hz/step3
1
0
Fork 0
Code Issues Pull Requests Actions Packages Projects Releases Wiki Activity

Complete CCS results and rating flow

Browse Source
This commit is contained in:
hz
2026-07-15 11:08:13 -05:00
parent 9f379cda5c
commit 52d435fa2e
14 changed files with 402 additions and 47 deletions
Download Patch File Download Diff File Expand all files Collapse all files
content/ccs/dka-emergency-001.json
+16 -16
View File
@@ -68,22 +68,22 @@
{ "id": "metabolic_improvement", "triggerMinute": 270, "requiresOrderCodes": ["insulin_infusion", "potassium_chloride_iv", "dextrose_half_normal_saline", "serial_bmp"], "message": "Glucose and acidosis continue to improve without hypoglycemia or hypokalemia. Case-end instructions are available.", "vitalPatches": { "bloodPressure": "112/70 mm Hg", "pulse": "88/min", "respirations": "18/min" }, "endCase": true }
],
"scoringCriteria": [
{ "id": "assess_hydration", "actionType": "exam", "targetCode": "general_exam", "points": 4, "latestMinute": 10, "afterTargetCode": "", "rationale": "Early assessment should identify severe volume depletion and altered mentation." },
{ "id": "iv_access", "actionType": "order", "targetCode": "iv_access", "points": 4, "latestMinute": 5, "afterTargetCode": "", "rationale": "Prompt intravenous access is needed for fluid resuscitation and treatment." },
{ "id": "cardiac_monitor", "actionType": "order", "targetCode": "cardiac_monitor", "points": 3, "latestMinute": 10, "afterTargetCode": "", "rationale": "Potassium shifts during DKA treatment create arrhythmia risk." },
{ "id": "fluid_resuscitation", "actionType": "order", "targetCode": "", "targetCodes": ["normal_saline_bolus", "balanced_crystalloid_bolus"], "points": 12, "latestMinute": 10, "afterTargetCode": "", "rationale": "Immediate isotonic crystalloid treats severe intravascular depletion and hypotension." },
{ "id": "electrolytes", "actionType": "order", "targetCode": "bmp", "points": 8, "latestMinute": 10, "afterTargetCode": "", "rationale": "Electrolytes, renal function, glucose, bicarbonate, and anion gap guide diagnosis and safe treatment." },
{ "id": "ketone_confirmation", "actionType": "order", "targetCode": "beta_hydroxybutyrate", "points": 5, "latestMinute": 20, "afterTargetCode": "", "rationale": "Direct beta-hydroxybutyrate measurement confirms and monitors clinically important ketonemia." },
{ "id": "acid_base", "actionType": "order", "targetCode": "venous_blood_gas", "points": 5, "latestMinute": 20, "afterTargetCode": "", "rationale": "Venous pH establishes the severity of metabolic acidosis without requiring an arterial sample." },
{ "id": "pregnancy", "actionType": "order", "targetCode": "pregnancy_test", "points": 3, "latestMinute": 30, "afterTargetCode": "", "rationale": "Pregnancy status affects the differential diagnosis, monitoring, and disposition in a reproductive-age patient." },
{ "id": "insulin_after_potassium", "actionType": "order", "targetCode": "insulin_infusion", "points": 15, "latestMinute": 30, "afterTargetCode": "bmp", "rationale": "Insulin suppresses ketogenesis but should follow assessment of serum potassium." },
{ "id": "hourly_glucose", "actionType": "order", "targetCode": "hourly_glucose", "points": 5, "latestMinute": 35, "afterTargetCode": "insulin_infusion", "rationale": "Frequent glucose monitoring is required during continuous insulin therapy." },
{ "id": "serial_electrolytes", "actionType": "order", "targetCode": "serial_bmp", "points": 8, "latestMinute": 40, "afterTargetCode": "insulin_infusion", "rationale": "Serial chemistry identifies falling potassium and tracks resolution of acidosis." },
{ "id": "potassium_replacement", "actionType": "order", "targetCode": "potassium_chloride_iv", "points": 10, "earliestMinute": 12, "latestMinute": 260, "afterTargetCode": "bmp", "rationale": "Total-body potassium is depleted and replacement is needed as serum potassium falls during therapy." },
{ "id": "dextrose_with_continued_insulin", "actionType": "order", "targetCode": "dextrose_half_normal_saline", "points": 10, "earliestMinute": 240, "latestMinute": 300, "afterTargetCode": "insulin_infusion", "rationale": "When glucose approaches 200 mg/dL before ketoacidosis resolves, add dextrose so insulin can continue safely." },
{ "id": "icu_disposition", "actionType": "order", "targetCode": "icu_admission", "points": 8, "latestMinute": 60, "afterTargetCode": "", "rationale": "Severe DKA with hypotension and altered mentation requires closely monitored inpatient care." },
{ "id": "avoid_bicarbonate", "actionType": "order", "targetCode": "sodium_bicarbonate_iv", "points": -10, "afterTargetCode": "", "rationale": "Routine bicarbonate provides no benefit at pH 7.08 and may worsen potassium shifts and other complications." },
{ "id": "avoid_empiric_antibiotic", "actionType": "order", "targetCode": "ceftriaxone", "points": -4, "afterTargetCode": "", "rationale": "No history, examination, or urine findings support bacterial infection requiring empiric ceftriaxone." }
{ "id": "assess_hydration", "title": "Assess hydration and mental status", "actionType": "exam", "targetCode": "general_exam", "points": 4, "latestMinute": 10, "afterTargetCode": "", "rationale": "Early assessment should identify severe volume depletion and altered mentation." },
{ "id": "iv_access", "title": "Establish intravenous access", "actionType": "order", "targetCode": "iv_access", "points": 4, "latestMinute": 5, "afterTargetCode": "", "rationale": "Prompt intravenous access is needed for fluid resuscitation and treatment." },
{ "id": "cardiac_monitor", "title": "Start cardiac monitoring", "actionType": "order", "targetCode": "cardiac_monitor", "points": 3, "latestMinute": 10, "afterTargetCode": "", "rationale": "Potassium shifts during DKA treatment create arrhythmia risk." },
{ "id": "fluid_resuscitation", "title": "Begin isotonic fluid resuscitation", "actionType": "order", "targetCode": "", "targetCodes": ["normal_saline_bolus", "balanced_crystalloid_bolus"], "points": 12, "latestMinute": 10, "afterTargetCode": "", "rationale": "Immediate isotonic crystalloid treats severe intravascular depletion and hypotension." },
{ "id": "electrolytes", "title": "Check electrolytes and anion gap", "actionType": "order", "targetCode": "bmp", "points": 8, "latestMinute": 10, "afterTargetCode": "", "rationale": "Electrolytes, renal function, glucose, bicarbonate, and anion gap guide diagnosis and safe treatment." },
{ "id": "ketone_confirmation", "title": "Measure serum beta-hydroxybutyrate", "actionType": "order", "targetCode": "beta_hydroxybutyrate", "points": 5, "latestMinute": 20, "afterTargetCode": "", "rationale": "Direct beta-hydroxybutyrate measurement confirms and monitors clinically important ketonemia." },
{ "id": "acid_base", "title": "Assess acid-base status", "actionType": "order", "targetCode": "venous_blood_gas", "points": 5, "latestMinute": 20, "afterTargetCode": "", "rationale": "Venous pH establishes the severity of metabolic acidosis without requiring an arterial sample." },
{ "id": "pregnancy", "title": "Check pregnancy status", "actionType": "order", "targetCode": "pregnancy_test", "points": 3, "latestMinute": 30, "afterTargetCode": "", "rationale": "Pregnancy status affects the differential diagnosis, monitoring, and disposition in a reproductive-age patient." },
{ "id": "insulin_after_potassium", "title": "Start insulin after assessing potassium", "actionType": "order", "targetCode": "insulin_infusion", "points": 15, "latestMinute": 30, "afterTargetCode": "bmp", "rationale": "Insulin suppresses ketogenesis but should follow assessment of serum potassium." },
{ "id": "hourly_glucose", "title": "Monitor glucose hourly", "actionType": "order", "targetCode": "hourly_glucose", "points": 5, "latestMinute": 35, "afterTargetCode": "insulin_infusion", "rationale": "Frequent glucose monitoring is required during continuous insulin therapy." },
{ "id": "serial_electrolytes", "title": "Monitor serial electrolytes", "actionType": "order", "targetCode": "serial_bmp", "points": 8, "latestMinute": 40, "afterTargetCode": "insulin_infusion", "rationale": "Serial chemistry identifies falling potassium and tracks resolution of acidosis." },
{ "id": "potassium_replacement", "title": "Replace potassium during treatment", "actionType": "order", "targetCode": "potassium_chloride_iv", "points": 10, "earliestMinute": 12, "latestMinute": 260, "afterTargetCode": "bmp", "rationale": "Total-body potassium is depleted and replacement is needed as serum potassium falls during therapy." },
{ "id": "dextrose_with_continued_insulin", "title": "Add dextrose while continuing insulin", "actionType": "order", "targetCode": "dextrose_half_normal_saline", "points": 10, "earliestMinute": 240, "latestMinute": 300, "afterTargetCode": "insulin_infusion", "rationale": "When glucose approaches 200 mg/dL before ketoacidosis resolves, add dextrose so insulin can continue safely." },
{ "id": "icu_disposition", "title": "Admit for intensive monitoring", "actionType": "order", "targetCode": "icu_admission", "points": 8, "latestMinute": 60, "afterTargetCode": "", "rationale": "Severe DKA with hypotension and altered mentation requires closely monitored inpatient care." },
{ "id": "avoid_bicarbonate", "title": "Avoid unnecessary bicarbonate", "actionType": "order", "targetCode": "sodium_bicarbonate_iv", "points": -10, "afterTargetCode": "", "rationale": "Routine bicarbonate provides no benefit at pH 7.08 and may worsen potassium shifts and other complications." },
{ "id": "avoid_empiric_antibiotic", "title": "Avoid unsupported empiric antibiotics", "actionType": "order", "targetCode": "ceftriaxone", "points": -4, "afterTargetCode": "", "rationale": "No history, examination, or urine findings support bacterial infection requiring empiric ceftriaxone." }
],
"references": [
{ "title": "Hyperglycemic Crises in Adults With Diabetes: A Consensus Report", "publisher": "American Diabetes Association, EASD, AACE, JBDS-IP, and Diabetes Technology Society", "url": "https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A", "supports": "DKA diagnosis, fluid resuscitation, insulin and potassium sequencing, dextrose addition, monitoring, bicarbonate avoidance, and resolution criteria", "accessedOn": "2026-07-15", "reviewer": "Question bank editorial review" },