text-gray-700">
806
+ <li class="flex items-start">
807
+ <span class="bg-red-100 text-red-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">1</span>
808
+ <span><strong>ECG contínuo:</strong> Arritmias são comuns em cirróticos</span>
809
+ </li>
810
+ <li class="flex items-start">
811
+ <span class="bg-red-100 text-red-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">2</span>
812
+ <span><strong>Pressão arterial não invasiva:</strong> Limitações em hipotensão grave</span>
813
+ </li>
814
+ <li class="flex items-start">
815
+ <span class="bg-red-100 text-red-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">3</span>
816
+ <span><strong>Oximetria de pulso:</strong> Importante na HPS e hipoxemia</span>
817
+ </li>
818
+ <li class="flex items-start">
819
+ <span class="bg-red-100 text-red-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">4</span>
820
+ <span><strong>Capnografia:</strong> Avaliação de ventilação e shunt</span>
821
+ </li>
822
+ <li class="flex items-start">
823
+ <span class="bg-red-100 text-red-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">5</span>
824
+ <span><strong>Temperatura:</strong> Risco aumentado de hipotermia</span>
825
+ </li>
826
+ <li class="flex items-start">
827
+ <span class="bg-red-100 text-red-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">6</span>
828
+ <span><strong>BIS/Entropia:</strong> Útil devido à sensibilidade aumentada</span>
829
+ </li>
830
+ </ul>
831
+ </div>
832
+ </div>
833
+
834
+ <div>
835
+ <h3 class="text-2xl font-semibold text-gray-700 mb-4 flex items-center">
836
+ <i class="fas fa-tachometer-alt text-blue-500 mr-3"></i> Monitorização Avançada
837
+ </h3>
838
+ <div class="bg-blue-50 p-6 rounded-lg shadow">
839
+ <ul class="space-y-4 text-gray-700">
840
+ <li class="flex items-start">
841
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">1</span>
842
+ <span><strong>Pressão arterial invasiva:</strong> Recomendada em Child B/C ou cirurgias maiores</span>
843
+ </li>
844
+ <li class="flex items-start">
845
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">2</span>
846
+ <span><strong>Cateter venoso central:</strong> Avaliação de volemia e administração de vasopressores</span>
847
+ </li>
848
+ <li class="flex items-start">
849
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">3</span>
850
+ <span><strong>Gasometria arterial:</strong> Avaliação de oxigenação, acidose e eletrólitos</span>
851
+ </li>
852
+ <li class="flex items-start">
853
+ <span class="bg-blue-100 text-blue-800 font-bold rounded-full w-6 h-6 flex items-center justify-center mr-3">4</span>
854
+ <span><strong>Ecocardiografia transes
855
+ </html>
prompts.txt ADDED
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1
+ Elabora uma apresentação de slides para os residentes de anestesiologia usando este arquivo como referencia. apresentação de 60 slides bem ilustrativos com imagens, gráficos, tabelas e fluxogramas. Meu nome é Cyro Vieira. /Users/cyrofranklin/Desktop/Protocolo Tx Hepatico HUWC-Hsc.docx