1273 lines
28 KiB
JSON
1273 lines
28 KiB
JSON
{
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"scenario": {
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"id": "cardiac-arrest-post-mi-01",
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"name": "Cardiac Arrest Post-MI with Hemodynamic Collapse",
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"description": "65-year-old male admitted for chest pain evolving into STEMI with hemodynamic collapse over 3 hours. Rising HR, falling BP and SpO2 culminate in near-arrest requiring vasopressor support. Triggers NEWS2_EMERGENCY and RAPID_DETERIORATION.",
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"durationMinutes": 180,
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"tags": [
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"cardiac",
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"stemi",
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"arrest",
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"deterioration",
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"emergency",
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"cardiology",
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"vasopressor"
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]
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},
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"patient": {
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"firstName": "Robert",
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"lastName": "Callahan",
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"dateOfBirth": "1961-03-14",
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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. Anita Sharma",
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"roomBed": "ED-03A",
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"admissionReason": "Acute chest pain radiating to left arm, diaphoresis"
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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": 82,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Baseline triage \u2014 chest pain but vitals near-normal. NEWS2=0"
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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": 18,
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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": 138,
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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": 85,
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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": 37.0,
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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": 15,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 85,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Slight increase in HR, physiological noise. NEWS2=0"
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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": 17,
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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": 136,
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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": 84,
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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": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 88,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Mild tachycardia trend beginning. NEWS2=0"
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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": "RESP_RATE",
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"value": 18,
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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,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 132,
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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,
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"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 80,
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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,
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"type": "observation",
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"data": {
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"code": "TEMP_C",
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"value": 37.0,
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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": 30,
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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": 30,
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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": 32,
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"type": "observation",
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"data": {
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"code": "POTASSIUM_MEQ_L",
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"value": 4.2,
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"unit": "mEq/L",
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"source": "Lab"
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},
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"note": "First lab draw \u2014 troponin ordered, potassium and glucose normal"
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},
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{
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"offsetMinutes": 32,
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"type": "observation",
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"data": {
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"code": "GLUCOSE_MG_DL",
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"value": 118,
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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": 27,
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"type": "order",
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"data": {
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"orderType": "Lab",
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"description": "Troponin I, stat",
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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": 32,
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"type": "order_result",
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"data": {
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"orderDescription": "Troponin I, stat",
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"resultSummary": "Troponin I 0.08 ng/mL (borderline elevated, reference <0.04)"
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},
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"note": "Initial troponin mildly elevated, consistent with early ACS"
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},
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{
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"offsetMinutes": 45,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 93,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "HR crosses into warning range (91-110). NEWS2: HR=1. Total=1"
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},
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{
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"offsetMinutes": 45,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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"value": 19,
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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": 45,
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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": 45,
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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": 45,
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"type": "observation",
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"data": {
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"code": "TEMP_C",
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"value": 37.0,
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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": 45,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 96,
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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": 45,
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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": 60,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 98,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Tachycardia progressing, BP starting to drop. NEWS2: HR=1. Total=1"
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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": "RESP_RATE",
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"value": 20,
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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": 60,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 122,
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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": 60,
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|
"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 75,
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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": 60,
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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": 60,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 96,
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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": 60,
|
|
"type": "observation",
|
|
"data": {
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|
"code": "AVPU",
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"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
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}
|
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},
|
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{
|
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"offsetMinutes": 75,
|
|
"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 106,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Accelerating deterioration \u2014 HR rising, SpO2 dropping. NEWS2: HR=1, RR=2, SpO2=1. Total=4"
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},
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{
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"offsetMinutes": 75,
|
|
"type": "observation",
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|
"data": {
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"code": "RESP_RATE",
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|
"value": 22,
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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": 75,
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|
"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 115,
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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": 75,
|
|
"type": "observation",
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|
"data": {
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"code": "DIASTOLIC_BP",
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|
"value": 71,
|
|
"unit": "mmHg",
|
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"source": "Device"
|
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}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
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|
"value": 37.0,
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|
"unit": "\u00b0C",
|
|
"source": "Manual"
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}
|
|
},
|
|
{
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|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
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|
"code": "SPO2",
|
|
"value": 95,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 75,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 112,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "HR enters critical range (>=111). NEWS2: HR=2, RR=2, SBP=1, SpO2=1. Total=6 -> WARNING"
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 23,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 108,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 66,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 94,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 121,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Rapid worsening \u2014 NEWS2: HR=2, RR=2, SBP=2, SpO2=2. Total=8 -> EMERGENCY. RAPID_DETERIORATION triggered."
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 24,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 100,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 62,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 93,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 128,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Severe deterioration \u2014 NEWS2: HR=2, RR=3, SBP=3, SpO2=2. Total=10 -> EMERGENCY (RR single=3, SBP single=3)"
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 26,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 92,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 56,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.9,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 92,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 4.8,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
},
|
|
"note": "Repeat labs \u2014 potassium rising, glucose elevated (stress response), troponin markedly elevated"
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "GLUCOSE_MG_DL",
|
|
"value": 168,
|
|
"unit": "mg/dL",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "LACTATE_MMOL_L",
|
|
"value": 3.4,
|
|
"unit": "mmol/L",
|
|
"source": "Lab"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 117,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Troponin I, repeat stat",
|
|
"orderedBy": "Dr. Anita Sharma"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 122,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Troponin I, repeat stat",
|
|
"resultSummary": "Troponin I 8.6 ng/mL (markedly elevated, reference <0.04) \u2014 consistent with acute STEMI"
|
|
},
|
|
"note": "Troponin confirms large territory MI"
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 134,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Critical phase \u2014 NEWS2: HR=3, RR=3, SBP=3, SpO2=3, AVPU=3. Total=15 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 28,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 86,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 50,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.7,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 91,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 130,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 142,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Peak crisis \u2014 near-arrest. NEWS2: HR=3, RR=3, SBP=3, SpO2=3, AVPU=3. Total=15 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 30,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 80,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 46,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.5,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 89,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 140,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 150,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "aspirin",
|
|
"dose": 325,
|
|
"doseUnit": "mg",
|
|
"route": "PO",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "Resuscitation medications initiated \u2014 aspirin for ACS"
|
|
},
|
|
{
|
|
"offsetMinutes": 151,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "heparin",
|
|
"dose": 5000,
|
|
"doseUnit": "units",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "Anticoagulation for STEMI"
|
|
},
|
|
{
|
|
"offsetMinutes": 153,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "morphine sulfate",
|
|
"dose": 4,
|
|
"doseUnit": "mg",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "Analgesia for chest pain and afterload reduction"
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 138,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "O2 applied, medications given. NEWS2: HR=3, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2. Total=17 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 28,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 82,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 48,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.6,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 90,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 155,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
},
|
|
"note": "High-flow nasal cannula 15L/min started"
|
|
},
|
|
{
|
|
"offsetMinutes": 158,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "norepinephrine",
|
|
"dose": 8,
|
|
"doseUnit": "mcg/min",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "Vasopressor initiated for cardiogenic shock"
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 128,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Early vasopressor response. NEWS2: HR=2, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2. Total=16 -> EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 26,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 88,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 52,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.8,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 91,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 1,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 165,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 118,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "End of scenario \u2014 stabilizing on vasopressor + O2 but still critical. NEWS2: HR=2, RR=2, SBP=2, SpO2=2, O2=2. Total=10 -> EMERGENCY. Transfer to cath lab pending."
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 24,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 94,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 58,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 36.9,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 93,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 175,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Imaging",
|
|
"description": "12-Lead ECG, stat",
|
|
"orderedBy": "Dr. Anita Sharma"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 180,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "12-Lead ECG, stat",
|
|
"resultSummary": "ST elevation in leads II, III, aVF with reciprocal ST depression in I, aVL \u2014 inferior STEMI confirmed, cardiology consulted for emergent PCI"
|
|
},
|
|
"note": "ECG confirms inferior STEMI, cath lab activation"
|
|
}
|
|
],
|
|
"expectedOutcomes": [
|
|
{
|
|
"afterOffsetMinutes": 45,
|
|
"type": "alert",
|
|
"alertType": "WARNING_HEART_RATE",
|
|
"description": "HR enters warning range (93 bpm, 91-110 range scores NEWS2=1)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 90,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 6,
|
|
"description": "NEWS2 reaches 6 (HR=2, RR=2, SBP=1, SpO2=1) -> NEWS2_WARNING threshold"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 90,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_WARNING",
|
|
"description": "NEWS2 total of 6 triggers WARNING (5-6 range)"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 105,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 8,
|
|
"description": "NEWS2 reaches 8 (HR=2, RR=2, SBP=2, SpO2=2) -> exceeds EMERGENCY threshold of 7"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 105,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_EMERGENCY",
|
|
"description": "NEWS2 total of 8 (>=7) triggers EMERGENCY alert \u2014 rapid hemodynamic compromise"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 105,
|
|
"type": "alert",
|
|
"alertType": "RAPID_DETERIORATION",
|
|
"description": "HR rose from 88 to 121 (+33 bpm) and SBP fell from 132 to 100 (-32 mmHg) within 75 minutes, SpO2 dropped from 97 to 93 \u2014 consistent with rapid deterioration detection"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 130,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 15,
|
|
"description": "NEWS2 reaches 15 (HR=3, RR=3, SBP=3, SpO2=3, AVPU=3) \u2014 critical hemodynamic collapse with altered consciousness"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 155,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 17,
|
|
"description": "NEWS2 reaches 17 (HR=3, RR=3, SBP=3, SpO2=3, AVPU=3, O2=2) \u2014 peak score with supplemental oxygen added"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 180,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 10,
|
|
"description": "NEWS2 stabilizes at 10 (HR=2, RR=2, SBP=2, SpO2=2, O2=2) \u2014 still EMERGENCY but improving on vasopressor support"
|
|
}
|
|
]
|
|
}
|