{
  "id": "hyperkalemia",
  "title": "Hyperkalemia \u2014 emergent cardiac stabilization",
  "patient_id": "pat-1015",
  "encounter_id": "enc-1015",
  "role": "Attending Physician",
  "objective": "As the attending physician, review potassium and ECG, place emergent calcium gluconate and insulin-dextrose, document the potassium level, ECG changes, and management cascade, then sign the encounter.",
  "required_orders": [
    "Calcium gluconate IV",
    "Insulin and dextrose IV"
  ],
  "required_note_elements": [
    "Potassium level",
    "ECG changes",
    "Emergent management",
    "Potassium shifting agents"
  ],
  "scoring": {
    "base_reward": 1.0,
    "substeps": {
      "order:Calcium gluconate IV": 0.18,
      "order:Insulin and dextrose IV": 0.12,
      "note_element:Potassium level": 0.12,
      "note_element:ECG changes": 0.12,
      "note_element:Emergent management": 0.1,
      "note_element:Potassium shifting agents": 0.1,
      "encounter_signed": 0.26
    }
  }
}