{
  "scenario": {
    "id": "sepsis-sofa-progression-01",
    "name": "Pneumonia → Multi-Organ Dysfunction (SOFA Pathway)",
    "description": "ICU patient with community-acquired pneumonia. Initial SOFA baseline ~2. Over 4 hours, respiratory failure, thrombocytopenia, and renal impairment develop. qSOFA screen fires early; SOFA delta ≥ 2 triggers sepsis bundle. GCS remains 15 until late decline to 13.",
    "durationMinutes": 240,
    "tags": ["sofa", "sepsis", "multi-organ", "gcs", "qsofa-screen"]
  },
  "patient": {
    "firstName": "Margaret",
    "lastName": "Torres",
    "dateOfBirth": "1954-03-18",
    "gender": "Female"
  },
  "encounter": {
    "department": "Icu",
    "encounterType": "Inpatient",
    "attendingPhysician": "Dr. Elena Vasquez",
    "roomBed": "ICU-2A-6",
    "admissionReason": "Community-acquired pneumonia, worsening dyspnea"
  },
  "events": [
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "HEART_RATE", "value": 88, "unit": "bpm", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "RESP_RATE", "value": 18, "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": 78, "unit": "mmHg", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "TEMP_C", "value": 38.2, "unit": "°C", "source": "Manual" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "SPO2", "value": 94, "unit": "%", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "SUPPLEMENTAL_O2", "value": 1, "unit": "flag", "source": "Manual" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "GCS_EYE", "value": 4, "unit": "score", "source": "Manual" },
      "note": "Baseline GCS 15 — fully alert"
    },
    {
      "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": 5,
      "type": "observation",
      "data": { "code": "PAO2_MMHG", "value": 85, "unit": "mmHg", "source": "Lab" },
      "note": "ABG baseline — P/F ~283 at FiO2 30%"
    },
    {
      "offsetMinutes": 5,
      "type": "observation",
      "data": { "code": "FIO2_PCT", "value": 30, "unit": "%", "source": "Manual" }
    },
    {
      "offsetMinutes": 5,
      "type": "observation",
      "data": { "code": "PLATELET_K_UL", "value": 185, "unit": "k/µL", "source": "Lab" }
    },
    {
      "offsetMinutes": 5,
      "type": "observation",
      "data": { "code": "BILIRUBIN_MG_DL", "value": 0.9, "unit": "mg/dL", "source": "Lab" }
    },
    {
      "offsetMinutes": 5,
      "type": "observation",
      "data": { "code": "CREATININE_MG_DL", "value": 1.0, "unit": "mg/dL", "source": "Lab" }
    },
    {
      "offsetMinutes": 5,
      "type": "observation",
      "data": { "code": "LACTATE_MMOL_L", "value": 1.8, "unit": "mmol/L", "source": "Lab" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "HEART_RATE", "value": 102, "unit": "bpm", "source": "Device" },
      "note": "Mild tachycardia; qSOFA RR ≥ 22"
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "RESP_RATE", "value": 24, "unit": "/min", "source": "Device" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "SYSTOLIC_BP", "value": 105, "unit": "mmHg", "source": "Device" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "TEMP_C", "value": 38.9, "unit": "°C", "source": "Manual" }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "RESP_RATE", "value": 28, "unit": "/min", "source": "Device" }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "SYSTOLIC_BP", "value": 92, "unit": "mmHg", "source": "Device" },
      "note": "SBP ≤ 100 → qSOFA ≥ 2 → QSOFA_SCREEN"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "DIASTOLIC_BP", "value": 58, "unit": "mmHg", "source": "Device" }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "SPO2", "value": 89, "unit": "%", "source": "Device" }
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": { "code": "PAO2_MMHG", "value": 62, "unit": "mmHg", "source": "Lab" },
      "note": "Repeat ABG — P/F 155 at FiO2 40% → SOFA Resp 2"
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": { "code": "FIO2_PCT", "value": 40, "unit": "%", "source": "Manual" }
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": { "code": "PLATELET_K_UL", "value": 88, "unit": "k/µL", "source": "Lab" },
      "note": "Thrombocytopenia → SOFA Coag 1"
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": { "code": "CREATININE_MG_DL", "value": 2.3, "unit": "mg/dL", "source": "Lab" },
      "note": "AKI → SOFA Renal 2"
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": { "code": "LACTATE_MMOL_L", "value": 3.1, "unit": "mmol/L", "source": "Lab" }
    },
    {
      "offsetMinutes": 130,
      "type": "medication",
      "data": {
        "drugName": "Norepinephrine",
        "dose": 0.05,
        "doseUnit": "mcg/kg/min",
        "route": "IV",
        "administeredBy": "RN-Torres"
      },
      "note": "Vasopressor → SOFA CV 3; delta ≥ 2 → SOFA_SEPSIS + bundle"
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": { "code": "PAO2_MMHG", "value": 55, "unit": "mmHg", "source": "Lab" }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": { "code": "FIO2_PCT", "value": 60, "unit": "%", "source": "Manual" }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": { "code": "PLATELET_K_UL", "value": 42, "unit": "k/µL", "source": "Lab" }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": { "code": "CREATININE_MG_DL", "value": 3.8, "unit": "mg/dL", "source": "Lab" }
    },
    {
      "offsetMinutes": 200,
      "type": "observation",
      "data": { "code": "GCS_EYE", "value": 3, "unit": "score", "source": "Manual" },
      "note": "GCS 13 — SOFA CNS 1"
    },
    {
      "offsetMinutes": 200,
      "type": "observation",
      "data": { "code": "GCS_VERBAL", "value": 4, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 200,
      "type": "observation",
      "data": { "code": "GCS_MOTOR", "value": 6, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 210,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "orderCode": "BLOOD_CULTURE",
        "description": "Blood cultures x2 — sepsis workup",
        "orderedBy": "Dr. Elena Vasquez"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "orderCode": "SERUM_LACTATE",
        "description": "Repeat lactate",
        "orderedBy": "Dr. Elena Vasquez"
      }
    }
  ],
  "expectedOutcomes": [
    {
      "afterOffsetMinutes": 120,
      "type": "alert",
      "alertType": "QSOFA_SCREEN",
      "description": "qSOFA ≥ 2 — bedside screen positive, recommend SOFA labs"
    },
    {
      "afterOffsetMinutes": 130,
      "type": "alert",
      "alertType": "SOFA_SEPSIS",
      "narrativeContains": "SOFA",
      "description": "SOFA delta ≥ 2 from baseline after labs + vasopressor"
    },
    {
      "afterOffsetMinutes": 130,
      "type": "bundle",
      "description": "Sepsis bundle auto-created; triggeringAlertType = SOFA_SEPSIS"
    }
  ]
}