{
  "scenario": {
    "id": "post-op-hemorrhage-01",
    "name": "Post-Op Hemorrhagic Shock",
    "description": "58-year-old male, 2 hours post open abdominal surgery (colectomy), develops occult intra-abdominal hemorrhage over 4 hours. Classic hemorrhagic shock progression: compensatory tachycardia gives way to falling blood pressure, dropping SpO2, and altered consciousness. Temperature remains relatively stable throughout. Fluid and blood product resuscitation initiated at T+180 with partial stabilization by scenario end.",
    "durationMinutes": 240,
    "tags": [
      "hemorrhage",
      "post-op",
      "surgery",
      "shock",
      "deterioration",
      "transfusion",
      "rapid-response"
    ]
  },
  "patient": {
    "firstName": "Gerald",
    "lastName": "Kowalski",
    "dateOfBirth": "1968-03-14",
    "gender": "Male"
  },
  "encounter": {
    "department": "Surgery",
    "encounterType": "Inpatient",
    "attendingPhysician": "Dr. Anita Sharma",
    "roomBed": "SURG-4A-12",
    "admissionReason": "Post-operative monitoring following open colectomy for sigmoid diverticular disease"
  },
  "events": [
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 74,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Post-op baseline \u2014 patient arrived from PACU, awake and oriented, incision clean and dry"
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 14,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 128,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 76,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.8,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 98,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      },
      "note": "Nasal cannula 2L/min \u2014 standard post-op order"
    },
    {
      "offsetMinutes": 1,
      "type": "observation",
      "data": {
        "code": "GCS_EYE",
        "value": 4,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 1,
      "type": "observation",
      "data": {
        "code": "GCS_VERBAL",
        "value": 5,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 1,
      "type": "observation",
      "data": {
        "code": "GCS_MOTOR",
        "value": 6,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 72,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Stable post-op recovery, patient resting comfortably"
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 13,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 130,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 78,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 98,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 1.2,
        "unit": "mmol/L",
        "source": "Lab"
      },
      "note": "Routine post-op labs \u2014 lactate within normal limits"
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.1,
        "unit": "mEq/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 138,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 25,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Post-op CBC and metabolic panel",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "order_result",
      "data": {
        "orderDescription": "Post-op CBC and metabolic panel",
        "resultSummary": "Hgb 12.8 g/dL, Hct 38.4%, WBC 9.2 K/uL, platelets 198 K/uL, BMP within normal limits. Expected post-operative values."
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 76,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Normal post-op fluctuation"
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 14,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 126,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 74,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.9,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 80,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "End of stable phase \u2014 subtle upward HR drift begins"
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 15,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 125,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 73,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.8,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 85,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Early compensatory tachycardia \u2014 occult bleeding suspected in hindsight"
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 16,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 120,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 70,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 88,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "HR rising \u2014 still within normal range but trend is concerning"
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 17,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 118,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 68,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.8,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 95,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "HR now in warning range (91-110) \u2014 compensatory tachycardia accelerating"
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 18,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 112,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 66,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 102,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Hemorrhagic shock Class II \u2014 tachycardia with early hypotension"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 20,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 105,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 62,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.9,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 95,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "GCS_EYE",
        "value": 3,
        "unit": "score",
        "source": "Manual"
      },
      "note": "GCS 11 \u2014 hemorrhagic shock, declining consciousness"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "GCS_VERBAL",
        "value": 4,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "GCS_MOTOR",
        "value": 4,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 121,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 121,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 2.4,
        "unit": "mmol/L",
        "source": "Lab"
      },
      "note": "Stat labs drawn \u2014 lactate elevated above normal, indicating tissue hypoperfusion"
    },
    {
      "offsetMinutes": 122,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.3,
        "unit": "mEq/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 121,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 152,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 115,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Stat CBC and metabolic panel",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "order_result",
      "data": {
        "orderDescription": "Stat CBC and metabolic panel",
        "resultSummary": "Hgb 10.1 g/dL (down from 12.8), Hct 30.3%, WBC 11.8 K/uL, platelets 172 K/uL, lactate 2.4 mmol/L elevated. Hemoglobin drop of 2.7 g/dL in 90 minutes \u2014 active hemorrhage suspected."
      },
      "note": "Significant hemoglobin drop triggers surgical team notification"
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 110,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Rapid deterioration \u2014 hemorrhagic shock Class II-III transition"
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 22,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 98,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 58,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.8,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 94,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 118,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Class III hemorrhagic shock \u2014 critical HR with hypotension"
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 24,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 92,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 54,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 93,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 124,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Peak deterioration \u2014 patient confused, diaphoretic, pale. Rapid response team called."
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 26,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 86,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 50,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.6,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 91,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      },
      "note": "AVPU=1 (Voice) \u2014 patient responding only to verbal stimuli"
    },
    {
      "offsetMinutes": 160,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 128,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Sustained critical state \u2014 awaiting blood bank crossmatch"
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 27,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 84,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 48,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.5,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 90,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 170,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "medication",
      "data": {
        "drugName": "Normal Saline 0.9%",
        "dose": 1000,
        "doseUnit": "mL",
        "route": "IV",
        "administeredBy": "nurse-rn-7"
      },
      "note": "Aggressive fluid resuscitation initiated \u2014 wide-bore IV access x2"
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 130,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Nadir \u2014 resuscitation started, blood products being crossmatched"
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 28,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 82,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 46,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.4,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 89,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 4.1,
        "unit": "mmol/L",
        "source": "Lab"
      },
      "note": "Severely elevated lactate \u2014 significant tissue hypoperfusion"
    },
    {
      "offsetMinutes": 175,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Stat CBC, type and crossmatch",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "order_result",
      "data": {
        "orderDescription": "Stat CBC, type and crossmatch",
        "resultSummary": "Hgb 7.8 g/dL (critical \u2014 down from 10.1 at T+120), Hct 23.4%, platelets 155 K/uL, lactate 4.1 mmol/L. Type and crossmatch: A-positive, 4 units pRBC ordered STAT."
      },
      "note": "Critical hemoglobin triggers massive transfusion protocol consideration"
    },
    {
      "offsetMinutes": 190,
      "type": "medication",
      "data": {
        "drugName": "Packed Red Blood Cells",
        "dose": 1,
        "doseUnit": "unit",
        "route": "IV",
        "administeredBy": "nurse-rn-7"
      },
      "note": "First unit pRBC \u2014 rapid infuser, transfusion started"
    },
    {
      "offsetMinutes": 190,
      "type": "medication",
      "data": {
        "drugName": "Normal Saline 0.9%",
        "dose": 500,
        "doseUnit": "mL",
        "route": "IV",
        "administeredBy": "nurse-rn-12"
      },
      "note": "Concurrent crystalloid via second IV line"
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 126,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Early response to volume resuscitation \u2014 HR beginning to decrease"
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 26,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 86,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 50,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.5,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 90,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 205,
      "type": "medication",
      "data": {
        "drugName": "Packed Red Blood Cells",
        "dose": 1,
        "doseUnit": "unit",
        "route": "IV",
        "administeredBy": "nurse-rn-7"
      },
      "note": "Second unit pRBC started"
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 118,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Responding to transfusion \u2014 HR decreasing, BP improving"
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 24,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 94,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 56,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.6,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 92,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 220,
      "type": "medication",
      "data": {
        "drugName": "Tranexamic Acid",
        "dose": 1,
        "doseUnit": "g",
        "route": "IV",
        "administeredBy": "nurse-rn-7"
      },
      "note": "TXA administered to reduce surgical bleeding"
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 112,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Continued improvement with ongoing transfusion"
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 22,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 100,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 60,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 93,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      },
      "note": "Patient more alert \u2014 responding appropriately to questions"
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 230,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 3.2,
        "unit": "mmol/L",
        "source": "Lab"
      },
      "note": "Lactate trending down from 4.1 \u2014 tissue perfusion improving with resuscitation"
    },
    {
      "offsetMinutes": 225,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Post-transfusion CBC and lactate",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 230,
      "type": "order_result",
      "data": {
        "orderDescription": "Post-transfusion CBC and lactate",
        "resultSummary": "Hgb 9.2 g/dL (up from 7.8, 2 units pRBC given), Hct 27.6%, lactate 3.2 mmol/L (down from 4.1). Surgical team planning return to OR for exploration and hemostasis."
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 106,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "End of scenario \u2014 partial stabilization, patient being prepared for return to OR"
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 21,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 104,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 62,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 94,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    }
  ],
  "expectedOutcomes": [
    {
      "afterOffsetMinutes": 105,
      "type": "alert",
      "alertType": "WARNING_HEART_RATE",
      "description": "HR enters warning range at 95 bpm (91-110 \u2192 NEWS2 HR=1)"
    },
    {
      "afterOffsetMinutes": 120,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 5,
      "description": "NEWS2 reaches 5 at T+120 (HR=1, SBP=1, SpO2=1, O2=2) \u2192 WARNING threshold"
    },
    {
      "afterOffsetMinutes": 120,
      "type": "alert",
      "alertType": "NEWS2_WARNING",
      "description": "NEWS2 WARNING triggered \u2014 score 5 (HR 102=1, SBP 105=1, SpO2 95=1, O2=2)"
    },
    {
      "afterOffsetMinutes": 135,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 7,
      "description": "NEWS2 reaches 8 at T+135 (HR=1, RR=2, SBP=2, SpO2=1, O2=2) \u2192 EMERGENCY threshold"
    },
    {
      "afterOffsetMinutes": 135,
      "type": "alert",
      "alertType": "NEWS2_EMERGENCY",
      "description": "NEWS2 EMERGENCY triggered \u2014 score 8 (HR 110=1, RR 22=2, SBP 98=2, SpO2 94=1, O2=2)"
    },
    {
      "afterOffsetMinutes": 135,
      "type": "alert",
      "alertType": "CRITICAL_SYSTOLIC_BP",
      "description": "SBP drops to 98 mmHg \u2014 enters critical range (\u2264100)"
    },
    {
      "afterOffsetMinutes": 130,
      "type": "alert",
      "alertType": "RAPID_DETERIORATION",
      "description": "Rapid HR increase (74\u2192110 over 135 min) and SBP decrease (128\u219298) detected between T+120 and T+150"
    },
    {
      "afterOffsetMinutes": 160,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 16,
      "description": "NEWS2 peaks at 16 (HR=2, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2) \u2014 multiple single-parameter score=3 triggers"
    },
    {
      "afterOffsetMinutes": 150,
      "type": "alert",
      "alertType": "CRITICAL_SPO2",
      "description": "SpO2 drops to 93% at T+150, enters critical range (\u226493)"
    }
  ]
}
