1299 lines
30 KiB
JSON
1299 lines
30 KiB
JSON
{
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"scenario": {
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"id": "respiratory-failure-asthma-01",
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"name": "Pediatric Asthma Exacerbation Progressing to Respiratory Failure",
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"description": "14-year-old male presenting to ED with severe asthma attack, progressive respiratory failure over 2 hours despite nebulized bronchodilators. Rising RR, falling SpO2, compensatory tachycardia with escalation from nasal cannula to non-rebreather mask and IV magnesium sulfate before stabilization.",
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"durationMinutes": 120,
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"tags": [
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"asthma",
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"pediatric",
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"respiratory-failure",
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"ed",
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"deterioration",
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"supplemental-o2"
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]
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},
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"patient": {
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"firstName": "Ethan",
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"lastName": "Morales",
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"dateOfBirth": "2012-03-15",
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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. Sarah Okonkwo",
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"roomBed": "ED-03A",
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"admissionReason": "Severe asthma exacerbation, acute respiratory distress, wheezing, accessory muscle use"
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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": 105,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Triage vitals \u2014 arrives in acute respiratory distress, audible wheezing, accessory muscle use. NEWS2: HR=1 RR=3 SBP=0 Temp=0 SpO2=2 AVPU=0 = 6, single param 3 (RR) \u2192 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": 26,
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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": 118,
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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": 74,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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|
"offsetMinutes": 0,
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|
"type": "observation",
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|
"data": {
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|
"code": "TEMP_C",
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"value": 37.1,
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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": 0,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 93,
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"unit": "%",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 0,
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|
"type": "observation",
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"data": {
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"code": "AVPU",
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"value": 0,
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|
"unit": "score",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 0,
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"type": "order",
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"data": {
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"orderType": "Lab",
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"description": "Peak expiratory flow (PEF)",
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"orderedBy": "Dr. Sarah Okonkwo"
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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": "Peak expiratory flow (PEF)",
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"resultSummary": "PEF 120 L/min (predicted 380 L/min for age/height) \u2014 32% predicted, severe obstruction"
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},
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"note": "Severely reduced airflow confirms acute severe asthma"
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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": "albuterol nebulizer",
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"dose": 2.5,
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"doseUnit": "mg",
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"route": "Nebulized",
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"administeredBy": "nurse-rn-2"
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},
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"note": "First-line bronchodilator \u2014 continuous nebulization initiated"
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},
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{
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"offsetMinutes": 10,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 102,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Slight improvement post-albuterol. NEWS2: HR=1 RR=2 SBP=0 Temp=0 SpO2=1 AVPU=0 = 4"
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},
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{
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"offsetMinutes": 10,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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"value": 24,
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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": 10,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 117,
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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": 10,
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"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 73,
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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": 10,
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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": 10,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 94,
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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": 10,
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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": "medication",
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"data": {
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"drugName": "albuterol nebulizer",
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"dose": 2.5,
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"doseUnit": "mg",
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"route": "Nebulized",
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"administeredBy": "nurse-rn-2"
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},
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"note": "Second nebulized albuterol \u2014 incomplete response to first dose"
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "HEART_RATE",
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"value": 108,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Worsening despite second neb. NEWS2: HR=1 RR=3 SBP=0 Temp=0 SpO2=2 AVPU=0 = 6, single param 3 (RR) \u2192 EMERGENCY"
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "RESP_RATE",
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"value": 27,
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"unit": "/min",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "SYSTOLIC_BP",
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"value": 119,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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|
"type": "observation",
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"data": {
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"code": "DIASTOLIC_BP",
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"value": 74,
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"unit": "mmHg",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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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": 20,
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"type": "observation",
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"data": {
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"code": "SPO2",
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"value": 92,
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"unit": "%",
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"source": "Device"
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}
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},
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{
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"offsetMinutes": 20,
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"type": "observation",
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"data": {
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"code": "AVPU",
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"value": 0,
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|
"unit": "score",
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"source": "Manual"
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}
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},
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{
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"offsetMinutes": 25,
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"type": "medication",
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"data": {
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"drugName": "ipratropium bromide nebulizer",
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"dose": 0.5,
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"doseUnit": "mg",
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"route": "Nebulized",
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"administeredBy": "nurse-rn-2"
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},
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"note": "Added anticholinergic for poor response to albuterol alone"
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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": 113,
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"unit": "bpm",
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"source": "Device"
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},
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"note": "Continued decline \u2014 HR now critical (\u2265111). NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=3 AVPU=0 = 8 \u2192 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": {
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|
"code": "RESP_RATE",
|
|
"value": 28,
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|
"unit": "/min",
|
|
"source": "Device"
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|
}
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},
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|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
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|
"code": "SYSTOLIC_BP",
|
|
"value": 117,
|
|
"unit": "mmHg",
|
|
"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": {
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|
"code": "DIASTOLIC_BP",
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|
"value": 73,
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|
"unit": "mmHg",
|
|
"source": "Device"
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|
}
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|
},
|
|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 91,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 30,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
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"offsetMinutes": 30,
|
|
"type": "order",
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"data": {
|
|
"orderType": "Lab",
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"description": "Venous blood gas",
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"orderedBy": "Dr. Sarah Okonkwo"
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}
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},
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{
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"offsetMinutes": 35,
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"type": "order_result",
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"data": {
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"orderDescription": "Venous blood gas",
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"resultSummary": "pH 7.36, pCO2 42 mmHg, HCO3 24 \u2014 normal pCO2 in setting of tachypnea suggests impending respiratory failure (should be low if compensating)"
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},
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"note": "Ominous VBG \u2014 normal pCO2 with RR 28 indicates respiratory muscle fatigue"
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|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 118,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
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"note": "Worsening tachycardia and desaturation. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=3 AVPU=0 = 8 \u2192 EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 30,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 116,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 72,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 90,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 40,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "methylprednisolone sodium succinate",
|
|
"dose": 60,
|
|
"doseUnit": "mg",
|
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"route": "IV",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
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"note": "IV corticosteroid \u2014 systemic anti-inflammatory for severe exacerbation"
|
|
},
|
|
{
|
|
"offsetMinutes": 45,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
},
|
|
"note": "Nasal cannula 4L/min started \u2014 SpO2 90% on room air unacceptable"
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 115,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Brief SpO2 improvement on nasal cannula O2. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=2 AVPU=0 O2=2 = 9 \u2192 EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 28,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 116,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 73,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 93,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 50,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 120,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Deteriorating on O2 \u2014 bronchospasm overcoming supplemental O2 benefit. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=3 AVPU=0 O2=2 = 10 \u2192 EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 30,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 114,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 71,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 91,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 60,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 65,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "albuterol nebulizer",
|
|
"dose": 2.5,
|
|
"doseUnit": "mg",
|
|
"route": "Nebulized",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "Third nebulized albuterol \u2014 back-to-back dosing for refractory bronchospasm"
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 124,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "No improvement from third neb. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=3 AVPU=0 O2=2 = 10 \u2192 EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 32,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 113,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 70,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 89,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 70,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 126,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Progressive failure \u2014 approaching critical thresholds. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=3 AVPU=0 O2=2 = 10 \u2192 EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 34,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 112,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 70,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 88,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 80,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Imaging",
|
|
"description": "Chest X-ray portable AP",
|
|
"orderedBy": "Dr. Sarah Okonkwo"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 85,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Chest X-ray portable AP",
|
|
"resultSummary": "Hyperinflated lung fields bilaterally, no focal consolidation or pneumothorax, no pleural effusion"
|
|
},
|
|
"note": "CXR confirms air trapping consistent with severe bronchospasm, no pneumonia or PTX"
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 128,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Critical \u2014 escalation to non-rebreather mask at 15L/min. NEWS2: HR=2 RR=3 SBP=1 Temp=0 SpO2=3 AVPU=0 O2=2 = 11 \u2192 EMERGENCY"
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 36,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 110,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 68,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 87,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 90,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 88,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Procedure",
|
|
"description": "O2 delivery escalation",
|
|
"orderedBy": "Dr. Sarah Okonkwo"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 93,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "O2 delivery escalation",
|
|
"resultSummary": "Changed from nasal cannula 4L/min to non-rebreather mask 15L/min"
|
|
},
|
|
"note": "Escalation of respiratory support \u2014 failing nasal cannula"
|
|
},
|
|
{
|
|
"offsetMinutes": 95,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "magnesium sulfate",
|
|
"dose": 40,
|
|
"doseUnit": "mg/kg",
|
|
"route": "IV",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "IV magnesium sulfate bolus for refractory severe asthma \u2014 smooth muscle relaxation"
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 131,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Peak deterioration \u2014 HR now \u2265131. NEWS2: HR=3 RR=3 SBP=1 Temp=0 SpO2=3 AVPU=0 O2=2 = 12 \u2192 EMERGENCY (peak score)"
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 37,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 108,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 66,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.0,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 86,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 100,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 98,
|
|
"type": "order",
|
|
"data": {
|
|
"orderType": "Lab",
|
|
"description": "Repeat venous blood gas",
|
|
"orderedBy": "Dr. Sarah Okonkwo"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 103,
|
|
"type": "order_result",
|
|
"data": {
|
|
"orderDescription": "Repeat venous blood gas",
|
|
"resultSummary": "pH 7.31, pCO2 52 mmHg, HCO3 25 \u2014 respiratory acidosis, CO2 retention indicating ventilatory failure"
|
|
},
|
|
"note": "Rising pCO2 confirms respiratory muscle fatigue \u2014 intubation readiness ordered"
|
|
},
|
|
{
|
|
"offsetMinutes": 105,
|
|
"type": "medication",
|
|
"data": {
|
|
"drugName": "albuterol nebulizer",
|
|
"dose": 2.5,
|
|
"doseUnit": "mg",
|
|
"route": "Nebulized",
|
|
"administeredBy": "nurse-rn-2"
|
|
},
|
|
"note": "Continuous nebulization resumed while magnesium takes effect"
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 122,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Treatment response \u2014 MgSO4 + NRB + steroids taking effect. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=3 AVPU=0 O2=2 = 10 \u2192 EMERGENCY (improving)"
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 31,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 112,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 70,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "TEMP_C",
|
|
"value": 37.1,
|
|
"unit": "\u00b0C",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SPO2",
|
|
"value": 91,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 110,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 115,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "POTASSIUM_MEQ_L",
|
|
"value": 3.8,
|
|
"unit": "mEq/L",
|
|
"source": "Lab"
|
|
},
|
|
"note": "Potassium checked \u2014 albuterol can cause hypokalemia; level acceptable"
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "HEART_RATE",
|
|
"value": 116,
|
|
"unit": "bpm",
|
|
"source": "Device"
|
|
},
|
|
"note": "Stabilization \u2014 aggressive treatment working but still critical. NEWS2: HR=2 RR=3 SBP=0 Temp=0 SpO2=2 AVPU=0 O2=2 = 9 \u2192 EMERGENCY. Patient to be transferred to PICU for monitoring."
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "RESP_RATE",
|
|
"value": 26,
|
|
"unit": "/min",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SYSTOLIC_BP",
|
|
"value": 114,
|
|
"unit": "mmHg",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "DIASTOLIC_BP",
|
|
"value": 72,
|
|
"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": 93,
|
|
"unit": "%",
|
|
"source": "Device"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "AVPU",
|
|
"value": 0,
|
|
"unit": "score",
|
|
"source": "Manual"
|
|
}
|
|
},
|
|
{
|
|
"offsetMinutes": 120,
|
|
"type": "observation",
|
|
"data": {
|
|
"code": "SUPPLEMENTAL_O2",
|
|
"value": 1,
|
|
"unit": "flag",
|
|
"source": "Manual"
|
|
}
|
|
}
|
|
],
|
|
"expectedOutcomes": [
|
|
{
|
|
"afterOffsetMinutes": 0,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_EMERGENCY",
|
|
"description": "NEWS2 = 6 at triage with RR score 3 (single parameter = 3 triggers EMERGENCY). Patient arrives already in emergency state."
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 0,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 6,
|
|
"description": "NEWS2 = 6 at arrival: HR=1(105) + RR=3(26) + SBP=0(118) + Temp=0(37.1) + SpO2=2(93) + AVPU=0"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 20,
|
|
"type": "alert",
|
|
"alertType": "RAPID_DETERIORATION",
|
|
"description": "SpO2 drops from 94% (T+10) to 92% (T+20) \u2014 rapid decline after brief post-albuterol improvement"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 30,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 8,
|
|
"description": "NEWS2 = 8 at T+30: HR=2(113) + RR=3(28) + SBP=0(117) + Temp=0(37.1) + SpO2=3(91) + AVPU=0 \u2014 worsening despite bronchodilators"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 50,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 9,
|
|
"description": "NEWS2 = 9 at T+50: HR=2(115) + RR=3(28) + SBP=0(116) + Temp=0(37.1) + SpO2=2(93) + AVPU=0 + O2=2 \u2014 supplemental O2 adds 2 points"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 70,
|
|
"type": "alert",
|
|
"alertType": "RAPID_DETERIORATION",
|
|
"description": "SpO2 drops from 93% (T+50 on O2) to 89% (T+70 on O2) \u2014 failing supplemental oxygen therapy"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 90,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 11,
|
|
"description": "NEWS2 = 11 at T+90: HR=2(128) + RR=3(36) + SBP=1(110) + Temp=0(37.1) + SpO2=3(87) + AVPU=0 + O2=2 \u2014 critical deterioration"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 100,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 12,
|
|
"description": "NEWS2 = 12 (peak) at T+100: HR=3(131) + RR=3(37) + SBP=1(108) + Temp=0(37.0) + SpO2=3(86) + AVPU=0 + O2=2 \u2014 maximum severity before treatment effect"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 100,
|
|
"type": "alert",
|
|
"alertType": "NEWS2_EMERGENCY",
|
|
"description": "Sustained NEWS2 EMERGENCY throughout scenario \u2014 peak score 12 at T+100 with HR, RR, and SpO2 all at maximum NEWS2 scores"
|
|
},
|
|
{
|
|
"afterOffsetMinutes": 120,
|
|
"type": "score",
|
|
"scoreType": "NEWS2",
|
|
"expectedMinimum": 9,
|
|
"description": "NEWS2 = 9 at T+120 \u2014 still EMERGENCY but improving from peak of 12. SpO2 recovering to 93% on non-rebreather. Patient stabilized for PICU transfer."
|
|
}
|
|
]
|
|
}
|