1305 lines
28 KiB
JSON
1305 lines
28 KiB
JSON
{
|
|
"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",
|
|
"narrativeContains": "NEWS2",
|
|
"description": "NEWS2 total of 8 (>=7) triggers EMERGENCY alert — rapid hemodynamic compromise"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 105,
|
|
"type": "alert",
|
|
"alertType": "RAPID_DETERIORATION",
|
|
"narrativeContains": "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 — 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"
|
|
}
|
|
]
|
|
}
|