1686 lines
36 KiB
JSON
1686 lines
36 KiB
JSON
{
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"scenario": {
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"id": "post-op-hemorrhage-01",
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"name": "Post-Op Hemorrhagic Shock",
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"description": "58-year-old male, 2 hours post open abdominal surgery (colectomy), develops occult intra-abdominal hemorrhage over 4 hours. Classic hemorrhagic shock progression: compensatory tachycardia gives way to falling blood pressure, dropping SpO2, and altered consciousness. Temperature remains relatively stable throughout. Fluid and blood product resuscitation initiated at T+180 with partial stabilization by scenario end.",
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"durationMinutes": 240,
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"tags": [
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"hemorrhage",
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"post-op",
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"surgery",
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"shock",
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"deterioration",
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"transfusion",
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"rapid-response"
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]
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},
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"patient": {
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"firstName": "Gerald",
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"lastName": "Kowalski",
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"dateOfBirth": "1968-03-14",
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"gender": "Male"
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},
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"encounter": {
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"department": "Surgery",
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"encounterType": "Inpatient",
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"attendingPhysician": "Dr. Anita Sharma",
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"roomBed": "SURG-4A-12",
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"admissionReason": "Post-operative monitoring following open colectomy for sigmoid diverticular disease"
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},
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"events": [
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{
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"offsetMinutes": 0,
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|
"type": "observation",
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"data": {
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"code": "HEART_RATE",
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|
"value": 74,
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|
"unit": "bpm",
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"source": "Device"
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},
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"note": "Post-op baseline \u2014 patient arrived from PACU, awake and oriented, incision clean and dry"
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},
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{
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"offsetMinutes": 0,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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|
"value": 14,
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|
"unit": "/min",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 0,
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|
"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 128,
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|
"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 0,
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|
"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 76,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 0,
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|
"type": "observation",
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"data": {
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|
"code": "TEMP_C",
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"value": 36.8,
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"unit": "\u00b0C",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 0,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 98,
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"unit": "%",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 0,
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"type": "observation",
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"data": {
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"code": "AVPU",
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"value": 0,
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|
"unit": "score",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 0,
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"type": "observation",
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"data": {
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"code": "SUPPLEMENTAL_O2",
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"value": 1,
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"unit": "flag",
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"source": "Manual"
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},
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"note": "Nasal cannula 2L/min \u2014 standard post-op order"
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 72,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Stable post-op recovery, patient resting comfortably"
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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"value": 13,
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"unit": "/min",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 130,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 78,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "TEMP_C",
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"value": 36.7,
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"unit": "\u00b0C",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 98,
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"unit": "%",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "AVPU",
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"value": 0,
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"unit": "score",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "SUPPLEMENTAL_O2",
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"value": 1,
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"unit": "flag",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 30,
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"type": "observation",
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"data": {
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"code": "LACTATE_MMOL_L",
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"value": 1.2,
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"unit": "mmol/L",
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"source": "Lab"
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},
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"note": "Routine post-op labs \u2014 lactate within normal limits"
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},
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{
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"offsetMinutes": 30,
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"type": "observation",
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"data": {
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"code": "POTASSIUM_MEQ_L",
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"value": 4.1,
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"unit": "mEq/L",
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"source": "Lab"
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}
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},
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{
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"offsetMinutes": 30,
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"type": "observation",
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"data": {
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"code": "GLUCOSE_MG_DL",
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"value": 138,
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"unit": "mg/dL",
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"source": "Lab"
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}
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},
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{
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"offsetMinutes": 25,
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"type": "order",
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"data": {
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"orderType": "Lab",
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"description": "Post-op CBC and metabolic panel",
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"orderedBy": "Dr. Anita Sharma"
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}
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},
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{
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"offsetMinutes": 30,
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"type": "order_result",
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"data": {
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"orderDescription": "Post-op CBC and metabolic panel",
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"resultSummary": "Hgb 12.8 g/dL, Hct 38.4%, WBC 9.2 K/uL, platelets 198 K/uL, BMP within normal limits. Expected post-operative values."
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}
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},
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{
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"offsetMinutes": 40,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 76,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Normal post-op fluctuation"
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},
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{
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"offsetMinutes": 40,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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"value": 14,
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"unit": "/min",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 40,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 126,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 40,
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"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 74,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 40,
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"type": "observation",
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"data": {
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"code": "TEMP_C",
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"value": 36.9,
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"unit": "\u00b0C",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 40,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 97,
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"unit": "%",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 40,
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|
"type": "observation",
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"data": {
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"code": "AVPU",
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"value": 0,
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|
"unit": "score",
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|
"source": "Manual"
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}
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},
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|
{
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|
"offsetMinutes": 40,
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|
"type": "observation",
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|
"data": {
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|
"code": "SUPPLEMENTAL_O2",
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|
"value": 1,
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|
"unit": "flag",
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|
"source": "Manual"
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|
}
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|
},
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|
{
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"offsetMinutes": 60,
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|
"type": "observation",
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"data": {
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"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": "End of stable phase \u2014 subtle upward HR drift begins"
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},
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{
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"offsetMinutes": 60,
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|
"type": "observation",
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|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 15,
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|
"unit": "/min",
|
|
"source": "Device"
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}
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|
},
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|
{
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|
"offsetMinutes": 60,
|
|
"type": "observation",
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|
"data": {
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|
"code": "SYSTOLIC_BP",
|
|
"value": 125,
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|
"unit": "mmHg",
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|
"source": "Device"
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|
}
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|
},
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|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 73,
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|
"unit": "mmHg",
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|
"source": "Device"
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|
}
|
|
},
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|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
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|
"code": "TEMP_C",
|
|
"value": 36.8,
|
|
"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"
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}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 85,
|
|
"unit": "bpm",
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"source": "Device"
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},
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"note": "Early compensatory tachycardia \u2014 occult bleeding suspected in hindsight"
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},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 16,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 120,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 70,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
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|
"code": "TEMP_C",
|
|
"value": 36.7,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 88,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "HR rising \u2014 still within normal range but trend is concerning"
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 17,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 118,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 68,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.8,
|
|
"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": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 95,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "HR now in warning range (91-110) \u2014 compensatory tachycardia accelerating"
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 18,
|
|
"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": 66,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.7,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 96,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 102,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Hemorrhagic shock Class II \u2014 tachycardia with early hypotension"
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 20,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 105,
|
|
"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": 36.9,
|
|
"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": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 2.4,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
},
|
|
"note": "Stat labs drawn \u2014 lactate elevated above normal, indicating tissue hypoperfusion"
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 4.3,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 121,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GLUCOSE_MG_DL",
|
|
"value": 152,
|
|
"unit": "mg/dL",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 115,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Stat CBC and metabolic panel",
|
|
"orderedBy": "Dr. Anita Sharma"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Stat CBC and metabolic panel",
|
|
"resultSummary": "Hgb 10.1 g/dL (down from 12.8), Hct 30.3%, WBC 11.8 K/uL, platelets 172 K/uL, lactate 2.4 mmol/L elevated. Hemoglobin drop of 2.7 g/dL in 90 minutes \u2014 active hemorrhage suspected."
|
|
},
|
|
"note": "Significant hemoglobin drop triggers surgical team notification"
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 110,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Rapid deterioration \u2014 hemorrhagic shock Class II-III transition"
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 22,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 98,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 58,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.8,
|
|
"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": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 118,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Class III hemorrhagic shock \u2014 critical HR with hypotension"
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 24,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 92,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 54,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.7,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 93,
|
|
"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": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 124,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Peak deterioration \u2014 patient confused, diaphoretic, pale. Rapid response team called."
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 26,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 86,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 50,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.6,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 91,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
},
|
|
"note": "AVPU=1 (Voice) \u2014 patient responding only to verbal stimuli"
|
|
},
|
|
{
|
|
"offsetMinutes": 160,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 128,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Sustained critical state \u2014 awaiting blood bank crossmatch"
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 27,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 84,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 48,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.5,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 90,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "Normal Saline 0.9%",
|
|
"dose": 1000,
|
|
"doseUnit": "mL",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-7"
|
|
},
|
|
"note": "Aggressive fluid resuscitation initiated \u2014 wide-bore IV access x2"
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 130,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Nadir \u2014 resuscitation started, blood products being crossmatched"
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 28,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 82,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 46,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.4,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 89,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 4.1,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
},
|
|
"note": "Severely elevated lactate \u2014 significant tissue hypoperfusion"
|
|
},
|
|
{
|
|
"offsetMinutes": 175,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Stat CBC, type and crossmatch",
|
|
"orderedBy": "Dr. Anita Sharma"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Stat CBC, type and crossmatch",
|
|
"resultSummary": "Hgb 7.8 g/dL (critical \u2014 down from 10.1 at T+120), Hct 23.4%, platelets 155 K/uL, lactate 4.1 mmol/L. Type and crossmatch: A-positive, 4 units pRBC ordered STAT."
|
|
},
|
|
"note": "Critical hemoglobin triggers massive transfusion protocol consideration"
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "Packed Red Blood Cells",
|
|
"dose": 1,
|
|
"doseUnit": "unit",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-7"
|
|
},
|
|
"note": "First unit pRBC \u2014 rapid infuser, transfusion started"
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "Normal Saline 0.9%",
|
|
"dose": 500,
|
|
"doseUnit": "mL",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-12"
|
|
},
|
|
"note": "Concurrent crystalloid via second IV line"
|
|
},
|
|
{
|
|
"offsetMinutes": 195,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 126,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Early response to volume resuscitation \u2014 HR beginning to decrease"
|
|
},
|
|
{
|
|
"offsetMinutes": 195,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 26,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 195,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 86,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 195,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 50,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 195,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.5,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 195,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 90,
|
|
"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": 205,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "Packed Red Blood Cells",
|
|
"dose": 1,
|
|
"doseUnit": "unit",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-7"
|
|
},
|
|
"note": "Second unit pRBC started"
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 118,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Responding to transfusion \u2014 HR decreasing, BP improving"
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 24,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 94,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 56,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.6,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 92,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 220,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "Tranexamic Acid",
|
|
"dose": 1,
|
|
"doseUnit": "g",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-7"
|
|
},
|
|
"note": "TXA administered to reduce surgical bleeding"
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 112,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Continued improvement with ongoing transfusion"
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 22,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 100,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 60,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.7,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 93,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
},
|
|
"note": "Patient more alert \u2014 responding appropriately to questions"
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 230,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 3.2,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
},
|
|
"note": "Lactate trending down from 4.1 \u2014 tissue perfusion improving with resuscitation"
|
|
},
|
|
{
|
|
"offsetMinutes": 225,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Post-transfusion CBC and lactate",
|
|
"orderedBy": "Dr. Anita Sharma"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 230,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Post-transfusion CBC and lactate",
|
|
"resultSummary": "Hgb 9.2 g/dL (up from 7.8, 2 units pRBC given), Hct 27.6%, lactate 3.2 mmol/L (down from 4.1). Surgical team planning return to OR for exploration and hemostasis."
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 106,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "End of scenario \u2014 partial stabilization, patient being prepared for return to OR"
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 21,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 104,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 62,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.7,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 94,
|
|
"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": 105,
|
|
"type": "alert",
|
|
"alertType": "WARNING_HEART_RATE",
|
|
"description": "HR enters warning range at 95 bpm (91-110 \u2192 NEWS2 HR=1)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 120,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 5,
|
|
"description": "NEWS2 reaches 5 at T+120 (HR=1, SBP=1, SpO2=1, O2=2) \u2192 WARNING threshold"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 120,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_WARNING",
|
|
"description": "NEWS2 WARNING triggered \u2014 score 5 (HR 102=1, SBP 105=1, SpO2 95=1, O2=2)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 135,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 7,
|
|
"description": "NEWS2 reaches 8 at T+135 (HR=1, RR=2, SBP=2, SpO2=1, O2=2) \u2192 EMERGENCY threshold"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 135,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_EMERGENCY",
|
|
"description": "NEWS2 EMERGENCY triggered \u2014 score 8 (HR 110=1, RR 22=2, SBP 98=2, SpO2 94=1, O2=2)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 135,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_SYSTOLIC_BP",
|
|
"description": "SBP drops to 98 mmHg \u2014 enters critical range (\u2264100)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 130,
|
|
"type": "alert",
|
|
"alertType": "RAPID_DETERIORATION",
|
|
"description": "Rapid HR increase (74\u2192110 over 135 min) and SBP decrease (128\u219298) detected between T+120 and T+150"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 160,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 16,
|
|
"description": "NEWS2 peaks at 16 (HR=2, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2) \u2014 multiple single-parameter score=3 triggers"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 150,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_SPO2",
|
|
"description": "SpO2 drops to 93% at T+150, enters critical range (\u226493)"
|
|
}
|
|
]
|
|
}
|