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Running
| { | |
| "task_id": "thyroid-storm-rollout", | |
| "description": "Synthetic rollout for Thyroid storm \u2014 multi-drug thyroid blockade and rate control. Reviews chart, writes progress note, places orders, and signs the encounter.", | |
| "reset_request": { | |
| "patient_id": "pat-1022" | |
| }, | |
| "actions": [ | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='patient-card-pat-1022']" | |
| }, | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='activity-notes']" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Note author']", | |
| "text": "Patrick Sullivan, MD" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Note title']", | |
| "text": "Progress Note" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Progress note content']", | |
| "text": "S: Patient presents with agitation, fever, and palpitations. History of Graves' disease, stopped methimazole on her own 2 weeks ago. Husband reports progressive confusion.\nO: Thyroid hormone levels: free T4 5.8 ng/dL (markedly elevated), TSH <0.01. HR 142, irregular. Temp 39.8 C. Burch-Wartofsky score 55 (suggestive of thyroid storm). Precipitating event: medication non-compliance with methimazole discontinuation.\nA: Thyroid storm (Burch-Wartofsky >45). Anti-thyroid therapy: PTU preferred over methimazole in storm due to additional inhibition of T4-to-T3 conversion. Beta-blocker rationale: propranolol preferred for adrenergic symptom control AND additional inhibition of peripheral T4-to-T3 conversion. Temperature management: active cooling required.\nP: Propylthiouracil oral 200mg q4h loading. Propranolol IV 1mg q5-10 min until HR <100, then PO 60mg q6h. Beta-blocker rationale: propranolol for dual benefit of rate control and T4-to-T3 conversion block. SSKI (potassium iodide) after 1 hour of PTU loading. Hydrocortisone 100mg IV q8h (relative adrenal insufficiency). Temperature management: acetaminophen, cooling blanket. Avoid aspirin (displaces thyroid hormone from TBG). ICU admission." | |
| }, | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='save-note-button']" | |
| }, | |
| { | |
| "type": "wait", | |
| "milliseconds": 600 | |
| }, | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='activity-orders']" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order name']", | |
| "text": "Propylthiouracil oral" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order category']", | |
| "text": "MED" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order parameters']", | |
| "text": "PO, per protocol" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order rationale']", | |
| "text": "Indicated for Thyroid storm management" | |
| }, | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='save-order-button']" | |
| }, | |
| { | |
| "type": "wait", | |
| "milliseconds": 600 | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order name']", | |
| "text": "Propranolol IV" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order category']", | |
| "text": "MED" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order parameters']", | |
| "text": "IV, per protocol" | |
| }, | |
| { | |
| "type": "fill", | |
| "selector": "[aria-label='Order rationale']", | |
| "text": "Indicated for Thyroid storm management" | |
| }, | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='save-order-button']" | |
| }, | |
| { | |
| "type": "wait", | |
| "milliseconds": 600 | |
| }, | |
| { | |
| "type": "click", | |
| "selector": "[data-testid='sign-encounter-button']" | |
| } | |
| ] | |
| } | |