INTEGRATEDWORKUPAUDIT.json
{
"date": "2026-10-28",
"topics": 42,
"synthetic_profiles": 84,
"domains_per_case": 8,
"lab_catalogue": [
{
"id": "CBC",
"test": "CBC: hemoglobin/hematocrit, platelets, differential",
"when": "Suspected bleeding, anemia, infection context or thrombocytopenia",
"question": "Blood-loss trend, oxygen-carrying capacity and platelet trend",
"decision": "May inform bleeding/transfusion evaluation or drug-exposure review alongside clinical findings",
"limit": "Hemoglobin can lag acute hemorrhage or reflect dilution; WBC does not prove infection; platelets do not measure all platelet function",
"sources": [
"POSTCARD",
"PBM",
"FEVER"
]
},
{
"id": "GAS",
"test": "Arterial blood gas when oxygenation, ventilation or acid-base status needs clarification",
"when": "New respiratory failure, altered support or unexplained acid-base disturbance",
"question": "PaO2, PaCO2 and pH under recorded oxygen/support conditions",
"decision": "May inform respiratory-support assessment and whether a metabolic/respiratory process is changing",
"limit": "Venous PO2 cannot replace arterial oxygenation assessment; record FiO2/device; do not schedule ABGs automatically",
"sources": [
"ARDS",
"NIV",
"AIRWAY"
]
},
{
"id": "LAC",
"test": "Lactate, with repeat justified by a response question",
"when": "Shock or unexplained change in perfusion",
"question": "Trend compatible with altered production/clearance or delivery-demand imbalance",
"decision": "May prompt reassessment of shock mechanism or response to an intervention",
"limit": "Not specific for hypoperfusion and not a standalone fluid, transfusion or inotrope trigger",
"sources": [
"SEPSIS",
"POSTCARD"
]
},
{
"id": "RENALCHEM",
"test": "Basic metabolic chemistry: sodium, potassium, bicarbonate/total CO2, urea/BUN, creatinine and glucose",
"when": "AKI, oliguria, arrhythmia, diuresis, metabolic or neurologic concern",
"question": "Electrolyte/acid-base changes and kidney-function trajectory",
"decision": "May inform medication-exposure review, electrolyte management or renal-support evaluation",
"limit": "Creatinine lags injury; an isolated value does not distinguish low flow from congestion or choose dialysis",
"sources": [
"KIDNEY",
"RENAL"
]
},
{
"id": "MGPHOS",
"test": "Magnesium and phosphate when clinically relevant",
"when": "Arrhythmia, nutritional risk, ongoing losses or respiratory-muscle concern",
"question": "Potential reversible electrolyte contribution",
"decision": "May inform replacement assessment and review of losses or drug effects",
"limit": "Not every abnormal value explains the illness; replacement needs kidney function and local policy",
"sources": [
"POSTCARD",
"KIDNEY"
]
},
{
"id": "ICAL",
"test": "Ionized calcium",
"when": "Major bleeding/transfusion or unexplained circulatory dysfunction",
"question": "Biologically active calcium in the current clinical context",
"decision": "May inform correction assessment while investigating the primary problem",
"limit": "Total calcium is not interchangeable; sampling/pH and clinical context matter",
"sources": [
"PBM",
"POSTCARD"
]
},
{
"id": "COAG",
"test": "PT/INR, aPTT and fibrinogen selected for the question",
"when": "Bleeding, hepatic/coagulation concern or relevant anticoagulant exposure",
"question": "Selected clotting-pathway/fibrinogen abnormalities",
"decision": "May inform hemostatic or anticoagulant assessment with bleeding history and drug identity",
"limit": "Do not equate a normal screen with no bleeding risk or use INR to quantify every anticoagulant",
"sources": [
"PBM",
"VALVE"
]
},
{
"id": "VET",
"test": "Viscoelastic/platelet-function testing if indicated and locally available",
"when": "Active complex cardiac-surgical bleeding under an established clinical pathway",
"question": "More specific clot formation or platelet-function questions",
"decision": "May inform component-directed hemostatic discussion and distinguish hypotheses",
"limit": "Does not replace surgical source evaluation; not a routine screening or independent treatment algorithm here",
"sources": [
"PBM"
]
},
{
"id": "CROSS",
"test": "Type and screen / compatibility testing through the transfusion service",
"when": "Clinically meaningful bleeding or a realistic transfusion question",
"question": "Compatibility and preparation for potential blood-product support",
"decision": "May support timely transfusion logistics if the clinical team determines need",
"limit": "Not a transfusion indication, hemoglobin target or proof of ongoing bleeding",
"sources": [
"PBM"
]
},
{
"id": "CULT",
"test": "Source-directed microbiology, including blood cultures when indicated",
"when": "Suspected infection, new fever with a plausible source or shock",
"question": "Organism identification and susceptibility/context",
"decision": "May refine antimicrobial/source-control decisions and later de-escalation",
"limit": "Avoid reflex cultures from every site; contamination/colonization matter; sampling must not cause harmful treatment delay",
"sources": [
"FEVER",
"SEPSIS"
]
},
{
"id": "RESPMIC",
"test": "Respiratory sample / pathogen testing selected for suspected pneumonia",
"when": "New pulmonary infection question",
"question": "Potential respiratory pathogen evidence",
"decision": "May refine antimicrobial assessment with imaging and clinical course",
"limit": "Positive results may reflect colonization; specimen quality, prior therapy and immune status matter",
"sources": [
"FEVER",
"SEPSIS",
"TRANSPLANT"
]
},
{
"id": "URINE",
"test": "Urinalysis, microscopy and selective culture",
"when": "Kidney-injury mechanism or suspected urinary infection",
"question": "Sediment/urine findings and source-specific microbiology",
"decision": "May inform AKI differential or urinary-source evaluation",
"limit": "Pyuria or bacteriuria is not automatically symptomatic infection; catheter and collection method matter",
"sources": [
"KIDNEY",
"FEVER"
]
},
{
"id": "SODOSM",
"test": "Serum sodium with osmolality/urine studies if the specific question warrants them",
"when": "Neurocritical electrolyte/water-balance problem",
"question": "Patterns of water/solute regulation in context",
"decision": "May inform supervised fluid/medication reassessment and correction planning",
"limit": "No universal sodium target or rapid-correction instruction follows from this vignette",
"sources": [
"TBI",
"SAH"
]
},
{
"id": "POCGLU",
"test": "Prompt bedside glucose when mental status or metabolic stability changes",
"when": "Reduced consciousness, agitation or unstable metabolic state",
"question": "A potentially reversible glucose abnormality",
"decision": "May inform immediate clinical assessment and supervised correction",
"limit": "An abnormal result does not exclude a concurrent neurologic or circulatory event",
"sources": [
"PADISBASE",
"TBI",
"SAH"
]
},
{
"id": "TROP",
"test": "Troponin when a myocardial-injury question is present",
"when": "New ischemic/rhythm/pump concern after assessment",
"question": "Myocardial injury pattern with serial context if justified",
"decision": "May inform coronary/structural evaluation together with ECG and imaging",
"limit": "Postoperative elevation alone does not establish type, mechanism or an infarction diagnosis",
"sources": [
"POSTCARD"
]
},
{
"id": "HEMOL",
"test": "Hemolysis evaluation: LDH, plasma-free hemoglobin, bilirubin/haptoglobin as appropriate",
"when": "ECMO/LVAD blood-trauma concern, anemia or device alarm",
"question": "Evidence compatible with hemolysis, integrated with device data",
"decision": "May prompt specialist evaluation of pump/circuit/loading or alternative causes",
"limit": "Each marker is nonspecific; no single result proves pump thrombosis or selects a speed/anticoagulant change",
"sources": [
"LVAD",
"VA",
"VV"
]
},
{
"id": "DRUGCOAG",
"test": "Anticoagulant-appropriate assay, e.g. anti-Xa or aPTT under the actual protocol",
"when": "Mechanical support, bleeding/thrombotic concern or anticoagulant monitoring need",
"question": "Exposure/effect question specific to the medicine, assay and timing",
"decision": "May inform specialist anticoagulant assessment",
"limit": "Assays are not interchangeable; interferences and concurrent drugs matter; no universal target supplied",
"sources": [
"VA",
"VV",
"LVAD",
"PBM"
]
},
{
"id": "LIVER",
"test": "Selected hepatic chemistry/bilirubin",
"when": "Congestion, shock, hepatobiliary or medication-exposure concern",
"question": "Hepatic injury/cholestasis pattern or congestion context",
"decision": "May inform perfusion/differential assessment and drug handling review",
"limit": "Abnormal tests do not uniquely distinguish ischemia, congestion, obstruction or drug injury",
"sources": [
"POSTCARD",
"PANCREASGUIDE",
"LVAD"
]
},
{
"id": "LIPASE",
"test": "Lipase when pancreatitis diagnosis remains a live question",
"when": "Compatible abdominal presentation or uncertain diagnosis",
"question": "Evidence contributing to diagnostic criteria with history/imaging",
"decision": "May help establish the disease context and need for further evaluation",
"limit": "Serial lipase is not a target for resuscitation or a substitute for organ-failure assessment",
"sources": [
"PANCREASGUIDE"
]
},
{
"id": "TROUGH",
"test": "Agent-specific drug level when indicated by the treating transplant/pharmacy protocol",
"when": "Potential immunosuppressant toxicity, interaction or exposure problem",
"question": "Concentration at the correct timing for the actual agent",
"decision": "May inform specialist exposure/interaction assessment alongside organ function",
"limit": "Not every agent uses the same level/target; an isolated value does not diagnose rejection",
"sources": [
"TRANSPLANT"
]
}
],
"nonlaboratory_catalogue": [
{
"id": "ECHO",
"test": "Focused cardiac imaging, TTE and specialist TEE when appropriate",
"question": "Ventricular function/loading, pericardial or valvular/mechanical questions",
"decision": "May redirect shock assessment toward pump, obstructive or structural causes",
"limit": "A limited study can miss pathology; postoperative windows and loculated collections complicate interpretation",
"sources": [
"POSTCARD",
"RV",
"VALVE"
]
},
{
"id": "ECG",
"test": "ECG and rhythm/pacing review",
"question": "Rhythm, conduction and ischemic-pattern questions",
"decision": "May inform rate-related or ischemic evaluation with perfusion assessment",
"limit": "Rate alone does not establish causation or choose a drug/pacing setting",
"sources": [
"POSTCARD"
]
},
{
"id": "CHEST",
"test": "Chest imaging / lung ultrasound when indicated",
"question": "Tube/line or pleural/parenchymal explanation for deterioration",
"decision": "May distinguish mechanical or pulmonary hypotheses and guide further evaluation",
"limit": "Not a routine daily-image instruction; findings alone may not separate edema from infection",
"sources": [
"ARDS",
"FEVER"
]
},
{
"id": "HEAD",
"test": "Neuroimaging and neurologic reassessment when indicated",
"question": "New structural explanation for reduced consciousness or focal change",
"decision": "May alter neurocritical/surgical assessment",
"limit": "Do not attribute new decline to sedation without evaluating competing urgent causes",
"sources": [
"TBI",
"SAH"
]
},
{
"id": "VASC",
"test": "Procedure-appropriate vascular imaging / perfusion assessment",
"question": "Aortic, graft, limb or organ malperfusion question",
"decision": "May prompt surgical/vascular or device-team reassessment",
"limit": "Transport/contrast risks must be balanced against the urgency; a normal lab does not exclude malperfusion",
"sources": [
"AORTA",
"VA"
]
},
{
"id": "ABDOMEN",
"test": "Abdominal imaging or pressure assessment chosen for the suspected problem",
"question": "Source control, obstruction, pancreatitis complication or intra-abdominal hypertension",
"decision": "May inform procedural/surgical assessment",
"limit": "Pressure alone does not establish compartment syndrome; a test is not a dressing-change order",
"sources": [
"ABD",
"SEPSIS",
"PANCREASGUIDE"
]
},
{
"id": "DEVICE",
"test": "Specialist device/circuit review with appropriate imaging, gases and trends",
"question": "LVAD/ECMO performance, loading, cannula or oxygenator questions",
"decision": "May identify a mechanism requiring expert adjustment",
"limit": "Displayed flow, one gradient or one post-membrane gas is not a complete diagnostic rule",
"sources": [
"LVAD",
"VA",
"VV"
]
}
],
"cases": [
{
"id": "ICU-01-01",
"title": "Postoperative hemodynamic instability",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "Vasoactive support does not correct a surgical bleeding source; analgesic/sedative effects also belong in the medication review.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-01-02",
"title": "DNI status and respiratory distress",
"module": "NIV",
"domains": {
"diagnostic_reasoning": "COPD/pneumonia, gas-exchange failure, fatigue, interface problems and distress need separate assessment; clarify the treatment ceiling.",
"pain_sedation": "Assess pain, fear and dyspnea before assuming a sedation indication; review respiratory effects of prior medicines.",
"airway_breathing": "Document NIV/HFNC/oxygen device, work of breathing, consciousness, secretion handling and gas trends; goals determine escalation options.",
"blood_pressure_perfusion": "Assess perfusion and tolerance of respiratory support, not oxygen saturation alone.",
"renal_metabolic": "Review kidney function and acid-base contributors where they would change decisions.",
"treatment_medication": "Analgesia and anxiolysis require respiratory reassessment; a sedative combination is not implied by DNI.",
"response_stability": "Reassess comfort, respiratory work, ventilation and the agreed trial goals; DNR/DNI does not itself establish comfort-only care.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"RENALCHEM",
"CULT",
"RESPMIC",
"POCGLU"
],
"candidate_nonlaboratory_tests": [
"CHEST"
],
"sources": [
"NIV",
"DNR",
"GOALS",
"FEVER",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-01-03",
"title": "Worsening septic shock",
"module": "SEPSIS",
"domains": {
"diagnostic_reasoning": "Reassess source, source control and competing noninfectious or mixed-shock causes.",
"pain_sedation": "Assess pain and agitation causes; distinguish analgesic need from the sedation goal and delirium.",
"airway_breathing": "Evaluate actual airway/support, work of breathing and oxygenation/ventilation; assess deterioration without delaying stabilization for tests.",
"blood_pressure_perfusion": "Evaluate perfusion and both fluid responsiveness and tolerance; reassess source control alongside circulatory support.",
"renal_metabolic": "Review output, kidney chemistry, fluid balance and medication clearance; positive balance and oliguria are not interchangeable indications.",
"treatment_medication": "Antimicrobials and vasopressor support are distinct interventions; culture/resistance and organ function inform drug discussions.",
"response_stability": "Use clinical response and source information to revisit antimicrobial, procedural and hemodynamic decisions; biomarkers do not independently choose a regimen.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"CULT",
"URINE"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ABDOMEN",
"ECHO"
],
"sources": [
"SEPSIS",
"FEVER",
"PADISBASE",
"KIDNEY",
"AIRWAY",
"TESTING"
]
},
{
"id": "ICU-01-04",
"title": "Rib fractures and impaired ventilation",
"module": "TRAUMA",
"domains": {
"diagnostic_reasoning": "Pain-limited breathing is one hypothesis; assess associated lung, pleural, vascular and other injuries.",
"pain_sedation": "Compare systemic versus regional/local analgesic options after injury and bleeding-risk review; reassess breathing and function as well as reported pain.",
"airway_breathing": "Evaluate splinting, secretions, work of breathing and oxygenation; deterioration may reflect injury rather than inadequate analgesia alone.",
"blood_pressure_perfusion": "Consider blood loss and other shock mechanisms before attributing tachycardia solely to pain.",
"renal_metabolic": "Review kidney function and exposure before nonopioid or opioid choices; assess losses if clinically relevant.",
"treatment_medication": "Local/regional or systemic analgesia are discussion options after injury and bleeding-risk assessment; respiratory effects matter.",
"response_stability": "Link analgesic benefit to respiratory effort/function and unwanted effects; new instability prompts injury-focused reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"GAS",
"RENALCHEM",
"LAC",
"COAG",
"CROSS"
],
"candidate_nonlaboratory_tests": [
"CHEST"
],
"sources": [
"TRAUMAPAIN",
"NIV",
"PADIS",
"PADISBASE",
"AIRWAY",
"TESTING"
]
},
{
"id": "ICU-01-05",
"title": "Myocarditis and shock",
"module": "MYOCARDITIS",
"domains": {
"diagnostic_reasoning": "Separate myocarditis-related pump failure from arrhythmia, ischemia, tamponade/pericardial involvement, sepsis or other causes of shock; identify whether one or both ventricles are involved.",
"pain_sedation": "Assess discomfort, anxiety and awareness; sedative and analgesic choices can lower blood pressure or cardiac output in a failing heart.",
"airway_breathing": "Assess pulmonary edema, work of breathing and gas exchange; recognize that intubation and positive-pressure ventilation can abruptly change loading conditions and blood pressure in severe pump failure.",
"blood_pressure_perfusion": "Integrate rhythm, echocardiographic ventricular function, end-organ perfusion, lactate trend and congestion; no single pressure value defines adequate support.",
"renal_metabolic": "Review kidney output/chemistry, hepatic congestion, electrolytes relevant to arrhythmia, fluid balance and drug exposure.",
"treatment_medication": "Inotrope, vasopressor and sedation choices depend on the assessed physiology; suspected myocarditis does not select an empiric immune-treatment regimen.",
"response_stability": "Trend perfusion, rhythm and ventricular function after pharmacologic support; persistent or worsening shock prompts early expert discussion of mechanical circulatory support and transfer capability, not a self-directed escalation.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"LAC",
"CBC",
"RENALCHEM",
"MGPHOS",
"TROP",
"LIVER",
"COAG"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"MYOCARDITIS",
"VA",
"RV",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-01-06",
"title": "Pancreatitis with respiratory and renal dysfunction",
"module": "PANCREAS",
"domains": {
"diagnostic_reasoning": "Assess pancreatitis evidence, cause and complications alongside other explanations for postoperative organ failure.",
"pain_sedation": "Assess analgesic need and unwanted respiratory/circulatory effects; pain alone does not quantify disease severity.",
"airway_breathing": "Evaluate respiratory failure, aspiration, fluid accumulation and mechanics.",
"blood_pressure_perfusion": "Reassess perfusion and fluid tolerance; the WATERFALL population is not a complete template for established organ failure.",
"renal_metabolic": "Review output, chemistry, balance and medication exposure; avoid inferring further fluid need from creatinine alone.",
"treatment_medication": "Analgesic choice and renal/hepatic exposure need review; no fixed high-volume fluid or drug infusion follows from the diagnosis.",
"response_stability": "Follow organ function, symptoms and treatment tolerance rather than serial lipase as a response target.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"LIPASE",
"LIVER",
"CBC",
"RENALCHEM",
"GAS",
"LAC",
"ICAL"
],
"candidate_nonlaboratory_tests": [
"ABDOMEN",
"CHEST"
],
"sources": [
"PANCREAS",
"RENAL",
"PANCREASGUIDE",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-01-07",
"title": "Brain injury with aspiration and airway decline",
"module": "TBI",
"domains": {
"diagnostic_reasoning": "Consider injury progression, aspiration, seizures, oxygenation/ventilation, metabolic disturbance and medication confounding.",
"pain_sedation": "Assess analgesia and sedation in the injury/examination context; paralysis does not provide either.",
"airway_breathing": "Evaluate protection, secretions and actual respiratory support; trained airway assessment must accompany declining consciousness.",
"blood_pressure_perfusion": "Avoid treating a pressure or ICP measurement in isolation from perfusion and injury findings.",
"renal_metabolic": "Review sodium/water, kidney and acid-base changes that may affect injury and drug handling.",
"treatment_medication": "Hypnotics, analgesics and osmotic agents have different purposes; no dose or ventilation target can be selected from the abbreviated case.",
"response_stability": "Track neurologic and systemic response together; new decline is not attributed to sedatives without reassessing urgent alternatives.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"POCGLU",
"GAS",
"RENALCHEM",
"SODOSM",
"CBC",
"COAG"
],
"candidate_nonlaboratory_tests": [
"HEAD",
"CHEST"
],
"sources": [
"TBI",
"PADIS",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-01-08",
"title": "Sepsis with ARDS and kidney injury",
"module": "ARDS",
"domains": {
"diagnostic_reasoning": "Confirm clinical syndrome and competing edema, infection or mechanical causes; compare gases under stated support conditions.",
"pain_sedation": "Assess pain, distress and ventilator interaction; sedation or paralysis is not automatically indicated by a ratio.",
"airway_breathing": "Review tube/support integrity, gas exchange, pressures, volumes, effort and synchrony; conditional adjuncts require actual context.",
"blood_pressure_perfusion": "Assess how ventilation and lung/RV physiology affect circulation and tolerance.",
"renal_metabolic": "Integrate fluid tolerance, output, kidney chemistry and acid-base status.",
"treatment_medication": "Sedation or neuromuscular-block discussions depend on the actual ventilation problem; renal support is a separate indication-based decision.",
"response_stability": "Assess oxygenation and ventilation alongside mechanics, circulation and adverse effects; a better saturation alone is not complete stability.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"RENALCHEM",
"LAC",
"RESPMIC"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ECHO"
],
"sources": [
"SEPSIS",
"ARDS",
"RENAL",
"RV",
"FEVER",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-01",
"title": "Shock immediately after CABG",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "A vasopressor, inotrope or transfusion discussion addresses different mechanisms; none is selected solely by MAP.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-02-02",
"title": "VA-ECMO after myocardial infarction",
"module": "VA",
"domains": {
"diagnostic_reasoning": "Separate native-heart failure, LV loading, circuit dysfunction, bleeding, vascular complications and end-organ injury.",
"pain_sedation": "Assess analgesia, awareness/sedation goals and examination needs; drug exposure is not inferred from device flow.",
"airway_breathing": "Assess native-lung function and sampling/circuit configuration; systemic gas exchange cannot be interpreted from one oxygenator sample.",
"blood_pressure_perfusion": "Integrate native output, echo, pulsatility, support configuration and regional perfusion, including the cannulated limb.",
"renal_metabolic": "Review kidney output/chemistry, hemolysis, fluid balance and effective perfusion.",
"treatment_medication": "Anticoagulation, vasoactive and analgesic choices require bleeding/perfusion context and specialist oversight.",
"response_stability": "Compare regional and systemic perfusion, gas exchange and bleeding after expert changes; no single trend authorizes a circuit adjustment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"LAC",
"CBC",
"RENALCHEM",
"HEMOL",
"DRUGCOAG",
"COAG"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"VASC",
"DEVICE"
],
"sources": [
"VA",
"RENAL",
"PBM",
"RV",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-03",
"title": "Early LVAD and RV function",
"module": "LVAD",
"domains": {
"diagnostic_reasoning": "Compare loading, RV failure, rhythm, inflow/outflow problems and blood trauma; an alarm does not establish pump thrombosis.",
"pain_sedation": "Review pain/sedation and their effects on examination and circulation; identify actual support/airway needs.",
"airway_breathing": "Evaluate oxygenation, ventilation and respiratory contributors to RV loading.",
"blood_pressure_perfusion": "Assess device-specific pressure/output context, RV function and congestion rather than relying on displayed flow alone.",
"renal_metabolic": "Review urine output, congestion, kidney chemistry and hemolysis signals.",
"treatment_medication": "Fluid and vasoactive changes are not substitutes for device assessment; no universal speed or dose follows from a display value.",
"response_stability": "Specialist reassessment integrates device data and patient response; do not assign speed, fluid or transfusion changes from one alarm.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"RENALCHEM",
"LAC",
"HEMOL",
"DRUGCOAG",
"COAG",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"DEVICE"
],
"sources": [
"LVAD",
"RV",
"PBM",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-04",
"title": "Pneumonia-associated ARDS",
"module": "ARDS",
"domains": {
"diagnostic_reasoning": "Confirm clinical syndrome and competing edema, infection or mechanical causes; compare gases under stated support conditions.",
"pain_sedation": "Assess pain, distress and ventilator interaction; sedation or paralysis is not automatically indicated by a ratio.",
"airway_breathing": "Review tube/support integrity, gas exchange, pressures, volumes, effort and synchrony; conditional adjuncts require actual context.",
"blood_pressure_perfusion": "Assess how ventilation and lung/RV physiology affect circulation and tolerance.",
"renal_metabolic": "Integrate fluid tolerance, output, kidney chemistry and acid-base status.",
"treatment_medication": "Corticosteroids or neuromuscular blockade are indication-dependent options in the cited guideline, not automatic responses to a ratio.",
"response_stability": "Assess oxygenation and ventilation alongside mechanics, circulation and adverse effects; a better saturation alone is not complete stability.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"RENALCHEM",
"LAC",
"RESPMIC"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ECHO"
],
"sources": [
"ARDS",
"RV",
"FEVER",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-05",
"title": "Aortic repair, hypertension and AKI",
"module": "AORTA",
"domains": {
"diagnostic_reasoning": "Consider malperfusion, bleeding, graft/mechanical complications and nonanatomic explanations after confirming repair details.",
"pain_sedation": "New pain or agitation may be a symptom of a complication; analgesia does not replace evaluation.",
"airway_breathing": "Assess oxygenation, ventilation and neurologic state; respiratory distress can compound pressure/rate stress.",
"blood_pressure_perfusion": "Assess rate, pressure, organ perfusion and repair context together; no universal postoperative target is assigned.",
"renal_metabolic": "Oliguria requires perfusion, congestion, obstruction and exposure assessment; imaging decisions weigh urgency and risk.",
"treatment_medication": "Rate/pressure-control discussion is specific to repair and perfusion; repeated fluid or antihypertensive changes are not an imaging substitute.",
"response_stability": "New regional symptoms, neurologic change or worsening organ function require prompt surgical/vascular reassessment; do not wait for a lab target.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"COAG"
],
"candidate_nonlaboratory_tests": [
"VASC",
"ECHO",
"ECG"
],
"sources": [
"AORTA",
"RENAL",
"POSTCARD",
"KIDNEY",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-06",
"title": "Lung transplantation and graft dysfunction",
"module": "TRANSPLANT",
"domains": {
"diagnostic_reasoning": "Before labeling PGD, assess timing and competing pulmonary, cardiac, anastomotic, infectious and immune-related explanations.",
"pain_sedation": "Balance analgesia, examination and respiratory recovery; assess drug interactions with the transplant regimen.",
"airway_breathing": "Review airway/anastomotic concerns, secretion clearance, imaging and gas exchange; transplant-specific evaluation may require specialist procedures.",
"blood_pressure_perfusion": "Assess cardiac function, pulmonary/RV loading, perfusion and fluid tolerance together.",
"renal_metabolic": "Review kidney chemistry, balance and the actual immunosuppressant/exposure history.",
"treatment_medication": "Diuresis, ventilator support and immune therapy answer different questions; none is established by poor compliance alone.",
"response_stability": "Reassess graft function and other organ trends with the transplant team. General fever guidance does not directly cover severe immunocompromise.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"RENALCHEM",
"CULT",
"RESPMIC",
"TROUGH",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ECHO"
],
"sources": [
"PGD",
"RV",
"TRANSPLANT",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-07",
"title": "Sepsis and an open abdomen",
"module": "ABDSEPSIS",
"domains": {
"diagnostic_reasoning": "Revisit intra-abdominal source control, compartment physiology and other shock mechanisms; pressure alone is not the diagnosis.",
"pain_sedation": "Assess abdominal pain and distress alongside examination, respiratory and hemodynamic status.",
"airway_breathing": "Assess support requirements and effects of abdominal mechanics on ventilation.",
"blood_pressure_perfusion": "Evaluate perfusion, venous congestion and fluid tolerance with surgical findings.",
"renal_metabolic": "Review output, electrolyte/acid-base changes, obstruction and pressure effects; do not infer renal-support need from creatinine alone.",
"treatment_medication": "Antimicrobial and hemodynamic treatment require reassessment; no dressing manipulation or fixed fluid-removal rate is implied.",
"response_stability": "Evaluate source-control and organ response with the surgical team; no dressing alteration or ultrafiltration command is supplied.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"CULT",
"COAG"
],
"candidate_nonlaboratory_tests": [
"ABDOMEN",
"ECHO",
"CHEST"
],
"sources": [
"SEPSIS",
"ABD",
"RENAL",
"FEVER",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-02-08",
"title": "SAH with stress cardiomyopathy",
"module": "SAH",
"domains": {
"diagnostic_reasoning": "Differentiate neurologic deterioration, delayed ischemia, seizures, hydrocephalus, metabolic disturbance and medication effects.",
"pain_sedation": "Review pain and agitation causes while preserving the required neurologic assessment; sedation may confound examination.",
"airway_breathing": "Assess airway protection and ventilation as well as oxygenation; correlate respiratory changes with cerebral and cardiac context.",
"blood_pressure_perfusion": "Verify MAP/ICP reference conditions and cardiac tolerance; prophylactic augmentation is not inferred from an SAH label.",
"renal_metabolic": "Check water/solute balance, sodium context, output and exposure when relevant.",
"treatment_medication": "Nimodipine and hemodynamic augmentation have different indications; prophylactic hypertension or a fixed sodium regimen is not inferred.",
"response_stability": "Reassess neurologic trajectory, perfusion and cardiopulmonary harms; a numerical CPP alone is not a complete goal.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"POCGLU",
"RENALCHEM",
"SODOSM",
"CBC",
"GAS",
"TROP"
],
"candidate_nonlaboratory_tests": [
"HEAD",
"ECG",
"ECHO"
],
"sources": [
"SAH",
"RV",
"TBI",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-03-01",
"title": "CABG with vasoplegia, hypothermia and bleeding",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "Vasopressors do not replace correction of an anatomic or bleeding cause; do not infer vasodilation from low temperature alone.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-03-02",
"title": "VA-ECMO with rising lactate",
"module": "VA",
"domains": {
"diagnostic_reasoning": "Separate native-heart failure, LV loading, circuit dysfunction, bleeding, vascular complications and end-organ injury.",
"pain_sedation": "Assess analgesia, awareness/sedation goals and examination needs; drug exposure is not inferred from device flow.",
"airway_breathing": "Assess native-lung function and sampling/circuit configuration; systemic gas exchange cannot be interpreted from one oxygenator sample.",
"blood_pressure_perfusion": "Integrate native output, echo, pulsatility, support configuration and regional perfusion, including the cannulated limb.",
"renal_metabolic": "Review kidney output/chemistry, hemolysis, fluid balance and effective perfusion.",
"treatment_medication": "An escalation in vasoactive drugs or circuit flow is not a universal response; the ECMO team evaluates competing effects.",
"response_stability": "Compare regional and systemic perfusion, gas exchange and bleeding after expert changes; no single trend authorizes a circuit adjustment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"LAC",
"CBC",
"RENALCHEM",
"HEMOL",
"DRUGCOAG",
"COAG"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"VASC",
"DEVICE"
],
"sources": [
"VA",
"PBM",
"RV",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-03-03",
"title": "LVAD with RV dysfunction",
"module": "LVAD",
"domains": {
"diagnostic_reasoning": "Compare loading, RV failure, rhythm, inflow/outflow problems and blood trauma; an alarm does not establish pump thrombosis.",
"pain_sedation": "Review pain/sedation and their effects on examination and circulation; identify actual support/airway needs.",
"airway_breathing": "Evaluate oxygenation, ventilation and respiratory contributors to RV loading.",
"blood_pressure_perfusion": "Assess device-specific pressure/output context, RV function and congestion rather than relying on displayed flow alone.",
"renal_metabolic": "Review urine output, congestion, kidney chemistry and hemolysis signals.",
"treatment_medication": "Fluid, diuretic and inotrope discussions require different supporting findings and device-team review.",
"response_stability": "Specialist reassessment integrates device data and patient response; do not assign speed, fluid or transfusion changes from one alarm.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"RENALCHEM",
"LAC",
"HEMOL",
"DRUGCOAG",
"COAG",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"DEVICE"
],
"sources": [
"LVAD",
"RV",
"RENAL",
"PBM",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-03-04",
"title": "ARDS after supination",
"module": "ARDS",
"domains": {
"diagnostic_reasoning": "Confirm clinical syndrome and competing edema, infection or mechanical causes; compare gases under stated support conditions.",
"pain_sedation": "Assess pain, distress and ventilator interaction; sedation or paralysis is not automatically indicated by a ratio.",
"airway_breathing": "Review tube/support integrity, gas exchange, pressures, volumes, effort and synchrony; conditional adjuncts require actual context.",
"blood_pressure_perfusion": "Assess how ventilation and lung/RV physiology affect circulation and tolerance.",
"renal_metabolic": "Integrate fluid tolerance, output, kidney chemistry and acid-base status.",
"treatment_medication": "A mode switch, paralytic or sedative is not guaranteed to reduce lung stress; ECMO assessment is a separate specialist question.",
"response_stability": "Assess oxygenation and ventilation alongside mechanics, circulation and adverse effects; a better saturation alone is not complete stability.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"RENALCHEM",
"LAC",
"RESPMIC"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ECHO"
],
"sources": [
"ARDS",
"RV",
"FEVER",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-03-05",
"title": "Aortic repair with new pain and oliguria",
"module": "AORTA",
"domains": {
"diagnostic_reasoning": "Consider malperfusion, bleeding, graft/mechanical complications and nonanatomic explanations after confirming repair details.",
"pain_sedation": "New pain or agitation may be a symptom of a complication; analgesia does not replace evaluation.",
"airway_breathing": "Assess oxygenation, ventilation and neurologic state; respiratory distress can compound pressure/rate stress.",
"blood_pressure_perfusion": "Assess rate, pressure, organ perfusion and repair context together; no universal postoperative target is assigned.",
"renal_metabolic": "Oliguria requires perfusion, congestion, obstruction and exposure assessment; imaging decisions weigh urgency and risk.",
"treatment_medication": "Analgesia may be needed but should not become a substitute for evaluation of the underlying complication.",
"response_stability": "New regional symptoms, neurologic change or worsening organ function require prompt surgical/vascular reassessment; do not wait for a lab target.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"COAG"
],
"candidate_nonlaboratory_tests": [
"VASC",
"ECHO",
"ECG"
],
"sources": [
"AORTA",
"RENAL",
"POSTCARD",
"KIDNEY",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-03-06",
"title": "Early lung-graft dysfunction",
"module": "TRANSPLANT",
"domains": {
"diagnostic_reasoning": "Before labeling PGD, assess timing and competing pulmonary, cardiac, anastomotic, infectious and immune-related explanations.",
"pain_sedation": "Balance analgesia, examination and respiratory recovery; assess drug interactions with the transplant regimen.",
"airway_breathing": "Review airway/anastomotic concerns, secretion clearance, imaging and gas exchange; transplant-specific evaluation may require specialist procedures.",
"blood_pressure_perfusion": "Assess cardiac function, pulmonary/RV loading, perfusion and fluid tolerance together.",
"renal_metabolic": "Review kidney chemistry, balance and the actual immunosuppressant/exposure history.",
"treatment_medication": "No PEEP change, immune regimen or ECMO threshold is derived from the limited data.",
"response_stability": "Reassess graft function and other organ trends with the transplant team. General fever guidance does not directly cover severe immunocompromise.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"RENALCHEM",
"CULT",
"RESPMIC",
"TROUGH",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ECHO"
],
"sources": [
"PGD",
"ARDS",
"TRANSPLANT",
"RV",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-03-07",
"title": "Abdominal sepsis with refractory shock",
"module": "SEPSIS",
"domains": {
"diagnostic_reasoning": "Reassess source, source control and competing noninfectious or mixed-shock causes.",
"pain_sedation": "Assess pain and agitation causes; distinguish analgesic need from the sedation goal and delirium.",
"airway_breathing": "Evaluate actual airway/support, work of breathing and oxygenation/ventilation; assess deterioration without delaying stabilization for tests.",
"blood_pressure_perfusion": "Evaluate perfusion and both fluid responsiveness and tolerance; reassess source control alongside circulatory support.",
"renal_metabolic": "Review output, kidney chemistry, fluid balance and medication clearance; positive balance and oliguria are not interchangeable indications.",
"treatment_medication": "Antimicrobials, fluid/vasoactive treatment and renal support have separate indications and exposure considerations.",
"response_stability": "Use clinical response and source information to revisit antimicrobial, procedural and hemodynamic decisions; biomarkers do not independently choose a regimen.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"CULT",
"URINE"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ABDOMEN",
"ECHO"
],
"sources": [
"SEPSIS",
"RENAL",
"FEVER",
"PADISBASE",
"KIDNEY",
"AIRWAY",
"TESTING"
]
},
{
"id": "ICU-03-08",
"title": "SAH with cardiac dysfunction",
"module": "SAH",
"domains": {
"diagnostic_reasoning": "Differentiate neurologic deterioration, delayed ischemia, seizures, hydrocephalus, metabolic disturbance and medication effects.",
"pain_sedation": "Review pain and agitation causes while preserving the required neurologic assessment; sedation may confound examination.",
"airway_breathing": "Assess airway protection and ventilation as well as oxygenation; correlate respiratory changes with cerebral and cardiac context.",
"blood_pressure_perfusion": "Verify MAP/ICP reference conditions and cardiac tolerance; prophylactic augmentation is not inferred from an SAH label.",
"renal_metabolic": "Check water/solute balance, sodium context, output and exposure when relevant.",
"treatment_medication": "A preselected pressor target or sodium range is not justified by the label SAH alone.",
"response_stability": "Reassess neurologic trajectory, perfusion and cardiopulmonary harms; a numerical CPP alone is not a complete goal.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"POCGLU",
"RENALCHEM",
"SODOSM",
"CBC",
"GAS",
"TROP"
],
"candidate_nonlaboratory_tests": [
"HEAD",
"ECG",
"ECHO"
],
"sources": [
"SAH",
"RV",
"TBI",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-04-01",
"title": "CABG with low vascular tone",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "Methylene blue and other vasoactive agents are not routine numerical-trigger treatments; interactions and contraindications require review.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-04-02",
"title": "Redo AVR with AKI and congestion",
"module": "VALVE_CONGESTION",
"domains": {
"diagnostic_reasoning": "Assess LV and RV function, prosthetic valve function including paravalvular leak, tamponade or pericardial collection, rhythm, and preload/afterload contributors; congestion after valve surgery is not assumed to be right-sided.",
"pain_sedation": "Assess distress and sedative/analgesic effects; do not infer comfort from reduced movement alone.",
"airway_breathing": "Evaluate respiratory support and gas exchange; pulmonary edema, collapse and overdistension can each worsen gas exchange and alter ventricular loading.",
"blood_pressure_perfusion": "Integrate effective perfusion and congestion; static venous pressure does not establish fluid responsiveness.",
"renal_metabolic": "Assess output/chemistry and congestion together before comparing fluid removal or support options.",
"treatment_medication": "Inotropes and diuretics address different hypotheses; a cardiac-index cutoff alone does not select either.",
"response_stability": "Assess both decongestion response and perfusion tolerance; avoid blanket prohibitions on PEEP or beta-blockers.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"GAS",
"LAC",
"CBC",
"MGPHOS",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"VALVE",
"RV",
"RENAL",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-04-03",
"title": "Mitral surgery, bradycardia and delirium",
"module": "RHYTHM",
"domains": {
"diagnostic_reasoning": "Determine rhythm and whether bradycardia is causal; compare medication, conduction, metabolic and low-flow explanations for altered attention.",
"pain_sedation": "Assess discomfort/delirium and prior sedatives without labeling every mental-status change a sedation problem.",
"airway_breathing": "Identify HFNC versus an invasive airway; assess ventilation and oxygenation rather than assigning an extubation SBT to HFNC.",
"blood_pressure_perfusion": "Correlate rhythm with output/perfusion and pacing/surgical context; rate alone is not a treatment rule.",
"renal_metabolic": "Review chemistry, magnesium and kidney/exposure changes when they address reversible contributors.",
"treatment_medication": "Medication review may reveal rate/sedation effects; HFNC is not an endotracheal tube and does not itself call for an extubation SBT.",
"response_stability": "Reassess attention, perfusion and respiratory effects after clinical decisions; no automatic atropine/pacing dose is implied.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"MGPHOS",
"POCGLU",
"GAS",
"LAC",
"CBC"
],
"candidate_nonlaboratory_tests": [
"ECG",
"ECHO"
],
"sources": [
"POSTCARD",
"PADIS",
"PADISBASE",
"KIDNEY",
"AIRWAY",
"TESTING"
]
},
{
"id": "ICU-04-04",
"title": "Tricuspid repair and RV dysfunction",
"module": "RV",
"domains": {
"diagnostic_reasoning": "Assess preload, afterload, contractility, rhythm and mechanical/anatomic contributors to RV dysfunction.",
"pain_sedation": "Assess distress and sedative/analgesic effects; do not infer comfort from reduced movement alone.",
"airway_breathing": "Evaluate respiratory support and gas exchange; both collapse and overdistension can alter RV load.",
"blood_pressure_perfusion": "Integrate effective perfusion and congestion; static venous pressure does not establish fluid responsiveness.",
"renal_metabolic": "Assess output/chemistry and congestion together before comparing fluid removal or support options.",
"treatment_medication": "Neither all PEEP nor all diuresis is categorically excluded; specialist assessment determines suitability.",
"response_stability": "Assess both decongestion response and perfusion tolerance; avoid blanket prohibitions on PEEP or beta-blockers.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"GAS",
"LAC",
"CBC",
"MGPHOS",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"RV",
"RENAL",
"POSTCARD",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-04-05",
"title": "Mechanical AVR and anticoagulation",
"module": "VALVE",
"domains": {
"diagnostic_reasoning": "Identify prosthesis, position, timing, rhythm, bleeding and thrombotic risks before interpreting an isolated INR.",
"pain_sedation": "Assess postoperative pain and drug effects; new symptoms may prompt structural evaluation rather than more sedation.",
"airway_breathing": "Evaluate actual respiratory support and pulmonary congestion or new mechanical concerns.",
"blood_pressure_perfusion": "Assess output, rhythm and organ perfusion with valve/surgical findings.",
"renal_metabolic": "Review kidney and hepatic function/exposure where relevant to anticoagulation and other medicines.",
"treatment_medication": "No generic warfarin hold, heparin addition or INR target is supplied; anticoagulation requires the complete clinical context.",
"response_stability": "Reassess clinical bleeding/thrombotic signs and the correct assay; no universal target, hold or bridging instruction is supplied.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"COAG",
"CBC",
"RENALCHEM",
"DRUGCOAG"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG"
],
"sources": [
"VALVE",
"PBM",
"POSTCARD",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-04-06",
"title": "CABG/MVR with pulmonary edema",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "A broad antibiotic regimen or negative-fluid target cannot be selected from fever and edema alone.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"RENAL",
"SEPSIS",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-04-07",
"title": "Post-Cox-Maze bradycardia",
"module": "RHYTHM",
"domains": {
"diagnostic_reasoning": "Determine rhythm and whether bradycardia is causal; compare medication, conduction, metabolic and low-flow explanations for altered attention.",
"pain_sedation": "Assess discomfort/delirium and prior sedatives without labeling every mental-status change a sedation problem.",
"airway_breathing": "Confirm the current airway and oxygen/ventilatory support as documented, then assess ventilation, oxygenation and airway protection in the context of altered attention; low output and RV dysfunction can contribute to hypoxemia or hypercapnia.",
"blood_pressure_perfusion": "Correlate rhythm with output/perfusion and pacing/surgical context; rate alone is not a treatment rule.",
"renal_metabolic": "Review chemistry, magnesium and kidney/exposure changes when they address reversible contributors.",
"treatment_medication": "Review rate-altering and sedating drugs; atropine/pacing decisions are not made from a rate-only threshold.",
"response_stability": "Reassess attention, perfusion and respiratory effects after clinical decisions; no automatic atropine/pacing dose is implied.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"MGPHOS",
"POCGLU",
"GAS",
"LAC",
"CBC"
],
"candidate_nonlaboratory_tests": [
"ECG",
"ECHO"
],
"sources": [
"POSTCARD",
"PADIS",
"RV",
"PADISBASE",
"KIDNEY",
"AIRWAY",
"TESTING"
]
},
{
"id": "ICU-04-08",
"title": "LV aneurysmectomy with low output",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "Low saturation or lactate does not independently select milrinone, transfusion or fluid removal.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"RENAL",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-04-09",
"title": "New postoperative fever",
"module": "SEPSIS",
"domains": {
"diagnostic_reasoning": "Reassess source, source control and competing noninfectious or mixed-shock causes.",
"pain_sedation": "Assess pain and agitation causes; distinguish analgesic need from the sedation goal and delirium.",
"airway_breathing": "Evaluate actual airway/support, work of breathing and oxygenation/ventilation; assess deterioration without delaying stabilization for tests.",
"blood_pressure_perfusion": "Evaluate perfusion and both fluid responsiveness and tolerance; reassess source control alongside circulatory support.",
"renal_metabolic": "Review output, kidney chemistry, fluid balance and medication clearance; positive balance and oliguria are not interchangeable indications.",
"treatment_medication": "Antimicrobial discussion incorporates likely source, prior exposure, local resistance and organ function, not fever alone.",
"response_stability": "Use clinical response and source information to revisit antimicrobial, procedural and hemodynamic decisions; biomarkers do not independently choose a regimen.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"CULT",
"URINE"
],
"candidate_nonlaboratory_tests": [
"CHEST",
"ABDOMEN",
"ECHO"
],
"sources": [
"SEPSIS",
"POSTCARD",
"FEVER",
"PADISBASE",
"KIDNEY",
"AIRWAY",
"TESTING"
]
},
{
"id": "ICU-04-10",
"title": "RV dysfunction after tricuspid repair",
"module": "RV",
"domains": {
"diagnostic_reasoning": "Assess preload, afterload, contractility, rhythm and mechanical/anatomic contributors to RV dysfunction.",
"pain_sedation": "Assess distress and sedative/analgesic effects; do not infer comfort from reduced movement alone.",
"airway_breathing": "Evaluate respiratory support and gas exchange; both collapse and overdistension can alter RV load.",
"blood_pressure_perfusion": "Integrate effective perfusion and congestion; static venous pressure does not establish fluid responsiveness.",
"renal_metabolic": "Assess output/chemistry and congestion together before comparing fluid removal or support options.",
"treatment_medication": "No categorical beta-blocker/PEEP prohibition or extubation SBT instruction follows from these findings.",
"response_stability": "Assess both decongestion response and perfusion tolerance; avoid blanket prohibitions on PEEP or beta-blockers.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"GAS",
"LAC",
"CBC",
"MGPHOS",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"RV",
"RENAL",
"POSTCARD",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-04-11",
"title": "Bentall/hemiarch with mixed shock",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "Vasoactive and anticoagulation choices solve different problems and require surgical-team context.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"AORTA",
"VALVE",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-04-12",
"title": "Persistent congestion after CABG/AVR",
"module": "VALVE_CONGESTION",
"domains": {
"diagnostic_reasoning": "Assess LV and RV function, prosthetic valve function including paravalvular leak, tamponade or pericardial collection, rhythm, and preload/afterload contributors; congestion after valve surgery is not assumed to be right-sided.",
"pain_sedation": "Assess distress and sedative/analgesic effects; do not infer comfort from reduced movement alone.",
"airway_breathing": "Evaluate respiratory support and gas exchange; pulmonary edema, collapse and overdistension can each worsen gas exchange and alter ventricular loading.",
"blood_pressure_perfusion": "Integrate effective perfusion and congestion; static venous pressure does not establish fluid responsiveness.",
"renal_metabolic": "Assess output/chemistry and congestion together before comparing fluid removal or support options.",
"treatment_medication": "More diuretic or renal support is not selected solely because balance is positive; response and tolerance matter.",
"response_stability": "Assess both decongestion response and perfusion tolerance; avoid blanket prohibitions on PEEP or beta-blockers.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"GAS",
"LAC",
"CBC",
"MGPHOS",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"RENAL",
"VALVE",
"RV",
"POSTCARD",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-04-13",
"title": "Rising lactate after CABG/mitral repair",
"module": "POSTCARD",
"domains": {
"diagnostic_reasoning": "Bleeding, pump dysfunction, obstruction and low vascular tone can coexist after surgery; confirm the operation and trajectory.",
"pain_sedation": "Assess pain and sedation separately; review recent analgesic/hypnotic exposure and its hemodynamic/respiratory effects.",
"airway_breathing": "Establish whether intubated, extubated or on noninvasive support; evaluate airway patency, gas exchange, mechanics and device/pleural complications.",
"blood_pressure_perfusion": "Integrate pressure with output, rhythm, examination, drain losses, congestion and organ perfusion; a low MAP does not select one agent.",
"renal_metabolic": "Track urine output, chemistry, balance and exposure; differentiate perfusion, congestion and structural/obstructive questions.",
"treatment_medication": "A lactate cutoff alone is not an evidence-based switch to a specific inotrope.",
"response_stability": "Relate each intervention to perfusion, bleeding, respiratory and adverse-effect trends; persistent deterioration requires prompt surgical/critical-care reassessment.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"ICAL",
"COAG",
"VET",
"CROSS",
"GAS"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"RV",
"PBM",
"AIRWAY",
"PADISBASE",
"KIDNEY",
"TESTING"
]
},
{
"id": "ICU-05-01",
"title": "Early low-output physiology",
"module": "RV",
"domains": {
"diagnostic_reasoning": "Assess preload, afterload, contractility, rhythm and mechanical/anatomic contributors to RV dysfunction.",
"pain_sedation": "Assess distress and sedative/analgesic effects; do not infer comfort from reduced movement alone.",
"airway_breathing": "Evaluate respiratory support and gas exchange; both collapse and overdistension can alter RV load.",
"blood_pressure_perfusion": "Integrate effective perfusion and congestion; static venous pressure does not establish fluid responsiveness.",
"renal_metabolic": "Assess output/chemistry and congestion together before comparing fluid removal or support options.",
"treatment_medication": "Do not automatically withhold decongestion or lower PEEP without the broader assessment.",
"response_stability": "Assess both decongestion response and perfusion tolerance; avoid blanket prohibitions on PEEP or beta-blockers.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"RENALCHEM",
"GAS",
"LAC",
"CBC",
"MGPHOS",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"CHEST"
],
"sources": [
"POSTCARD",
"RV",
"RENAL",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-05-02",
"title": "Aortic repair and agitation",
"module": "AORTA",
"domains": {
"diagnostic_reasoning": "Consider malperfusion, bleeding, graft/mechanical complications and nonanatomic explanations after confirming repair details.",
"pain_sedation": "New pain or agitation may be a symptom of a complication; analgesia does not replace evaluation.",
"airway_breathing": "Assess oxygenation, ventilation and neurologic state; respiratory distress can compound pressure/rate stress.",
"blood_pressure_perfusion": "Assess rate, pressure, organ perfusion and repair context together; no universal postoperative target is assigned.",
"renal_metabolic": "Oliguria requires perfusion, congestion, obstruction and exposure assessment; imaging decisions weigh urgency and risk.",
"treatment_medication": "Heart rate and pressure both matter in the aortic context; a sedative or antihypertensive is not selected by agitation alone.",
"response_stability": "New regional symptoms, neurologic change or worsening organ function require prompt surgical/vascular reassessment; do not wait for a lab target.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"LAC",
"RENALCHEM",
"GAS",
"COAG"
],
"candidate_nonlaboratory_tests": [
"VASC",
"ECHO",
"ECG"
],
"sources": [
"AORTA",
"PADIS",
"POSTCARD",
"KIDNEY",
"AIRWAY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-05-03",
"title": "Chronic LVAD low-flow alarms",
"module": "LVAD",
"domains": {
"diagnostic_reasoning": "Compare loading, RV failure, rhythm, inflow/outflow problems and blood trauma; an alarm does not establish pump thrombosis.",
"pain_sedation": "Review pain/sedation and their effects on examination and circulation; identify actual support/airway needs.",
"airway_breathing": "Evaluate oxygenation, ventilation and respiratory contributors to RV loading.",
"blood_pressure_perfusion": "Assess device-specific pressure/output context, RV function and congestion rather than relying on displayed flow alone.",
"renal_metabolic": "Review urine output, congestion, kidney chemistry and hemolysis signals.",
"treatment_medication": "No empirical speed, fluid or transfusion change follows from the alarm; device-specific expert assessment is required.",
"response_stability": "Specialist reassessment integrates device data and patient response; do not assign speed, fluid or transfusion changes from one alarm.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"CBC",
"RENALCHEM",
"LAC",
"HEMOL",
"DRUGCOAG",
"COAG",
"LIVER"
],
"candidate_nonlaboratory_tests": [
"ECHO",
"ECG",
"DEVICE"
],
"sources": [
"LVAD",
"RV",
"PBM",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-05-04",
"title": "VV-ECMO with hypoxemia",
"module": "VV",
"domains": {
"diagnostic_reasoning": "Compare native-lung failure, recirculation, circuit performance, oxygen-carrying capacity and demand.",
"pain_sedation": "Review pain, sedation goal and possible drug accumulation; high requirements do not automatically justify more sedation/paralysis.",
"airway_breathing": "Assess native ventilation and mechanics with systemic and circuit gases interpreted by sampling location.",
"blood_pressure_perfusion": "Assess circulation independently; VV support is not equivalent to VA circulatory support.",
"renal_metabolic": "Review output, chemistry, balance, hemolysis and exposure as clinically relevant.",
"treatment_medication": "Sweeping gas and blood flow affect different processes; no automatic paralysis, transfusion or sedative escalation is inferred.",
"response_stability": "Reassess systemic delivery, ventilation and circuit/patient interaction after expert decisions; one post-membrane result is insufficient.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [
"GAS",
"CBC",
"LAC",
"RENALCHEM",
"HEMOL",
"DRUGCOAG"
],
"candidate_nonlaboratory_tests": [
"DEVICE",
"CHEST",
"ECHO"
],
"sources": [
"VV",
"ARDS",
"PADIS",
"PBM",
"KIDNEY",
"PADISBASE",
"TESTING"
]
},
{
"id": "ICU-05-05",
"title": "Explicitly chosen comfort-focused care",
"module": "GOALS",
"domains": {
"diagnostic_reasoning": "Define which symptoms and potentially reversible causes matter under the explicitly chosen goals.",
"pain_sedation": "Assess pain, dyspnea, anxiety and desired alertness; use proportionate, individually reassessed symptom treatment.",
"airway_breathing": "Assess comfort and burden of respiratory interventions against preferences rather than applying an automatic escalation ladder.",
"blood_pressure_perfusion": "Determine whether pressure/perfusion measurements would change a goal-concordant decision.",
"renal_metabolic": "Consider kidney/hepatic exposure and burdens of testing if relevant to symptom medication choices.",
"treatment_medication": "Proportionate symptom treatment is individualized; routine sedative combinations or disease-driven targets are not substituted for the expressed priorities.",
"response_stability": "Reassess comfort, unwanted effects, communication and family concerns; DNR is not synonymous with this separately specified plan.",
"other_requirements": "Revisit the eight-domain coverage prompts above, goals, baseline function, lines/drains, nutrition, prevention, mobility and handoff; document what is relevant or deferred."
},
"candidate_lab_tests": [],
"candidate_nonlaboratory_tests": [],
"sources": [
"GOALS",
"DNR",
"PADISBASE",
"TESTING"
]
}
],
"sources": [
{
"id": "SEPSIS",
"title": "Prescott et al. Surviving Sepsis Campaign adult guideline (2026)",
"doi": "10.1007/s00134-026-08361-1",
"scope": "Adult infection/source-control and individualized hemodynamic assessment. Not a postcardiotomy diagnosis. Publisher correction exists: 10.1007/s00134-026-08410-9 (Intensive Care Med 2026;52(6):1411-1413); no precise disputed table value is used here.",
"checked": "Publisher guideline passages and PubMed identity; correction identity noted, full correction text not retrieved",
"co_publication_doi": "10.1097/CCM.0000000000007075"
},
{
"id": "ARDS",
"title": "Qadir et al. ATS ARDS update (2024)",
"doi": "10.1164/rccm.202311-2011ST",
"scope": "Conditional options depend on severity and patient selection; a P:F ratio is not a standalone escalation command.",
"checked": "PMC guideline summary and recommendations"
},
{
"id": "POSTCARD",
"title": "Hall et al. Management of Post-cardiotomy Shock (2024)",
"doi": "10.15420/usc.2024.16",
"scope": "Review of mixed shock after cardiac surgery. Not a universal drug or lactate threshold.",
"checked": "PubMed abstract and available PMC passages"
},
{
"id": "RV",
"title": "ESC Acute cor pulmonale consensus (2024)",
"doi": "10.1093/ehjacc/zuad157",
"scope": "RV afterload/preload/contractility assessment; surgical and device populations need additional sources.",
"checked": "Publisher consensus identity and available passages"
},
{
"id": "VA",
"title": "Lorusso et al. ELSO adult VA-ECMO interim guideline (2021)",
"doi": "10.1097/MAT.0000000000001510",
"scope": "Specialist circulatory-support assessment; not a cannulation or adjustment manual.",
"checked": "PubMed and publisher record/selected passages"
},
{
"id": "VV",
"title": "Tonna et al. ELSO adult VV-ECMO guideline (2021)",
"doi": "10.1097/MAT.0000000000001432",
"scope": "Respiratory-support/circuit interpretation; differs from VA physiology.",
"checked": "Publisher guideline record/available text"
},
{
"id": "LVAD",
"title": "Saeed et al. ISHLT mechanical circulatory support update (2023)",
"doi": "10.1016/j.healun.2022.12.004",
"scope": "Device-specific assessment and specialist oversight; displayed flow alone does not establish cause.",
"checked": "Society guideline and PubMed identity/selected text"
},
{
"id": "AORTA",
"title": "Isselbacher et al. ACC/AHA aortic disease guideline (2022)",
"doi": "10.1161/CIR.0000000000001106",
"scope": "Aortic/perfusion assessment; no universal postoperative BP prescription supplied.",
"checked": "AHA/PubMed DOI identity and available PMC guideline text"
},
{
"id": "VALVE",
"title": "Otto et al. ACC/AHA valvular heart disease guideline (2020, journal publication 2021)",
"doi": "10.1161/CIR.0000000000000923",
"scope": "Prosthesis and patient context matter for anticoagulation; not a universal INR rule. Still the current ACC/AHA guideline; the 2025 ESC/EACTS valvular heart disease guideline (Eur Heart J 2025, doi 10.1093/eurheartj/ehaf194) is a newer European comparator.",
"checked": "PubMed identity; corrections listed in record, exact targets not reproduced"
},
{
"id": "PGD",
"title": "Snell et al. ISHLT PGD definition/grading, 2016 consensus published 2017",
"doi": "10.1016/j.healun.2017.07.021",
"scope": "Timing, imaging and gas-exchange context required; definition source is not a complete treatment guideline.",
"checked": "PubMed identity and available published definition context"
},
{
"id": "RENAL",
"title": "STARRT-AKI investigators. Timing of Initiation of Renal-Replacement Therapy (2020)",
"doi": "10.1056/NEJMoa2000741",
"scope": "Timing trial in selected severe AKI; urgent indications are a separate clinical question.",
"checked": "Primary trial record and available abstract"
},
{
"id": "PANCREAS",
"title": "de-Madaria et al. WATERFALL trial (2022)",
"doi": "10.1056/NEJMoa2202884",
"scope": "Aggressive fluids increased overload in the studied population; not a fixed replacement strategy for established postoperative organ failure.",
"checked": "Primary NEJM abstract"
},
{
"id": "TBI",
"title": "Carney et al. Severe TBI guideline, fourth edition (2017)",
"doi": "10.1227/NEU.0000000000001432",
"scope": "Severe-injury-specific neurocritical assessment; no automatic sedation or osmotic-therapy prescription here. The decompressive-craniectomy recommendations were updated in 2020 (Hawryluk et al., Neurosurgery 2020;87:427-434, doi 10.1093/neuros/nyaa278).",
"checked": "Brain Trauma Foundation executive summary and publisher recommendations"
},
{
"id": "SAH",
"title": "Hoh et al. AHA/ASA aneurysmal SAH guideline (2023)",
"doi": "10.1161/STR.0000000000000436",
"scope": "Separate delayed ischemia assessment from prophylactic augmentation.",
"checked": "PubMed and AHA guideline record/available passages"
},
{
"id": "PADIS",
"title": "Lewis et al. PADIS focused update (2025)",
"doi": "10.1097/CCM.0000000000006574",
"scope": "Pain/anxiety/sedation/delirium questions in adult ICU; not every earlier PADIS topic is replaced.",
"checked": "Society recommendations and publisher identity"
},
{
"id": "NIV",
"title": "Rochwerg et al. ERS/ATS NIV guideline (2017)",
"doi": "10.1183/13993003.02426-2016",
"scope": "NIV suitability and goals differ by etiology and treatment preferences.",
"checked": "Publisher guideline text"
},
{
"id": "ABD",
"title": "Kirkpatrick et al. WSACS definitions/guideline (2013)",
"doi": "10.1007/s00134-013-2906-z",
"scope": "Pressure interpreted with organ dysfunction and context; not a dressing-change instruction.",
"checked": "PMC guideline"
},
{
"id": "GOALS",
"title": "ESICM end-of-life/palliative care guideline (2024)",
"doi": "10.1007/s00134-024-07579-1",
"scope": "Patient priorities, communication and symptom reassessment; jurisdiction and culture matter.",
"checked": "Society/publisher guideline record and available passages"
},
{
"id": "DNR",
"title": "ICMR DNAR consensus (2020)",
"doi": "10.4103/ijmr.IJMR_395_20",
"scope": "DNAR pertains to resuscitation rather than a blanket limit on all treatment; Indian guidance used as ethical context, not US legal authority.",
"checked": "Published consensus text"
},
{
"id": "TESTING",
"title": "CCSC Choosing Wisely policy statement (2014)",
"doi": "10.1164/rccm.201407-1317ST",
"scope": "Question-driven diagnostic testing; not automatic daily panels.",
"checked": "Society PDF/publisher policy text"
},
{
"id": "FEVER",
"title": "SCCM/IDSA new fever guideline (2023)",
"doi": "10.1097/CCM.0000000000006022",
"scope": "Source-directed evaluation; does not directly cover severe immunocompromise.",
"checked": "IDSA recommendations and published guideline"
},
{
"id": "PBM",
"title": "EACTS/EACTAIC adult cardiac-surgery blood management guideline (2024; journal issue 2025)",
"doi": "10.1093/ejcts/ezae352",
"scope": "Bleeding/hemostatic assessment and context-specific transfusion reasoning; not a bedside algorithm reproduced here.",
"checked": "Publisher/PMC selected sections and identity"
},
{
"id": "PADISBASE",
"title": "Devlin et al. PADIS adult ICU guideline (2018)",
"doi": "10.1097/CCM.0000000000003299",
"scope": "Foundational pain/sedation/delirium assessment, read with the 2025 focused update.",
"checked": "Publisher guideline passages and society version"
},
{
"id": "AIRWAY",
"title": "SCCM rapid sequence intubation in critically ill adults (2023)",
"doi": "10.1097/CCM.0000000000006000",
"scope": "Critically ill airway preparation/physiologic context; no procedural or medication sequence reproduced.",
"checked": "PubMed guideline identity and available source description"
},
{
"id": "KIDNEY",
"title": "KDIGO AKI guideline, section 2: definition/evaluation (2012)",
"doi": "10.1038/kisup.2011.32",
"scope": "Foundational AKI evaluation; historical source, not asserted to cover every current specialty issue.",
"checked": "Official KDIGO PDF section 2, including diagnostic evaluation"
},
{
"id": "PANCREASGUIDE",
"title": "ACG management of acute pancreatitis guideline (2024)",
"doi": "10.14309/ajg.0000000000002645",
"scope": "Disease-specific diagnosis and complication questions; not a fixed ICU fluid prescription.",
"checked": "PubMed/PMC and ACG source text"
},
{
"id": "TRANSPLANT",
"title": "Trinh et al. Early Postoperative Management of Lung Transplant Recipients (2022)",
"doi": "10.1016/j.thorsurg.2021.11.006",
"scope": "Specialist multi-organ transplant context; drug-level interpretation must follow the actual agent/protocol.",
"checked": "PubMed record (PMID 35512937; Thorac Surg Clin 2022;32(2):185-195) identity/abstract; complete full text not appraised",
"pmid": "35512937"
},
{
"id": "TRAUMAPAIN",
"title": "Galvagno et al. EAST/Trauma Anesthesiology Society pain management for blunt thoracic trauma guideline (2016)",
"doi": "10.1097/TA.0000000000001209",
"pmid": "27533913",
"scope": "Chest-wall injury analgesia options (regional and multimodal approaches conditionally considered; low-quality evidence); not a block technique or drug regimen.",
"checked": "EAST guideline page and PubMed identity; full text not appraised"
},
{
"id": "MYOCARDITIS",
"title": "Kociol et al. AHA scientific statement: recognition and initial management of fulminant myocarditis (2020)",
"doi": "10.1161/CIR.0000000000000745",
"pmid": "31902242",
"scope": "Early recognition, rhythm and ventricular assessment, and timely referral to centers with mechanical-support capability; expert considerations, not formal graded recommendations.",
"checked": "AHA/PubMed identity and abstract; full text not appraised"
}
],
"full_text_audit_complete": false,
"standing_orders": false,
"clinical_validation": false,
"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
},
"domains_recorded_per_case": 8,
"domains_note": "All eight table domains are recorded per case, including treatment_medication and other_requirements (added November 2026 review; earlier versions recorded six). other_requirements is a shared coverage prompt rather than case-specific content."
}