{
  "scenario": {
    "id": "cardiac-arrest-post-mi-01",
    "name": "Cardiac Arrest Post-MI with Hemodynamic Collapse",
    "description": "65-year-old male admitted for chest pain evolving into STEMI with hemodynamic collapse over 3 hours. Rising HR, falling BP and SpO2 culminate in near-arrest requiring vasopressor support. Triggers NEWS2_EMERGENCY and RAPID_DETERIORATION.",
    "durationMinutes": 180,
    "tags": [
      "cardiac",
      "stemi",
      "arrest",
      "deterioration",
      "emergency",
      "cardiology",
      "vasopressor"
    ]
  },
  "patient": {
    "firstName": "Robert",
    "lastName": "Callahan",
    "dateOfBirth": "1961-03-14",
    "gender": "Male"
  },
  "encounter": {
    "department": "Emergency",
    "encounterType": "Emergency",
    "attendingPhysician": "Dr. Anita Sharma",
    "roomBed": "ED-03A",
    "admissionReason": "Acute chest pain radiating to left arm, diaphoresis"
  },
  "events": [
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 82,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Baseline triage \u2014 chest pain but vitals near-normal. NEWS2=0"
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 18,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 138,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 85,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.0,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "GCS_EYE",
        "value": 4,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "GCS_VERBAL",
        "value": 5,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "GCS_MOTOR",
        "value": 6,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 85,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Slight increase in HR, physiological noise. NEWS2=0"
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 17,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 136,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 84,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.1,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 15,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 88,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Mild tachycardia trend beginning. NEWS2=0"
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 18,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 132,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 80,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.0,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 30,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 32,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.2,
        "unit": "mEq/L",
        "source": "Lab"
      },
      "note": "First lab draw \u2014 troponin ordered, potassium and glucose normal"
    },
    {
      "offsetMinutes": 32,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 118,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 27,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Troponin I, stat",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 32,
      "type": "order_result",
      "data": {
        "orderDescription": "Troponin I, stat",
        "resultSummary": "Troponin I 0.08 ng/mL (borderline elevated, reference <0.04)"
      },
      "note": "Initial troponin mildly elevated, consistent with early ACS"
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 93,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "HR crosses into warning range (91-110). NEWS2: HR=1. Total=1"
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 19,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 128,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 78,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.0,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 98,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Tachycardia progressing, BP starting to drop. NEWS2: HR=1. Total=1"
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 20,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 122,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 75,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.1,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 106,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Accelerating deterioration \u2014 HR rising, SpO2 dropping. NEWS2: HR=1, RR=2, SpO2=1. Total=4"
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 22,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 115,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 71,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.0,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 95,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 112,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "HR enters critical range (>=111). NEWS2: HR=2, RR=2, SBP=1, SpO2=1. Total=6 -> WARNING"
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 23,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 108,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 66,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.1,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 94,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 121,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Rapid worsening \u2014 NEWS2: HR=2, RR=2, SBP=2, SpO2=2. Total=8 -> EMERGENCY. RAPID_DETERIORATION triggered."
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 24,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 100,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 62,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.0,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 93,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 128,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Severe deterioration \u2014 NEWS2: HR=2, RR=3, SBP=3, SpO2=2. Total=10 -> EMERGENCY (RR single=3, SBP single=3)"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 26,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 92,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 56,
        "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": 92,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 122,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.8,
        "unit": "mEq/L",
        "source": "Lab"
      },
      "note": "Repeat labs \u2014 potassium rising, glucose elevated (stress response), troponin markedly elevated"
    },
    {
      "offsetMinutes": 122,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 168,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 122,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 3.4,
        "unit": "mmol/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 117,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Troponin I, repeat stat",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 122,
      "type": "order_result",
      "data": {
        "orderDescription": "Troponin I, repeat stat",
        "resultSummary": "Troponin I 8.6 ng/mL (markedly elevated, reference <0.04) \u2014 consistent with acute STEMI"
      },
      "note": "Troponin confirms large territory MI"
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 134,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Critical phase \u2014 NEWS2: HR=3, RR=3, SBP=3, SpO2=3, AVPU=3. Total=15 -> EMERGENCY"
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 28,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 86,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 50,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.7,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 91,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 130,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 142,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Peak crisis \u2014 near-arrest. NEWS2: HR=3, RR=3, SBP=3, SpO2=3, AVPU=3. Total=15 -> EMERGENCY"
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 30,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 80,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 46,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.5,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 89,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 140,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "medication",
      "data": {
        "drugName": "aspirin",
        "dose": 325,
        "doseUnit": "mg",
        "route": "PO",
        "administeredBy": "nurse-rn-2"
      },
      "note": "Resuscitation medications initiated \u2014 aspirin for ACS"
    },
    {
      "offsetMinutes": 151,
      "type": "medication",
      "data": {
        "drugName": "heparin",
        "dose": 5000,
        "doseUnit": "units",
        "route": "IV",
        "administeredBy": "nurse-rn-2"
      },
      "note": "Anticoagulation for STEMI"
    },
    {
      "offsetMinutes": 153,
      "type": "medication",
      "data": {
        "drugName": "morphine sulfate",
        "dose": 4,
        "doseUnit": "mg",
        "route": "IV",
        "administeredBy": "nurse-rn-2"
      },
      "note": "Analgesia for chest pain and afterload reduction"
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 138,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "O2 applied, medications given. NEWS2: HR=3, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2. Total=17 -> EMERGENCY"
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 28,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 82,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 48,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.6,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 90,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      },
      "note": "High-flow nasal cannula 15L/min started"
    },
    {
      "offsetMinutes": 158,
      "type": "medication",
      "data": {
        "drugName": "norepinephrine",
        "dose": 8,
        "doseUnit": "mcg/min",
        "route": "IV",
        "administeredBy": "nurse-rn-2"
      },
      "note": "Vasopressor initiated for cardiogenic shock"
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 128,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Early vasopressor response. NEWS2: HR=2, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2. Total=16 -> EMERGENCY"
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 26,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 88,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 52,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.8,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 91,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 118,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "End of scenario \u2014 stabilizing on vasopressor + O2 but still critical. NEWS2: HR=2, RR=2, SBP=2, SpO2=2, O2=2. Total=10 -> EMERGENCY. Transfer to cath lab pending."
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 24,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 94,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 58,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 36.9,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 93,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 175,
      "type": "order",
      "data": {
        "orderType": "Imaging",
        "description": "12-Lead ECG, stat",
        "orderedBy": "Dr. Anita Sharma"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "order_result",
      "data": {
        "orderDescription": "12-Lead ECG, stat",
        "resultSummary": "ST elevation in leads II, III, aVF with reciprocal ST depression in I, aVL \u2014 inferior STEMI confirmed, cardiology consulted for emergent PCI"
      },
      "note": "ECG confirms inferior STEMI, cath lab activation"
    }
  ],
  "expectedOutcomes": [
    {
      "afterOffsetMinutes": 45,
      "type": "alert",
      "alertType": "WARNING_HEART_RATE",
      "description": "HR enters warning range (93 bpm, 91-110 range scores NEWS2=1)"
    },
    {
      "afterOffsetMinutes": 90,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 6,
      "description": "NEWS2 reaches 6 (HR=2, RR=2, SBP=1, SpO2=1) -> NEWS2_WARNING threshold"
    },
    {
      "afterOffsetMinutes": 90,
      "type": "alert",
      "alertType": "NEWS2_WARNING",
      "description": "NEWS2 total of 6 triggers WARNING (5-6 range)"
    },
    {
      "afterOffsetMinutes": 105,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 8,
      "description": "NEWS2 reaches 8 (HR=2, RR=2, SBP=2, SpO2=2) -> exceeds EMERGENCY threshold of 7"
    },
    {
      "afterOffsetMinutes": 105,
      "type": "alert",
      "alertType": "NEWS2_EMERGENCY",
      "description": "NEWS2 total of 8 (>=7) triggers EMERGENCY alert \u2014 rapid hemodynamic compromise"
    },
    {
      "afterOffsetMinutes": 105,
      "type": "alert",
      "alertType": "RAPID_DETERIORATION",
      "description": "HR rose from 88 to 121 (+33 bpm) and SBP fell from 132 to 100 (-32 mmHg) within 75 minutes, SpO2 dropped from 97 to 93 \u2014 consistent with rapid deterioration detection"
    },
    {
      "afterOffsetMinutes": 130,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 15,
      "description": "NEWS2 reaches 15 (HR=3, RR=3, SBP=3, SpO2=3, AVPU=3) \u2014 critical hemodynamic collapse with altered consciousness"
    },
    {
      "afterOffsetMinutes": 155,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 17,
      "description": "NEWS2 reaches 17 (HR=3, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2) \u2014 peak score with supplemental oxygen added"
    },
    {
      "afterOffsetMinutes": 180,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 10,
      "description": "NEWS2 stabilizes at 10 (HR=2, RR=2, SBP=2, SpO2=2, O2=2) \u2014 still EMERGENCY but improving on vasopressor support"
    }
  ]
}
