{
  "scenario": {
    "id": "uti-sepsis-elderly-01",
    "name": "UTI Progressing to Sepsis in Elderly Patient",
    "description": "72-year-old female with UTI progressing to sepsis over 4 hours. qSOFA screen fires first; SOFA delta \u2265 2 triggers sepsis bundle. NEWS2 and bundle compliance still exercised.",
    "durationMinutes": 240,
    "tags": [
      "sepsis",
      "uti",
      "elderly",
      "ed",
      "deterioration",
      "bundle-compliance"
    ]
  },
  "patient": {
    "firstName": "Eleanor",
    "lastName": "Whitfield",
    "dateOfBirth": "1954-02-08",
    "gender": "Female"
  },
  "encounter": {
    "department": "Emergency",
    "encounterType": "Emergency",
    "attendingPhysician": "Dr. Marcus Reyes",
    "roomBed": "ED-07B",
    "admissionReason": "Fever, confusion, dysuria, urinary frequency"
  },
  "events": [
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 78,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Baseline triage vitals"
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 16,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 132,
        "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": 37.4,
        "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": 4,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": {
        "code": "GCS_MOTOR",
        "value": 6,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 76,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Stable with physiological noise"
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 15,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 134,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 77,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 20,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.5,
        "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": 40,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 80,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Subtle upward trend beginning"
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 16,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 129,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 75,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 37.6,
        "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": 45,
      "type": "observation",
      "data": {
        "code": "WBC_K_UL",
        "value": 10.2,
        "unit": "\u00d710\u00b3/\u00b5L",
        "source": "Lab"
      },
      "note": "Initial lab draw \u2014 all within normal limits"
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 1.3,
        "unit": "mmol/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 112,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.1,
        "unit": "mEq/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "PAO2_MMHG",
        "value": 92,
        "unit": "mmHg",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "FIO2_PCT",
        "value": 28,
        "unit": "%",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "PLATELET_K_UL",
        "value": 210,
        "unit": "k/\u00b5L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "BILIRUBIN_MG_DL",
        "value": 0.7,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 45,
      "type": "observation",
      "data": {
        "code": "CREATININE_MG_DL",
        "value": 1.0,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 40,
      "type": "order",
      "data": {
        "orderType": "Lab",
        "description": "Urinalysis with culture",
        "orderedBy": "Dr. Marcus Reyes"
      },
      "note": "Initial UTI workup"
    },
    {
      "offsetMinutes": 45,
      "type": "order_result",
      "data": {
        "orderDescription": "Urinalysis with culture",
        "resultSummary": "Positive nitrites, leukocyte esterase 3+, >100 WBC/hpf"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 84,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Mild tachycardia developing, temp rising"
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 17,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 126,
        "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": 37.9,
        "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": 75,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 91,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "HR crosses into warning range (>90)"
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 18,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 122,
        "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": 38.1,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 75,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "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": 96,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Temp >38.3 + HR >90 \u2014 early sepsis physiology"
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 20,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 116,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 67,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 90,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 38.4,
        "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": 92,
      "type": "order_result",
      "data": {
        "orderDescription": "SEP-1: Blood cultures",
        "resultSummary": "Two sets drawn from separate sites, sent to lab"
      },
      "note": "Sepsis bundle order 1 of 4"
    },
    {
      "offsetMinutes": 95,
      "type": "order_result",
      "data": {
        "orderDescription": "SEP-1: Serum lactate",
        "resultSummary": "Specimen collected, sent to lab"
      },
      "note": "Sepsis bundle order 2 of 4"
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 101,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Continued deterioration \u2014 NEWS2 reaches 5 (WARNING)"
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 21,
        "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": 64,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 38.6,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 95,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 105,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 110,
      "type": "order_result",
      "data": {
        "orderDescription": "SEP-1: Serum lactate",
        "resultSummary": "Lactate 2.4 mmol/L (elevated)"
      },
      "note": "Lactate result confirms tissue hypoperfusion"
    },
    {
      "offsetMinutes": 115,
      "type": "order_result",
      "data": {
        "orderDescription": "SEP-1: Blood cultures",
        "resultSummary": "Pending \u2014 gram stain in progress"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 106,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "NEWS2 = 6, continued deterioration"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 22,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 108,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 61,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 38.9,
        "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": "WBC_K_UL",
        "value": 14.8,
        "unit": "\u00d710\u00b3/\u00b5L",
        "source": "Lab"
      },
      "note": "Repeat labs \u2014 WBC elevated, lactate rising"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 2.8,
        "unit": "mmol/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 121,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 156,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 121,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.6,
        "unit": "mEq/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": {
        "code": "PAO2_MMHG",
        "value": 68,
        "unit": "mmHg",
        "source": "Lab"
      },
      "note": "Worsening gas exchange \u2014 SOFA Resp \u2191"
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": {
        "code": "FIO2_PCT",
        "value": 40,
        "unit": "%",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": {
        "code": "PLATELET_K_UL",
        "value": 95,
        "unit": "k/\u00b5L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 125,
      "type": "observation",
      "data": {
        "code": "CREATININE_MG_DL",
        "value": 2.1,
        "unit": "mg/dL",
        "source": "Lab"
      },
      "note": "AKI \u2014 SOFA Renal \u2191; delta \u2265 2 \u2192 SOFA_SEPSIS"
    },
    {
      "offsetMinutes": 125,
      "type": "medication",
      "data": {
        "drugName": "ceftriaxone",
        "dose": 2,
        "doseUnit": "g",
        "route": "IV",
        "administeredBy": "nurse-rn-4"
      },
      "note": "Sepsis bundle order 3 of 4 \u2014 broad-spectrum antibiotic"
    },
    {
      "offsetMinutes": 130,
      "type": "medication",
      "data": {
        "drugName": "sodium chloride 0.9%",
        "dose": 1000,
        "doseUnit": "mL",
        "route": "IV",
        "administeredBy": "nurse-rn-4"
      },
      "note": "Sepsis bundle order 4 of 4 \u2014 IV fluid resuscitation (30 mL/kg bolus)"
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 112,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "NEWS2 = 8 \u2192 EMERGENCY (HR critical, temp critical, all parameters worsening)"
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 23,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 104,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 57,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 135,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 39.1,
        "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": 150,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 118,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Peak deterioration \u2014 qSOFA 3/3 (RR \u226522, SBP \u2264100, AVPU \u22651)"
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 24,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 98,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 53,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 39.3,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 93,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 1,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "order_result",
      "data": {
        "orderDescription": "SEP-1: Blood cultures",
        "resultSummary": "Gram-negative rods identified in 1 of 2 bottles"
      }
    },
    {
      "offsetMinutes": 155,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      },
      "note": "Nasal cannula 2L/min started"
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 116,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "On supplemental O2, SpO2 improving slightly"
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 23,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 100,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 55,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 39.2,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 165,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 95,
        "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": "WBC_K_UL",
        "value": 15.2,
        "unit": "\u00d710\u00b3/\u00b5L",
        "source": "Lab"
      },
      "note": "Follow-up labs \u2014 WBC still rising, lactate peaked"
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 3.1,
        "unit": "mmol/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "GLUCOSE_MG_DL",
        "value": 148,
        "unit": "mg/dL",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 180,
      "type": "observation",
      "data": {
        "code": "POTASSIUM_MEQ_L",
        "value": 4.4,
        "unit": "mEq/L",
        "source": "Lab"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 112,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Early treatment response \u2014 HR and BP beginning to stabilize"
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 22,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 104,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 58,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 39.0,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 195,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "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": 210,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 106,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "Continued improvement with fluid resuscitation and antibiotics"
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 21,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 108,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 62,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 38.8,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 96,
        "unit": "%",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "AVPU",
        "value": 0,
        "unit": "score",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 210,
      "type": "observation",
      "data": {
        "code": "SUPPLEMENTAL_O2",
        "value": 1,
        "unit": "flag",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 225,
      "type": "observation",
      "data": {
        "code": "LACTATE_MMOL_L",
        "value": 2.2,
        "unit": "mmol/L",
        "source": "Lab"
      },
      "note": "Lactate trending down from 3.1 \u2014 tissue perfusion improving"
    },
    {
      "offsetMinutes": 225,
      "type": "order_result",
      "data": {
        "orderDescription": "SEP-1: Blood cultures",
        "resultSummary": "Preliminary: Escherichia coli, susceptibilities pending"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "HEART_RATE",
        "value": 100,
        "unit": "bpm",
        "source": "Device"
      },
      "note": "End of scenario \u2014 stabilizing but still requires ICU-level monitoring"
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "RESP_RATE",
        "value": 20,
        "unit": "/min",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "SYSTOLIC_BP",
        "value": 112,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "DIASTOLIC_BP",
        "value": 66,
        "unit": "mmHg",
        "source": "Device"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "TEMP_C",
        "value": 38.6,
        "unit": "\u00b0C",
        "source": "Manual"
      }
    },
    {
      "offsetMinutes": 240,
      "type": "observation",
      "data": {
        "code": "SPO2",
        "value": 97,
        "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": 75,
      "type": "alert",
      "alertType": "WARNING_HEART_RATE",
      "description": "HR enters warning range (91 bpm)"
    },
    {
      "afterOffsetMinutes": 105,
      "type": "alert",
      "alertType": "QSOFA_SCREEN",
      "description": "qSOFA \u2265 2 \u2014 screen positive, recommend SOFA labs"
    },
    {
      "afterOffsetMinutes": 125,
      "type": "alert",
      "alertType": "SOFA_SEPSIS",
      "description": "SOFA delta \u2265 2 from baseline after repeat labs"
    },
    {
      "afterOffsetMinutes": 125,
      "type": "bundle",
      "description": "Sepsis bundle auto-created; triggeringAlertType = SOFA_SEPSIS"
    },
    {
      "afterOffsetMinutes": 105,
      "type": "score",
      "scoreType": "NEWS2",
      "expectedMinimum": 5,
      "description": "NEWS2 reaches medium risk"
    },
    {
      "afterOffsetMinutes": 135,
      "type": "alert",
      "alertType": "NEWS2_EMERGENCY",
      "description": "NEWS2 \u2265 7 at peak deterioration"
    }
  ]
}