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vigilcare-clinical/VigilCare.Simulator/Scenarios/List/hypothermia-elderly-01.json
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{
"scenario": {
"id": "hypothermia-elderly-01",
"name": "Elderly Hypothermia with Bradycardia \u2014 Rewarming Recovery",
"description": "81-year-old female found outdoors in winter with core temp 33.5\u00b0C on arrival. Presents with hypothermia-induced bradycardia, hypotension, and altered mentation. Gradual active rewarming over 4 hours with warm IV fluids and warming blankets leads to full recovery of vitals and consciousness.",
"durationMinutes": 240,
"tags": [
"hypothermia",
"bradycardia",
"elderly",
"rewarming",
"recovery",
"emergency",
"winter"
]
},
"patient": {
"firstName": "Margaret",
"lastName": "Thornton",
"dateOfBirth": "1945-01-14",
"gender": "Female"
},
"encounter": {
"department": "Emergency",
"encounterType": "Emergency",
"attendingPhysician": "Dr. Elena Vasquez",
"roomBed": "ED-03A",
"admissionReason": "Found unresponsive outdoors in winter, hypothermia, bradycardia"
},
"events": [
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 48,
"unit": "bpm",
"source": "Device"
},
"note": "Arrival \u2014 severe hypothermia, bradycardia, altered mentation. NEWS2=14 (EMERGENCY)"
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 10,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 96,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 54,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 33.5,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "SPO2",
"value": 93,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "AVPU",
"value": 1,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 0,
"type": "observation",
"data": {
"code": "SUPPLEMENTAL_O2",
"value": 1,
"unit": "flag",
"source": "Manual"
},
"note": "Nasal cannula 2L/min started on arrival"
},
{
"offsetMinutes": 1,
"type": "observation",
"data": {
"code": "GCS_EYE",
"value": 4,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 1,
"type": "observation",
"data": {
"code": "GCS_VERBAL",
"value": 4,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 1,
"type": "observation",
"data": {
"code": "GCS_MOTOR",
"value": 5,
"unit": "score",
"source": "Manual"
},
"note": "GCS 13 — sluggish, confused from hypothermia"
},
{
"offsetMinutes": 0,
"type": "order",
"data": {
"orderType": "Procedure",
"description": "Active warming protocol \u2014 forced-air warming blanket",
"orderedBy": "Dr. Elena Vasquez"
}
},
{
"offsetMinutes": 5,
"type": "order_result",
"data": {
"orderDescription": "Active warming protocol \u2014 forced-air warming blanket",
"resultSummary": "Bair Hugger warming blanket applied, set to 43\u00b0C"
},
"note": "Warming blanket order initiated"
},
{
"offsetMinutes": 8,
"type": "medication",
"data": {
"drugName": "sodium chloride 0.9% (warmed to 40\u00b0C)",
"dose": 1000,
"doseUnit": "mL",
"route": "IV",
"administeredBy": "nurse-rn-2"
},
"note": "Warm IV fluids \u2014 first bolus for active core rewarming and volume support"
},
{
"offsetMinutes": 15,
"type": "observation",
"data": {
"code": "GLUCOSE_MG_DL",
"value": 74,
"unit": "mg/dL",
"source": "Lab"
},
"note": "Initial labs \u2014 glucose low-normal, potassium borderline high (hypothermia shifts K+ extracellularly)"
},
{
"offsetMinutes": 15,
"type": "observation",
"data": {
"code": "POTASSIUM_MEQ_L",
"value": 5.4,
"unit": "mEq/L",
"source": "Lab"
}
},
{
"offsetMinutes": 15,
"type": "observation",
"data": {
"code": "LACTATE_MMOL_L",
"value": 2.3,
"unit": "mmol/L",
"source": "Lab"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 47,
"unit": "bpm",
"source": "Device"
},
"note": "Minimal change \u2014 rewarming just started. NEWS2=14 (EMERGENCY)"
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 10,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 94,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 53,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 33.7,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "SPO2",
"value": 93,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "AVPU",
"value": 1,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 20,
"type": "observation",
"data": {
"code": "SUPPLEMENTAL_O2",
"value": 1,
"unit": "flag",
"source": "Manual"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 46,
"unit": "bpm",
"source": "Device"
},
"note": "Slow rewarming \u2014 temp barely above 34\u00b0C. SpO2 slightly improved with O2. NEWS2=13 (EMERGENCY)"
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 11,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 95,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 55,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 34.0,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "SPO2",
"value": 94,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "AVPU",
"value": 1,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 45,
"type": "observation",
"data": {
"code": "SUPPLEMENTAL_O2",
"value": 1,
"unit": "flag",
"source": "Manual"
}
},
{
"offsetMinutes": 50,
"type": "medication",
"data": {
"drugName": "sodium chloride 0.9% (warmed to 40\u00b0C)",
"dose": 500,
"doseUnit": "mL",
"route": "IV",
"administeredBy": "nurse-rn-2"
},
"note": "Second warm IV fluid bolus \u2014 continued active rewarming"
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 48,
"unit": "bpm",
"source": "Device"
},
"note": "One hour into rewarming \u2014 temp 34.3\u00b0C, still bradycardic. NEWS2=13 (EMERGENCY)"
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 11,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 97,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 56,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 34.3,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "SPO2",
"value": 94,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "AVPU",
"value": 1,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 60,
"type": "observation",
"data": {
"code": "SUPPLEMENTAL_O2",
"value": 1,
"unit": "flag",
"source": "Manual"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 50,
"unit": "bpm",
"source": "Device"
},
"note": "Temp approaching 35\u00b0C \u2014 HR and RR beginning to improve. NEWS2=12 (EMERGENCY)"
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 12,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 100,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 58,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 34.8,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "SPO2",
"value": 95,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "AVPU",
"value": 1,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 90,
"type": "observation",
"data": {
"code": "SUPPLEMENTAL_O2",
"value": 1,
"unit": "flag",
"source": "Manual"
}
},
{
"offsetMinutes": 120,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 54,
"unit": "bpm",
"source": "Device"
},
"note": "Temp crosses 35\u00b0C threshold \u2014 major improvement. HR normalizing, BP improving. NEWS2=7 (EMERGENCY \u2014 AVPU still 3)"
},
{
"offsetMinutes": 120,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 13,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 120,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 104,
"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": 35.2,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 120,
"type": "observation",
"data": {
"code": "SPO2",
"value": 96,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 120,
"type": "observation",
"data": {
"code": "AVPU",
"value": 1,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 120,
"type": "observation",
"data": {
"code": "SUPPLEMENTAL_O2",
"value": 1,
"unit": "flag",
"source": "Manual"
}
},
{
"offsetMinutes": 125,
"type": "observation",
"data": {
"code": "GLUCOSE_MG_DL",
"value": 88,
"unit": "mg/dL",
"source": "Lab"
},
"note": "Repeat labs at T+120 \u2014 glucose normalizing, potassium trending down as rewarming drives K+ intracellularly"
},
{
"offsetMinutes": 125,
"type": "observation",
"data": {
"code": "POTASSIUM_MEQ_L",
"value": 4.6,
"unit": "mEq/L",
"source": "Lab"
}
},
{
"offsetMinutes": 125,
"type": "observation",
"data": {
"code": "LACTATE_MMOL_L",
"value": 1.7,
"unit": "mmol/L",
"source": "Lab"
}
},
{
"offsetMinutes": 150,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 58,
"unit": "bpm",
"source": "Device"
},
"note": "Significant recovery \u2014 patient responding to name, temp 35.8\u00b0C. NEWS2=4 (below WARNING threshold)"
},
{
"offsetMinutes": 150,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 14,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 150,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 108,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 150,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 65,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 150,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 35.8,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 150,
"type": "observation",
"data": {
"code": "SPO2",
"value": 97,
"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": 180,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 62,
"unit": "bpm",
"source": "Device"
},
"note": "Temp in normal range \u2014 all vitals normalizing. O2 weaned off. NEWS2=0"
},
{
"offsetMinutes": 180,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 15,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 180,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 112,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 180,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 68,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 180,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 36.2,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 180,
"type": "observation",
"data": {
"code": "SPO2",
"value": 97,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 180,
"type": "observation",
"data": {
"code": "AVPU",
"value": 0,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 65,
"unit": "bpm",
"source": "Device"
},
"note": "Continued monitoring \u2014 stable, fully alert. NEWS2=0"
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 15,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 118,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 70,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 36.4,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "SPO2",
"value": 98,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 210,
"type": "observation",
"data": {
"code": "AVPU",
"value": 0,
"unit": "score",
"source": "Manual"
}
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "HEART_RATE",
"value": 68,
"unit": "bpm",
"source": "Device"
},
"note": "End of scenario \u2014 near-normal vitals, temp 36.5\u00b0C. Full recovery. NEWS2=0"
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "RESP_RATE",
"value": 16,
"unit": "/min",
"source": "Device"
}
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "SYSTOLIC_BP",
"value": 122,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "DIASTOLIC_BP",
"value": 72,
"unit": "mmHg",
"source": "Device"
}
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "TEMP_C",
"value": 36.5,
"unit": "\u00b0C",
"source": "Manual"
}
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "SPO2",
"value": 98,
"unit": "%",
"source": "Device"
}
},
{
"offsetMinutes": 240,
"type": "observation",
"data": {
"code": "AVPU",
"value": 0,
"unit": "score",
"source": "Manual"
}
}
],
"expectedOutcomes": [
{
"afterOffsetMinutes": 0,
"type": "alert",
"alertType": "NEWS2_EMERGENCY",
"description": "NEWS2=14 on arrival: Temp 33.5\u21923, HR 48\u21921, SBP 96\u21922, RR 10\u21921, SpO2 93\u21922, AVPU 1\u21923, O2\u21922. Total \u22657 with multiple single-param 3s"
},
{
"afterOffsetMinutes": 0,
"type": "score",
"scoreType": "NEWS2",
"expectedMinimum": 14,
"description": "Initial NEWS2 of 14 \u2014 critically elevated due to severe hypothermia with multi-organ effects"
},
{
"afterOffsetMinutes": 0,
"type": "alert",
"alertType": "WARNING_HEART_RATE",
"description": "HR 48 bpm in warning range (41-50) \u2014 hypothermia-induced bradycardia"
},
{
"afterOffsetMinutes": 0,
"type": "alert",
"alertType": "WARNING_POTASSIUM",
"description": "Potassium 5.4 mEq/L \u2014 borderline high (warning range 5.1-5.5) due to hypothermic cellular shifts"
},
{
"afterOffsetMinutes": 90,
"type": "score",
"scoreType": "NEWS2",
"expectedMinimum": 12,
"description": "NEWS2 decreasing to 12 at T+90: Temp 34.8\u21923, HR 50\u21921, SBP 100\u21922, RR 12\u21920, SpO2 95\u21921, AVPU 1\u21923, O2\u21922. Still EMERGENCY"
},
{
"afterOffsetMinutes": 120,
"type": "score",
"scoreType": "NEWS2",
"expectedMinimum": 7,
"description": "NEWS2 drops to 7 at T+120: Temp 35.2\u21921, HR 54\u21920, SBP 104\u21921, RR 13\u21920, SpO2 96\u21920, AVPU 1\u21923, O2\u21922. Still EMERGENCY due to AVPU=3"
},
{
"afterOffsetMinutes": 120,
"type": "alert",
"alertType": "NEWS2_EMERGENCY",
"description": "NEWS2 still \u22657 at T+120 \u2014 AVPU single-param score of 3 alone triggers EMERGENCY even as other parameters normalize"
},
{
"afterOffsetMinutes": 150,
"type": "score",
"scoreType": "NEWS2",
"expectedMinimum": 0,
"description": "NEWS2 drops to 4 at T+150: Temp 35.8\u21921, HR 58\u21920, SBP 108\u21921, RR 14\u21920, SpO2 97\u21920, AVPU 0\u21920, O2\u21922. Below WARNING threshold \u2014 recovery evident"
},
{
"afterOffsetMinutes": 180,
"type": "score",
"scoreType": "NEWS2",
"expectedMinimum": 0,
"description": "NEWS2 drops to 0 at T+180: all vitals in normal range, O2 weaned off. Full recovery from hypothermia"
},
{
"afterOffsetMinutes": 240,
"type": "score",
"scoreType": "NEWS2",
"expectedMinimum": 0,
"description": "NEWS2 remains 0 at end of scenario \u2014 sustained normothermia at 36.5\u00b0C with normal hemodynamics"
}
]
}
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