vigilcare-clinical/VigilCare.Simulator/Scenarios/List/neurological-decline-gcs-01.json

{
  "scenario": {
    "id": "neurological-decline-gcs-01",
    "name": "Traumatic Brain Injury — Progressive GCS Decline",
    "description": "Post-trauma patient with initial GCS 14 (E4V4M6). Over 3 hours, GCS declines to 6. Triggers GCS_WARNING then GCS_CRITICAL. Vitals remain stable — neuro-specific deterioration, not sepsis.",
    "durationMinutes": 180,
    "tags": ["gcs", "neurological", "no-sepsis", "news2"]
  },
  "patient": {
    "firstName": "David",
    "lastName": "Okonkwo",
    "dateOfBirth": "1981-07-22",
    "gender": "Male"
  },
  "encounter": {
    "department": "Icu",
    "encounterType": "Inpatient",
    "attendingPhysician": "Dr. Amara Singh",
    "roomBed": "ICU-1A-3",
    "admissionReason": "TBI — motor vehicle collision, GCS 14 on arrival"
  },
  "events": [
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "HEART_RATE", "value": 72, "unit": "bpm", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "RESP_RATE", "value": 16, "unit": "/min", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "SYSTOLIC_BP", "value": 135, "unit": "mmHg", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "DIASTOLIC_BP", "value": 82, "unit": "mmHg", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "TEMP_C", "value": 36.9, "unit": "°C", "source": "Manual" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "SPO2", "value": 99, "unit": "%", "source": "Device" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "SUPPLEMENTAL_O2", "value": 0, "unit": "flag", "source": "Manual" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "GCS_EYE", "value": 4, "unit": "score", "source": "Manual" },
      "note": "GCS 14 — confused speech"
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "GCS_VERBAL", "value": 4, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 0,
      "type": "observation",
      "data": { "code": "GCS_MOTOR", "value": 6, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "GCS_EYE", "value": 3, "unit": "score", "source": "Manual" },
      "note": "GCS 12 → GCS_WARNING"
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "GCS_VERBAL", "value": 3, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "GCS_MOTOR", "value": 6, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "HEART_RATE", "value": 68, "unit": "bpm", "source": "Device" }
    },
    {
      "offsetMinutes": 60,
      "type": "observation",
      "data": { "code": "SYSTOLIC_BP", "value": 142, "unit": "mmHg", "source": "Device" },
      "note": "Cushing response — HTN with bradycardia developing"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "GCS_EYE", "value": 2, "unit": "score", "source": "Manual" },
      "note": "GCS 9 — still GCS_WARNING band"
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "GCS_VERBAL", "value": 3, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "GCS_MOTOR", "value": 4, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "HEART_RATE", "value": 58, "unit": "bpm", "source": "Device" }
    },
    {
      "offsetMinutes": 120,
      "type": "observation",
      "data": { "code": "SYSTOLIC_BP", "value": 168, "unit": "mmHg", "source": "Device" }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": { "code": "GCS_EYE", "value": 1, "unit": "score", "source": "Manual" },
      "note": "GCS 6 → GCS_CRITICAL"
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": { "code": "GCS_VERBAL", "value": 2, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 150,
      "type": "observation",
      "data": { "code": "GCS_MOTOR", "value": 3, "unit": "score", "source": "Manual" }
    },
    {
      "offsetMinutes": 155,
      "type": "order",
      "data": {
        "orderType": "Imaging",
        "orderCode": "CT_HEAD",
        "description": "STAT CT head — GCS decline from 14 to 6",
        "orderedBy": "Dr. Amara Singh"
      }
    }
  ],
  "expectedOutcomes": [
    {
      "afterOffsetMinutes": 60,
      "type": "alert",
      "alertType": "GCS_WARNING",
      "narrativeContains": "GCS",
      "description": "GCS 12 in 9–12 band"
    },
    {
      "afterOffsetMinutes": 150,
      "type": "alert",
      "alertType": "GCS_CRITICAL",
      "narrativeContains": "GCS",
      "description": "GCS 6 ≤ 8"
    }
  ]
}