# rt-PA Standing Order Generator (ED-MNRH)

> Clinical decision support and standing order generator for acute ischemic stroke intravenous rt-PA (Alteplase) administration at Maharat Nakhon Ratchasima Hospital (โรงพยาบาลมหาราชนครราชสีมา).

## Overview
Web application and clinical tool for Emergency Medicine physicians, Neurologists, Stroke Fast Track nurses, and Clinical Pharmacists. Calculates exact rt-PA (Alteplase) doses and generates a standardized 4-page A4 hospital standing order document.

- **Canonical URL**: https://rtpamnrh.vercel.app/
- **Organization**: Maharat Nakhon Ratchasima Hospital (โรงพยาบาลมหาราชนครราชสีมา)
- **Clinical Department**: Emergency Department (ED-MNRH) & Stroke Unit
- **OpenAPI Specification**: https://rtpamnrh.vercel.app/openapi.json

## Dose Calculation Regimens

### 1. Standard Dose (0.9 mg/kg, Max 90 mg)
- Guidelines: AHA/ASA Guidelines for Early Management of Acute Ischemic Stroke
- Formula: Total Dose = min(weight * 0.9, 90) mg (rounded to 2 decimal places)
- IV Push (10%): floor(Total Dose * 0.10, 1 decimal place) injected over 1 minute
- IV Drip (90%): Total Dose - IV Push (injected over 60 minutes)

### 2. Alternative Low-Dose (0.6 mg/kg, Max 60 mg)
- Protocol: ENCHANTED Trial Protocol (Asian population / elevated bleeding risk)
- Formula: Total Dose = min(weight * 0.6, 60) mg (rounded to 2 decimal places)
- IV Push (15%): floor(Total Dose * 0.15, 1 decimal place) injected over 1 minute
- IV Drip (85%): Total Dose - IV Push (injected over 60 minutes)

## API Endpoints for AI Agents

- `GET /api/calculate?weight={kg}&regimen={0.9|0.6}`: Calculates rt-PA dose programmatically.
- `POST /api/calculate`: Accepts JSON `{"weight": 70, "regimen": 0.9}` and returns full dosage breakdown with administration instructions.
- `GET /api/protocols`: Returns clinical dosage regimens, Door-to-Needle timeline benchmarks, and standing order page metadata.
- `GET /api/health`: Service status, capabilities, and agent discovery.
- `GET /openapi.json`: Full OpenAPI 3.1.0 specification.
- `GET /?mode=agent`: Machine-readable agent view.

## Clinical Safety Guarantees
- Zero PHI Storage: Patient name and Citizen ID are never stored or logged. Patient identification relies on hospital barcode stickers on printed orders.
- Mathematical Precision: Push dose + Drip dose strictly equals Total dose across 100% of weights.
- Offline-First Resilience: Standalone single-file operation for hospital ER workstations.