1464 lines
30 KiB
JSON
1464 lines
30 KiB
JSON
{
|
|
"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": [
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"sepsis",
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|
"uti",
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|
"elderly",
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|
"ed",
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|
"deterioration",
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"bundle-compliance"
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|
]
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|
},
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|
"patient": {
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|
"firstName": "Eleanor",
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|
"lastName": "Whitfield",
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|
"dateOfBirth": "1954-02-08",
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|
"gender": "Female"
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|
},
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|
"encounter": {
|
|
"department": "Emergency",
|
|
"encounterType": "Emergency",
|
|
"attendingPhysician": "Dr. Marcus Reyes",
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|
"roomBed": "ED-07B",
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|
"admissionReason": "Fever, confusion, dysuria, urinary frequency"
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|
},
|
|
"events": [
|
|
{
|
|
"offsetMinutes": 0,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 78,
|
|
"unit": "bpm",
|
|
"source": "Device"
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|
},
|
|
"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"
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|
}
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|
},
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|
{
|
|
"offsetMinutes": 0,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GCS_VERBAL",
|
|
"value": 4,
|
|
"unit": "score",
|
|
"source": "Manual"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 0,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GCS_MOTOR",
|
|
"value": 6,
|
|
"unit": "score",
|
|
"source": "Manual"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 76,
|
|
"unit": "bpm",
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|
"source": "Device"
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|
},
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|
"note": "Stable with physiological noise"
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|
},
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|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 15,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
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|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
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|
"value": 134,
|
|
"unit": "mmHg",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 77,
|
|
"unit": "mmHg",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.5,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 20,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
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|
"value": 80,
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|
"unit": "bpm",
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|
"source": "Device"
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|
},
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|
"note": "Subtle upward trend beginning"
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|
},
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|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 16,
|
|
"unit": "/min",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 129,
|
|
"unit": "mmHg",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 75,
|
|
"unit": "mmHg",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"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"
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|
},
|
|
{
|
|
"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"
|
|
}
|
|
]
|
|
}
|