1702 lines
40 KiB
JSON
1702 lines
40 KiB
JSON
{
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"scenario": {
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"id": "dka-electrolyte-01",
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"name": "Diabetic Ketoacidosis with Electrolyte Derangement",
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"description": "34-year-old male presenting with Kussmaul breathing, tachycardia, and dehydration. Glucose >400 on arrival with hyperkalemia (5.6 mEq/L) due to acidosis. During insulin/fluid resuscitation, potassium drops critically low (3.0 mEq/L) requiring KCl replacement. Demonstrates V-shaped potassium curve and gradual normalization over 5 hours.",
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"durationMinutes": 300,
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"tags": [
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"dka",
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"diabetes",
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"electrolyte",
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"potassium",
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"hyperglycemia",
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"emergency",
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"insulin",
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"kussmaul",
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"acidosis"
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]
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},
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"patient": {
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"firstName": "Marcus",
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"lastName": "Devlin",
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"dateOfBirth": "1992-04-17",
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"gender": "Male"
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},
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"encounter": {
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"department": "Emergency",
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"encounterType": "Emergency",
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"attendingPhysician": "Dr. Priya Nair",
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"roomBed": "ED-07B",
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"admissionReason": "Altered mental status, rapid deep breathing, severe dehydration, blood glucose >400 mg/dL"
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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": 112,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Arrival \u2014 Kussmaul breathing, tachycardia, dry mucous membranes. NEWS2: HR=2, RR=3, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=6, RR single=3 -> EMERGENCY"
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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": 28,
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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": 102,
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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": 58,
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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": 37.2,
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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": 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": 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": 2,
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"type": "observation",
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"data": {
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"code": "GLUCOSE_MG_DL",
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"value": 438,
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"unit": "mg/dL",
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"source": "Lab"
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},
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"note": "Initial labs \u2014 critically elevated glucose, hyperkalemia from acidotic K+ shift, elevated lactate"
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},
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{
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"offsetMinutes": 2,
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"type": "observation",
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"data": {
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"code": "POTASSIUM_MEQ_L",
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"value": 5.6,
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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": 2,
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"type": "observation",
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"data": {
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"code": "LACTATE_MMOL_L",
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"value": 2.4,
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"unit": "mmol/L",
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"source": "Lab"
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}
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},
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{
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"offsetMinutes": 0,
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"type": "order",
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"data": {
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"orderType": "Lab",
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"description": "Basic metabolic panel, stat",
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"orderedBy": "Dr. Priya Nair"
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}
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},
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{
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"offsetMinutes": 2,
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"type": "order_result",
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"data": {
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"orderDescription": "Basic metabolic panel, stat",
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"resultSummary": "Glucose 438 mg/dL (critical high), K+ 5.6 mEq/L (critical high), CO2 12 mEq/L (low), anion gap 28 (elevated), BUN 32 mg/dL (elevated), Cr 1.4 mg/dL \u2014 consistent with DKA"
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},
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"note": "BMP confirms DKA: high anion gap metabolic acidosis with hyperglycemia"
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},
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{
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"offsetMinutes": 0,
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"type": "order",
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"data": {
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"orderType": "Lab",
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"description": "Venous blood gas, stat",
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"orderedBy": "Dr. Priya Nair"
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}
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},
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{
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"offsetMinutes": 3,
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"type": "order_result",
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"data": {
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"orderDescription": "Venous blood gas, stat",
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"resultSummary": "pH 7.18 (low), pCO2 22 mmHg (compensatory respiratory alkalosis), HCO3 10 mEq/L (critically low) \u2014 severe metabolic acidosis"
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},
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"note": "VBG confirms severe acidosis driving Kussmaul breathing"
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},
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{
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"offsetMinutes": 0,
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"type": "order",
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"data": {
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"orderType": "Lab",
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"description": "Urinalysis, stat",
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"orderedBy": "Dr. Priya Nair"
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}
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},
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{
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"offsetMinutes": 4,
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"type": "order_result",
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"data": {
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"orderDescription": "Urinalysis, stat",
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"resultSummary": "Ketones 3+ (large), glucose 4+ (>1000 mg/dL), specific gravity 1.035 (concentrated) \u2014 confirms ketonuria and dehydration"
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}
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},
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{
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"offsetMinutes": 5,
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"type": "medication",
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"data": {
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"drugName": "sodium chloride 0.9% (Normal Saline)",
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"dose": 1000,
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"doseUnit": "mL",
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"route": "IV",
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"administeredBy": "nurse-rn-4"
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},
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"note": "NS 1L bolus started for volume resuscitation"
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},
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{
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"offsetMinutes": 15,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 115,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Worsening slightly before treatment effect. NS bolus running. NEWS2: HR=2, RR=3, SBP=2, Temp=0, SpO2=0, AVPU=0. Total=7, RR single=3 -> EMERGENCY"
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},
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{
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"offsetMinutes": 15,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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"value": 29,
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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": 15,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 100,
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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": 15,
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"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 56,
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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": 15,
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"type": "observation",
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"data": {
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"code": "TEMP_C",
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"value": 37.1,
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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": 15,
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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": 15,
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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": 30,
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"type": "medication",
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"data": {
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"drugName": "regular insulin",
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"dose": 0.1,
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"doseUnit": "units/kg/hr",
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"route": "IV",
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"administeredBy": "nurse-rn-4"
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},
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"note": "Insulin drip started at 0.1 units/kg/hr after first liter NS \u2014 will drive K+ intracellularly"
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},
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{
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"offsetMinutes": 30,
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"type": "medication",
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"data": {
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"drugName": "sodium chloride 0.9% (Normal Saline)",
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"dose": 500,
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"doseUnit": "mL/hr",
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"route": "IV",
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"administeredBy": "nurse-rn-4"
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},
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"note": "NS continued at 500 mL/hr for ongoing volume resuscitation"
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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": "HEART_RATE",
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"value": 118,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Peak worsening \u2014 insulin drip just started. NEWS2: HR=2, RR=3, SBP=2, Temp=0, SpO2=0, AVPU=0. Total=7, RR single=3 -> EMERGENCY"
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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": {
|
|
"code": "RESP_RATE",
|
|
"value": 30,
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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": 30,
|
|
"type": "observation",
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|
"data": {
|
|
"code": "SYSTOLIC_BP",
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|
"value": 98,
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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": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 55,
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|
"unit": "mmHg",
|
|
"source": "Device"
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|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.2,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 96,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 116,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
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|
"note": "Insulin/fluids running 15 min. Slight HR improvement. NEWS2: HR=2, RR=3, SBP=2, Temp=0, SpO2=0, AVPU=0. Total=7, RR single=3 -> EMERGENCY"
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|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 28,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 100,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 57,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"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": 114,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Glucose dropping, K+ declining as insulin drives it intracellular. NEWS2: HR=2, RR=3, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=6, RR single=3 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 27,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 102,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 59,
|
|
"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": 97,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 62,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GLUCOSE_MG_DL",
|
|
"value": 380,
|
|
"unit": "mg/dL",
|
|
"source": "Lab"
|
|
},
|
|
"note": "1-hour labs \u2014 glucose dropping nicely, K+ falling as insulin shifts it intracellularly (dangerous trend)"
|
|
},
|
|
{
|
|
"offsetMinutes": 62,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 4.8,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 62,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 2.1,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 57,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Basic metabolic panel, repeat",
|
|
"orderedBy": "Dr. Priya Nair"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 62,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Basic metabolic panel, repeat",
|
|
"resultSummary": "Glucose 380 mg/dL (critical high, down from 438), K+ 4.8 mEq/L (down from 5.6, now normal range), CO2 14 mEq/L (improving), anion gap 24 (still elevated)"
|
|
},
|
|
"note": "K+ dropping from 5.6 to 4.8 in 1 hour \u2014 rate suggests will fall below 3.5 within 2 hours, anticipate replacement need"
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 112,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Gradual improvement with fluids. NEWS2: HR=2, RR=3, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=6, RR single=3 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 26,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 104,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 60,
|
|
"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": 97,
|
|
"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": 110,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "HR drops out of critical range. RR still critical. NEWS2: HR=1, RR=3, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=5, RR single=3 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 25,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 106,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 62,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"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": 108,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Improving \u2014 RR drops below 25. NEWS2: HR=1, RR=2, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=4. No longer EMERGENCY by total or single param."
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 24,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 108,
|
|
"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": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"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": 105,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "NEWS2: HR=1, RR=2, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=4. K+ critically low on labs!"
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 23,
|
|
"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": 65,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GLUCOSE_MG_DL",
|
|
"value": 245,
|
|
"unit": "mg/dL",
|
|
"source": "Lab"
|
|
},
|
|
"note": "2-hour labs \u2014 glucose improving but K+ critically low at 3.2, nadir of V-curve. Cardiac risk from hypokalemia."
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 3.2,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 1.6,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Basic metabolic panel, repeat",
|
|
"resultSummary": "Glucose 245 mg/dL (critical high, improving), K+ 3.2 mEq/L (WARNING \u2014 dropped from 4.8, insulin-driven intracellular shift), CO2 17 mEq/L (improving), anion gap 18 (closing)"
|
|
},
|
|
"note": "CRITICAL: K+ 3.2 \u2014 below 3.5, risk of cardiac arrhythmia. Must start KCl replacement before K+ drops further."
|
|
},
|
|
{
|
|
"offsetMinutes": 118,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Imaging",
|
|
"description": "12-Lead ECG, stat",
|
|
"orderedBy": "Dr. Priya Nair"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 123,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "12-Lead ECG, stat",
|
|
"resultSummary": "Sinus tachycardia at 105 bpm, ST depression in V3-V4, prominent U waves in V2-V4, flattened T waves \u2014 changes consistent with hypokalemia"
|
|
},
|
|
"note": "ECG changes confirm electrophysiologic effects of hypokalemia"
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 103,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "NEWS2: HR=1, RR=2, SBP=1, Temp=0, SpO2=0, AVPU=0. Total=4. Awaiting K+ replacement order."
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 22,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 110,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 66,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 135,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "potassium chloride (KCl)",
|
|
"dose": 40,
|
|
"doseUnit": "mEq",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-4"
|
|
},
|
|
"note": "KCl 40 mEq IV over 4 hours started for critical hypokalemia (K+ 3.2). Max rate 10 mEq/hr via peripheral line."
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 100,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "K+ replacement started. NEWS2: HR=1, RR=2, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=3."
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 22,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 112,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 68,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 97,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 98,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Steady improvement. Glucose still dropping, K+ being replaced. NEWS2: HR=1, RR=2, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=3."
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 21,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 114,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 70,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 170,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 182,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GLUCOSE_MG_DL",
|
|
"value": 168,
|
|
"unit": "mg/dL",
|
|
"source": "Lab"
|
|
},
|
|
"note": "3-hour labs \u2014 glucose near warning range, K+ recovering with replacement, lactate normalizing"
|
|
},
|
|
{
|
|
"offsetMinutes": 182,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 3.6,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 182,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 1.2,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 182,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Basic metabolic panel, repeat",
|
|
"resultSummary": "Glucose 168 mg/dL (warning range, improving), K+ 3.6 mEq/L (recovering with replacement, now normal), CO2 20 mEq/L (normalizing), anion gap 14 (closed)"
|
|
},
|
|
"note": "Anion gap closed \u2014 DKA resolving. K+ responding to replacement. Consider switching to D5 1/2NS when glucose <200."
|
|
},
|
|
{
|
|
"offsetMinutes": 185,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "dextrose 5% in 0.45% sodium chloride (D5 1/2NS)",
|
|
"dose": 250,
|
|
"doseUnit": "mL/hr",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-4"
|
|
},
|
|
"note": "Switched to D5 1/2NS as glucose approaching 200 mg/dL \u2014 prevents hypoglycemia while continuing insulin drip"
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 95,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Continued improvement. NEWS2: HR=1, RR=0, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=1."
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 20,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 116,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 72,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 190,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 93,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Nearly normal vitals. NEWS2: HR=1, RR=0, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=1."
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 19,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 118,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 74,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 210,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 90,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Near baseline. NEWS2: HR=0, RR=0, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=0."
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 18,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 120,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 76,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.9,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 240,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 88,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Final vital cluster. NEWS2: HR=0, RR=0, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=0."
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 17,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 122,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 78,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 270,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 272,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GLUCOSE_MG_DL",
|
|
"value": 124,
|
|
"unit": "mg/dL",
|
|
"source": "Lab"
|
|
},
|
|
"note": "Final labs \u2014 glucose normal, K+ recovered to normal, lactate normal. DKA resolved."
|
|
},
|
|
{
|
|
"offsetMinutes": 272,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 4.1,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 272,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 0.9,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 272,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Basic metabolic panel, repeat",
|
|
"resultSummary": "Glucose 124 mg/dL (normal), K+ 4.1 mEq/L (normal), CO2 22 mEq/L (normal), anion gap 10 (normal), BUN 18 mg/dL, Cr 1.1 mg/dL \u2014 DKA fully resolved"
|
|
},
|
|
"note": "DKA resolved: anion gap closed, bicarbonate normalized, glucose normal. Plan to transition to subcutaneous insulin."
|
|
},
|
|
{
|
|
"offsetMinutes": 268,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Venous blood gas, repeat",
|
|
"orderedBy": "Dr. Priya Nair"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 273,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Venous blood gas, repeat",
|
|
"resultSummary": "pH 7.38 (normal), pCO2 38 mmHg (normal), HCO3 22 mEq/L (normal) \u2014 acidosis fully corrected"
|
|
},
|
|
"note": "VBG normalized \u2014 supports transition from insulin drip to subcutaneous regimen"
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 86,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "End of scenario \u2014 fully resolved. NEWS2: HR=0, RR=0, SBP=0, Temp=0, SpO2=0, AVPU=0. Total=0. Patient stable for step-down."
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 16,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 124,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 78,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 98,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 300,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
}
|
|
],
|
|
"expectedOutcomes": [
|
|
{
|
|
"afterOffsetMinutes": 0,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 6,
|
|
"description": "NEWS2=6 on arrival (HR=2, RR=3, SBP=1). RR single param=3 triggers EMERGENCY despite total only 6."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 0,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_EMERGENCY",
|
|
"description": "NEWS2_EMERGENCY on arrival \u2014 RR 28 scores 3 (single parameter >=3 triggers emergency regardless of total)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 2,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_GLUCOSE",
|
|
"description": "Glucose 438 mg/dL \u2014 critically elevated (>180 mg/dL), consistent with DKA presentation"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 2,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_POTASSIUM_HIGH",
|
|
"description": "Potassium 5.6 mEq/L \u2014 critically high (>5.5), caused by acidotic extracellular K+ shift in DKA"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 2,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_LACTATE",
|
|
"description": "Lactate 2.4 mmol/L \u2014 critically elevated (>2.0), indicating tissue hypoperfusion"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 30,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 7,
|
|
"description": "NEWS2 peaks at 7 (HR=2, RR=3, SBP=2) at T+30 when vitals are worst before treatment effect. RR single=3 -> EMERGENCY."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 62,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_GLUCOSE",
|
|
"description": "Glucose 380 mg/dL \u2014 still critically high but trending down from 438. Insulin drip effect visible."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 90,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 5,
|
|
"description": "NEWS2=5 at T+90 (HR=1, RR=3, SBP=1). Still EMERGENCY due to RR single=3 but total score improving."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 105,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 4,
|
|
"description": "NEWS2 drops to 4 (HR=1, RR=2, SBP=1) \u2014 RR finally below 25, no more single param=3. No longer EMERGENCY."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 122,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_POTASSIUM_LOW",
|
|
"description": "Potassium 3.2 mEq/L \u2014 WARNING range (3.0-3.4). Dangerous drop from 5.6 to 3.2 during insulin treatment as K+ shifts intracellularly. ECG shows hypokalemic changes."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 122,
|
|
"type": "alert",
|
|
"alertType": "CRITICAL_GLUCOSE",
|
|
"description": "Glucose 245 mg/dL \u2014 still critically high (>180) but steadily improving from 438 to 245 over 2 hours"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 150,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 3,
|
|
"description": "NEWS2=3 at T+150 (HR=1, RR=2). Improving \u2014 KCl replacement started."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 182,
|
|
"type": "alert",
|
|
"alertType": "WARNING_POTASSIUM",
|
|
"description": "Potassium 3.6 mEq/L \u2014 recovered to normal range (3.5-5.0) with KCl replacement"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 190,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 1,
|
|
"description": "NEWS2=1 at T+190 (HR=1 only). Near-normal vitals as DKA resolves."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 240,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 0,
|
|
"description": "NEWS2=0 at T+240. All vitals normalized \u2014 HR 90, RR 18, SBP 120, SpO2 98."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 272,
|
|
"type": "alert",
|
|
"alertType": "NORMAL_GLUCOSE",
|
|
"description": "Glucose 124 mg/dL \u2014 normalized (70-140 range). DKA fully resolved."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 272,
|
|
"type": "alert",
|
|
"alertType": "NORMAL_POTASSIUM",
|
|
"description": "Potassium 4.1 mEq/L \u2014 fully normalized. V-curve complete: 5.6 (high) -> 3.2 (critical low) -> 4.1 (normal)."
|
|
}
|
|
]
|
|
}
|