{
  "date": "2026-10-28",
  "format": "worked examples, no quiz questions",
  "cases": [
    {
      "id": "CABG",
      "group": "cardiac",
      "title": "After coronary bypass",
      "male": "A man with diabetes has incisional pain, shallow breathing and a new fall in pressure.",
      "female": "A woman with prior ventricular dysfunction has the same operation and new congestion.",
      "sources": [
        "POSTCARD",
        "PBM",
        "ERASC"
      ],
      "visual_tree_anchor": "cabg",
      "visual_tree_present": true
    },
    {
      "id": "VALVE",
      "group": "cardiac",
      "title": "Aortic, mitral or tricuspid repair/replacement",
      "male": "A man after mechanical aortic replacement develops bradycardia and reduced urine output.",
      "female": "A woman after mitral repair develops breathlessness and congestion.",
      "sources": [
        "POSTCARD",
        "VALVE",
        "RV"
      ],
      "visual_tree_anchor": "valve",
      "visual_tree_present": true
    },
    {
      "id": "AORTIC",
      "group": "cardiac",
      "title": "Thoracic aortic repair or dissection",
      "male": "A man after dissection repair becomes hypertensive and reports new pain.",
      "female": "A woman after arch repair develops reduced urine output and a focal neurological change.",
      "sources": [
        "AORTA",
        "KIDNEY"
      ],
      "visual_tree_anchor": "aortic",
      "visual_tree_present": true
    },
    {
      "id": "VA",
      "group": "cardiac",
      "title": "VA-ECMO for cardiac failure",
      "male": "A man on VA-ECMO after myocardial injury develops cool extremities and rising lactate.",
      "female": "A woman on VA-ECMO after surgery develops pulmonary congestion despite displayed circuit flow.",
      "sources": [
        "VA",
        "RV"
      ],
      "visual_tree_anchor": "va",
      "visual_tree_present": true
    },
    {
      "id": "LVAD",
      "group": "cardiac",
      "title": "Early or established LVAD support",
      "male": "A man soon after LVAD implantation develops venous congestion and reduced device flow.",
      "female": "A woman with an established LVAD has alarms, dark urine and falling hemoglobin.",
      "sources": [
        "LVAD",
        "RV"
      ],
      "visual_tree_anchor": "lvad",
      "visual_tree_present": true
    },
    {
      "id": "IMPELLA",
      "group": "cardiac",
      "title": "Temporary microaxial flow-pump support",
      "male": "A man supported with an Impella develops access-site swelling and a cooler leg.",
      "female": "A woman supported with an Impella develops dark urine and a falling hemoglobin.",
      "sources": [
        "CS2025",
        "MCSHEM"
      ],
      "visual_tree_anchor": "impella",
      "visual_tree_present": true
    },
    {
      "id": "HEARTTX",
      "group": "cardiac",
      "title": "Immediate heart-transplant recovery",
      "male": "A man after heart transplant develops low output and worsening kidney function.",
      "female": "A woman after heart transplant has a new rhythm change and rising support needs.",
      "sources": [
        "HEARTTX"
      ],
      "visual_tree_anchor": "hearttx",
      "visual_tree_present": true
    },
    {
      "id": "LUNGRESECTION",
      "group": "thoracic",
      "title": "Lobectomy or pneumonectomy",
      "male": "A man after lobectomy has pain-limited coughing and a rising oxygen requirement.",
      "female": "A woman after pneumonectomy develops breathlessness and a new circulation change.",
      "sources": [
        "LUNGERAS"
      ],
      "visual_tree_anchor": "lungresection",
      "visual_tree_present": true
    },
    {
      "id": "LUNGTX",
      "group": "thoracic",
      "title": "Single or double lung transplantation",
      "male": "A man early after bilateral transplant develops impaired oxygenation and opacities.",
      "female": "A woman after single-lung transplant develops hypoxemia with altered airway pressures.",
      "sources": [
        "PGD",
        "TRANSPLANT"
      ],
      "visual_tree_anchor": "lungtx",
      "visual_tree_present": true
    },
    {
      "id": "ESOPH",
      "group": "thoracic",
      "title": "Esophagectomy",
      "male": "A man after esophagectomy develops tachycardia, new oxygen need and chest discomfort.",
      "female": "A woman after esophagectomy develops fever, hypotension and altered drain findings.",
      "sources": [
        "ESOPERAS",
        "FEVER"
      ],
      "visual_tree_anchor": "esoph",
      "visual_tree_present": true
    },
    {
      "id": "AIRWAYSURG",
      "group": "thoracic",
      "title": "Tracheal reconstruction or mediastinal surgery",
      "male": "A man after tracheal reconstruction develops stridor and distress.",
      "female": "A woman after mediastinal tumor surgery develops positional breathing difficulty and hypotension.",
      "sources": [
        "TRACHEAL",
        "AIRWAY"
      ],
      "visual_tree_anchor": "airwaysurg",
      "visual_tree_present": true
    },
    {
      "id": "AAA",
      "group": "vascular",
      "title": "Open or endovascular abdominal aortic repair",
      "male": "A man after open AAA repair develops abdominal distension and reduced urine output.",
      "female": "A woman after endovascular repair develops new pain and falling pressure.",
      "sources": [
        "AAA",
        "ABD",
        "KIDNEY"
      ],
      "visual_tree_anchor": "aaa",
      "visual_tree_present": true
    },
    {
      "id": "CAROTID",
      "group": "vascular",
      "title": "Carotid endarterectomy",
      "male": "A man after carotid endarterectomy develops neck swelling and voice change.",
      "female": "A woman after the same operation develops severe headache and a new focal deficit.",
      "sources": [
        "CAROTID"
      ],
      "visual_tree_anchor": "carotid",
      "visual_tree_present": true
    },
    {
      "id": "LIMB",
      "group": "vascular",
      "title": "Complex limb revascularization",
      "male": "A man after lower-limb bypass develops increasing pain, tense swelling and sensory change.",
      "female": "A woman after revascularization has a newly cool foot with diminished Doppler signals.",
      "sources": [
        "PAD2024"
      ],
      "visual_tree_anchor": "limb",
      "visual_tree_present": true
    },
    {
      "id": "SHOCK",
      "group": "crisis",
      "title": "Cardiogenic shock without a completed operation",
      "male": "A man with acute myocardial injury has cool skin, oliguria and pulmonary edema.",
      "female": "A woman with acute severe ventricular dysfunction has hypotension and increasing respiratory effort.",
      "sources": [
        "CS2025"
      ],
      "visual_tree_anchor": "shock",
      "visual_tree_present": true
    },
    {
      "id": "RESPFAIL",
      "group": "crisis",
      "title": "Severe respiratory failure or ARDS",
      "male": "A man with severe pneumonia develops diffuse lung injury and worsening oxygenation.",
      "female": "A woman with a similar lung injury develops hypercapnia and ventilator dyssynchrony.",
      "sources": [
        "ARDS",
        "VV"
      ],
      "visual_tree_anchor": "respfail",
      "visual_tree_present": true
    },
    {
      "id": "ENDOCARD",
      "group": "crisis",
      "title": "Complicated infective endocarditis",
      "male": "A man with valve infection develops pulmonary edema and low output.",
      "female": "A woman with suspected valve infection develops shock and a focal neurological change.",
      "sources": [
        "ENDO"
      ],
      "visual_tree_anchor": "endocard",
      "visual_tree_present": true
    },
    {
      "id": "COMFORT",
      "group": "crisis",
      "title": "A goals-concordant course with advanced cardiorespiratory failure",
      "male": "A man with persistent multiorgan failure chooses a comfort-focused plan after an informed discussion.",
      "female": "A woman with severe lung disease declines intubation but requests treatment of a potentially reversible infection.",
      "sources": [
        "GOALS",
        "DNR"
      ],
      "visual_tree_anchor": "comfort",
      "visual_tree_present": true
    }
  ],
  "synthetic_profiles": 36,
  "new_sources": [
    {
      "id": "ERASC",
      "title": "Grant et al. cardiac perioperative care consensus (2024)",
      "doi": "10.1016/j.athoracsur.2023.12.006",
      "checked": "Publisher consensus identity/abstract; procedure context, no pathway reproduced."
    },
    {
      "id": "HEARTTX",
      "title": "ISHLT care of heart transplant recipients (2023)",
      "doi": "10.1016/j.healun.2022.10.015",
      "checked": "Society and PubMed identity; complete guideline not appraised."
    },
    {
      "id": "LUNGERAS",
      "title": "ERAS/ESTS enhanced recovery after lung surgery (2019)",
      "doi": "10.1093/ejcts/ezy301",
      "checked": "PubMed identity; complete guideline not appraised."
    },
    {
      "id": "ESOPERAS",
      "title": "Low et al. ERAS esophagectomy recommendations (2019)",
      "doi": "10.1007/s00268-018-4786-4",
      "checked": "Publisher identity/abstract; complete guideline not appraised."
    },
    {
      "id": "TRACHEAL",
      "title": "Anesthesia for tracheal resection and reconstruction (2012)",
      "doi": "10.1016/j.anclin.2012.08.012",
      "checked": "PubMed abstract; historical review specific to tracheal surgery, not a complete mediastinal surgery guideline."
    },
    {
      "id": "AAA",
      "title": "ESVS abdominal aorto-iliac aneurysm guideline (2024)",
      "doi": "10.1016/j.ejvs.2023.11.002",
      "checked": "Society PDF and publisher scope; no complete recommendation audit."
    },
    {
      "id": "CAROTID",
      "title": "ESVS carotid and vertebral artery guideline (2023)",
      "doi": "10.1016/j.ejvs.2022.04.011",
      "checked": "PubMed identity and society postoperative chapter; no complete recommendation audit."
    },
    {
      "id": "PAD2024",
      "title": "ACC/AHA multisociety lower-extremity PAD guideline (2024)",
      "doi": "10.1161/CIR.0000000000001251",
      "checked": "Primary guideline identity and available text; no full recommendation audit."
    },
    {
      "id": "CS2025",
      "title": "ACC evaluation and management of cardiogenic shock consensus (2025)",
      "doi": "10.1016/j.jacc.2025.02.018",
      "checked": "Publisher text, including structured reassessment; no order schedule reproduced."
    },
    {
      "id": "MCSHEM",
      "title": "Prevention and Management of Hemolysis when Utilizing Mechanical Circulatory Support (2026)",
      "doi": "10.1016/j.iccl.2026.03.013",
      "pmid": "42209077",
      "checked": "Interventional Cardiology Clinics review; identity confirmed via ScienceDirect and PubMed records; abstract only, full text not appraised. Not proof of device benefit and no device adjustment instructions."
    },
    {
      "id": "ENDO",
      "title": "ESC management of endocarditis guideline (2023)",
      "doi": "10.1093/eurheartj/ehad193",
      "checked": "Primary guideline identity and available text. Corrections 10.1093/eurheartj/ehad625, ehad776 and ehae877 identified; not all correction content fully appraised."
    }
  ],
  "full_text_audit_complete": false,
  "clinical_validation": false,
  "visual_decision_trees": {
    "count": 18,
    "format": "Mermaid flowchart",
    "scope": "Original visual summaries of the existing paired narratives; not validated algorithms",
    "clinical_validation": false
  },
  "care_companions": {
    "lab": "CLINICAL_LAB_EXAMPLES.md",
    "pain_airway_ventilation": "AIRWAY_PAIN_AND_VENTILATION_EXAMPLES.md",
    "equipment": "ICU_EQUIPMENT_BASICS.md",
    "sources": "CLINICAL_CARE_PUBLIC_SOURCES.md",
    "audit": "CLINICAL_CARE_SOURCE_AUDIT.json",
    "case_mapping_count": 18
  },
  "evidence_classification": {
    "reviewed": "2026-10-28",
    "document": "EVIDENCE_CLASSIFICATION.md",
    "record": "EVIDENCE_CLASSIFICATION.json",
    "recommendation_groups": 27,
    "case_applications": "Synthetic examples using general clinical knowledge and context-dependent practice; not standardized protocols",
    "clinical_validation": false
  }
}