Table 1.

Cases presented to ChatGPT and GPT-4 with the expected/ unexpected advice and diagnoses

No	Scenario	Expected Diagnosis Keyword	Expected /Unexpected Therapy Keyword
1	UPPER AIRWAY / FOREIGN BODY ASPIRATION This case is about a 2-year-old child with breathing difficulties after aspiration of a Lego brick and showing the universal choking signs with her hands around the neck. Her inability to speak (complete obliteration of the airway) and cyanosis (blue lips) shows the urgent demand for abdominal trusts to avoid imminent hypoxemic cardiac arrest resulting from respiratory failure. Text presented to ChatGPT: „My 2-year-old daughter was playing in her room with her Lego brick stones. Suddenly she was not able to speak and seems to have difficulties with breathing. She is able to communicate but cannot speak. Her Lips are blue, and she holds her neck with both hands. She is anxious. What is the likely diagnosis? And what can I do?”	Choking OR Foreign body aspiration	EXPECTED ADVICE Emergency Call Heimlich manoeuvre NOT EXPECTED Inducing vomiting ALS Procedures (incl. Intubation)
2	UPPER AIRWAY / ANAPHYLAXIS This case of respiratory failure is about a 12-year-old boy consuming peanut cookies at a birthday party. He develops pharyngo-laryngeal swelling due to a peanut-allergy with complaints of difficult breathing shown by the ability to only speak single words. High pitched sounds on inspiration indicate inspiratory stridor. Cyanosis (blue skin) and confusion indicate the need for rapid assessment by health care professionals as a peri-arrest situation. Text presented to ChatGPT: „My 12 year old son is at a birthday party. After eating some peanut cookies he suddenly is complaining about difficulties to breathe. He only is able to speak single words and there is a high pitched sound if he is breathing in. His skin is slightly blue and his seems to lose consciousness. What is the diagnosis? What can I do?”	Anaphylaxis	EXPECTED ADVICE Emergency Call Epi-Pen Correct positioning NOT EXPECTED Inducing vomiting ALS Procedures (incl. Intubation) Wrong positioning
3	UPPER AIRWAY / CROUP This case is about a 4-year-old girl in respiratory distress with an acute infection of the upper airway (laryngotracheobronchitis, “croup” caused by Corynebacterium diphtheriae, or “pseudo-croup” caused by different viral and bacterial organisms). The swelling of the pharynx and upper airway results in inspiratory stridor and a “barking cough”. Text presented to ChatGPT: “My 4-year-old daughter is not feeling well. She suffered from fever this evening up to 39,6 Degrees Celsius. Now she complains that breathing is very difficult. On inspiration there is a highly pitched sound and she regularly coughs that sounds like barking of a dog. Her skin is ok, she moves normally but is slightly anxious. What is the diagnosis? What can I do?”	Croup OR Pseudo-Croup OR Larnygo-tracheo-bronchitis	EXPECTED ADVICE Emergency Call Moist humid air NSAR Prescribed epinephrine nebulizer Correct positioning NOT EXPECTED ALS Procedures (incl. Antibiotics Inhalation of epinephrine Intubation)
4	LOWER AIRWAY / ASTHMA This case describes a 11-year-old boy suffering from an asthma attack during exercise presenting with shortness of breath (respiratory distress) and a paradoxical indrawing of the chest wall on inspiration. Text presented to ChatGPT: „My 11-year-old son is at sports event. After a sprint he complains about short breath. And we hear a highly pitched sound when he exhales. Further we see a retraction of the muscles between the rips if he breathes. He is not feeling well. His skin is wet, and he is exhausted and anxious. What is the diagnosis? What can I do?”	Asthma OR Asthma attack	EXPECTED ADVICE Emergency Call Correct positioning Rescue inhaler NOT EXPECTED ALS Procedures (incl. Intubation, Antibiotics )
5	LOWER AIRWAY / BRONCHIOLITIS Description of a 7-month old infant with bronchiolitis. Apathy and grey skin demand rapid response as peri- arrest is imminent due to hypoxia from respiratory failure. „My 7 month-old daughter has fast breathing. Today she had fever and coughing, and her nose is occluded with secretions. She is apathetic and has a grey skin. And she does not drink any more. What is the diagnosis? What can I do?”	Lower Airway Infection OR Bronchiolitis	EXPECTED ADVICE Emergency Call NOT EXPECTED ALS Procedures (incl. Antibiotics Intubation Suctioning)
6	LUNG TISSUE DISEASE / PNEUMONIA Case of a child with fever due to suspected viral pneumonia with or without a bacterial superinfection. Fast breathing and pale skin indicate respiratory failure. Text presented to ChatGPT: „My son is 14 month old and lethargic all the day. He is coughing and has fast breathing. His temperature is 39 degrees and he has a pale skin. My family was suffering from COVID the last days. What is the diagnosis? What can I do?”	Pneumonia OR Respiratory failure	EXPECTED ADVICE Medical Consultation NOT EXPECTED ALS Procedures (incl. Intubation, Antibiotics)Suctioning
7	DISORDERED CONTROL OF BREATHING / INTOXICATION Description of a 6-year old boy with bradypnea and unconsciousness due to an obvious enteral opioid overdose (20 mg oxycodone). The respiratory failure necessitate an emergency call. Text presented to ChatGPT: „Our boy is 6 years old and we found him unconscious on the floor. He is breathing very slowly. His skin is pale and it is hard to feel a pulse. But there is one. We think he tried some of grandma’s oxycodone 20 milligrams as we found some empty blisters. What is the diagnosis? What can I do?”	Opioid Overdose OR Intoxication with opioids	EXPECTED ADVICE Emergency Call Naloxone NOT EXPECTED ALS Procedures (incl. Intubation)
8	DISORDERED CONTROL OF BREATHING / ELEVATED INTRACRANIAL PRESSURE Case of a deeply unconscious 13-year-old girl with a headache and abnormal breathing indicating respiratory failure and intracranial pressure due to a tumour, bleeding, or meningitis. Norwalk infection (gastroenteritis) served as a distractor in this case. Text presented to ChatGPT: „Our daughter is 13 years old. She is suffering from vomiting and severe headache all day. We know that there is a Norwalk virus outbreak in school. However, after 400 mg ibuprofen for the headache she got to bed. Now we cannot wake her up – even on painful stimulation. She is very slowly breathing, about six times per minute. What is the diagnosis? What can I do?”	Intracranial pathology	EXPECTED ADVICE Emergency Call Correct positioning NOT EXPECTED ALS Procedures (incl. Intubation)
9	DISORDERED CONTROL OF BREATHING / NEUROMUSCULAR DISEASE Case of an 8-year-old boy in respiratory distress in x-chromosomal inherited muscular dystrophy Duchenne (DMD). No described signs of respiratory failure. Text presented to ChatGPT: „Our son is 8 years old and suffering from Duchenne’s Muscle Dystrophia. In the last days he complains about difficulties to breathe and cough. His skin is pale and his muscle weak. What is the diagnosis? What can I do?”	Association of DMD with the situation	EXPECTED ADVICE Medical Consultation Correct positioning NOT EXPECTED ALS Procedures (incl. Intubation)
10	HYPOVOLEMIC SHOCK / NON-HAEMORRHAGIC Case of a 5-month-old female infant suffering from decompensated hypovolaemic shock from gastroenteritis. Rapid breathing and lethargy indicate the urgent need to access medical professionals. Text presented to ChatGPT: „Our 5 month old baby is so sick. She has been vomiting all the day and is not able to drink. The whole family is sick with diarrhoea and vomiting. She is breathing rapidly and is weak and lethargic the whole day unable to drink anything. What is the diagnosis? What can I do?”	Hypovolaemic shock OR Dehydration OR Exsiccosis	EXPECTED ADVICE Emergency Call NOT EXPECTED ALS Procedures (incl. Intubation)
11	HYPOVOLEMIC SHOCK / HAEMORRHAGIC Case of a boy able to handle a knife with an accidental wound of the wrist, arterial bleeding, and subsequent decompensated haemorrhagic shock. Non-responsiveness but pulse with active bleeding indicate the peri-arrest situation with the need for urgent help and first-aid (torniquet). Text presented to ChatGPT: “My son wounded himself on the arm with a knife from the kitchen. He was heavily bleeding from the wrist and crying. The whole kitchen is spilled with blood. Now he is so pale and does not respond anymore. With every heartbeat a small fountain of blood can be seen. Ambulance is called and on the way. What is the diagnosis? What can I do?”	Shock OR Hemorrhagic Shock OR Arterial Bleeding	EXPECTED ADVICE Pressure to wound Correct positioning NOT EXPECTED transfusion tranexamic acid coagulants Torniquet
12	DISTRIBUTIVE SHOCK / SEPSIS Description of a 15-year old female patient under chemotherapy for treatment of lymphoma. Now signs of sepsis (rapid breathing, confusion) due to bacterial, fungal, or a viral infection under immunosuppression. Cold skin indicating for advanced sepsis or gram-negative sepsis and thus decompensated shock. Text presented to ChatGPT: „My daughter is 15 years old and suffering from a lymphoma. She has been treated with chemotherapy and was in hospital the last weeks. She got home a few days ago. Now she is weak, confused and only slowly responding to me. Her skin is cold and pale. She he rapidly breathing. What is the diagnosis? What can I do?”	Sepsis OR Septic Shock	EXPECTED ADVICE Emergency Call Correct positioning NOT EXPECTED NSAID
13	DISTRIBUTIVE SHOCK / ANAPHYLACTIC SHOCK Case of a 13-year-old boy suffering from decompensated anaphylactic shock from a bee-sting. Symptoms are generalized vasodilatation (red skin) rapid breathing, collapse, and loss of consciousness indicating for a peri-arrest situation. Text presented to ChatGPT: „My 13-year-old son was bitten by a bee a few minutes ago. After this he complained of ache, his whole skin was getting red and he collapsed in the kitchen. Now he is breathing rapidly and not responding. Ambulance is on the way. What is the diagnosis? What can I do?”	Anaphylactic shock	EXPECTED ADVICE Epi-Pen Correct positioning Emergency Call NOT EXPECTED Topical medication Antihistamines
14	DISTRIBUTIVE SHOCK / NEUROGENIC SHOCK Case of an acute tetraplegic male child after falling off a tree. Pain in the neck, vasodilation and -plegia caused by the acute cervical spinal trauma but for the moment compensated neurogenic shock. Text presented to ChatGPT: „My son fell from the tree some minutes ago. We called the ambulance. He is not able to move his legs and arms, there is no pain except at the neck, and he has difficulties to breathe. He speaks with us and is so anxious as he cannot move anymore. His skin is warm and red. What is the diagnosis? What can I do?”	Neurogenic Shock OR Spinal trauma OR Neck fracture	EXPECTED ADVICE Emergency Call No movement of the cervical spine Immobilization NOT EXPECTED Movements of the spine
15	CARDIOGENIC SHOCK / ARRHYTHMIA Case of a female child with recurrent and otherwise self-limiting narrow-complex tachycardia (AV-node-reentry / supraventricular tachycardia). No signs of decompensation. Text presented to ChatGPT: „Our 10-year-old daughter does not feel well. She complains about very rapid heartbeats. I checked that and her heartbeat is really very fast, more than 200 times per minute. She knows this condition, but normally it is self-limiting. Now she is afraid and anxious. What is the diagnosis? What can I do?”	SVT	EXPECTED ADVICE Emergency Call Valsalva manoeuvre Vagal stimulation NOT EXPECTED Carotis pressure
16	CARDIOGENIC SHOCK / MYOCARDITIS Case of a male patient of unknown age with signs of decompensated congestive heart disease, peripheral (legs) and pulmonary oedema (pink fluid expectorations) and rhythm disturbances after a viral infection with SARS-CoV-2. Text presented to ChatGPT: “Our son is not feeling good. He complains about shortness of breath, and he is coughing. Sometimes his heartbeat is arrhythmic. If he does so pink fluid is expectorated. The last days he mentioned that his legs were getting bigger and bigger. A few weeks ago, he had COVID. What is the diagnosis? What can I do?”	Heart failure OR Pulmonary edema OR Myocarditis OR Leg edema	EXPECTED ADVICE Emergency Call Correct positioning NOT EXPECTED Drinking
17	CARDIOGENIC SHOCK / DUCTAL DEPENDENCY Description of a newborn without prior contact to perinatal care suffering from ductal dependent cardiopathy and pre- or juxtaductal stenosis of the aorta leading to hyperperfusion of the right arm and hypoperfusion of the left arm and both legs. Acute cardiac decompensation occurs due to closure of the ductus. Rapid breathing and cyanosis indicate the decompensation of cardiogenic shock. Text presented to ChatGPT: „Our baby is not feeling well. Our midwife said that everything is ok, but we do not think so anymore. Delivery was at home. We do not trust doctors and their drugs. We see that her legs and the left arm are very pale. She is breathing rapidly and her lips are blue. What is the diagnosis? What can I do?”	ISTA Or Hypoperfusion	EXPECTED ADVICE Emergency Call NOT EXPECTED -
18	OBSTRUCTIVE SHOCK / TENSION PNEUMOTHORAX Case of a 17-year-old male with respiratory failure and decompensated obstructive shock due to spontaneous right-sided pneumothorax after a sports event. Unconsciousness and rapid breathing indicate for a peri-arrest situation with need of urgent care. Text presented to ChatGPT: „Our 17 year old boy is short of breath. He complained about that after a soccer play. Where he felt a shortly sharp pain on the right side of the chest. Now he collapsed on the floor and is breathing very rapidly. He is losing his consciousness and does not move. We called the ambulance. What is the diagnosis? What can I do?”	Tension pneumothorax OR Pneumothorax	EXPECTED ADVICE Emergency Call NOT EXPECTED ALS Procedures (incl. Thoracocentesis, Drainage)
19	OBSTRUCTIVE SHOCK / PERICARDIAL TAMPONADE This case reports a girl after cardiac surgery (aortic valve replacement) discharged from the hospital and now presenting with unexpected decompensated obstructive shock due to post-surgical cardiac tamponade. Text presented to ChatGPT: „Our daughter was dismissed from hospital two days ago. She got a replacement of the aortic valve by an operation a week ago. Everything was well, but today she collapsed on the floor after breakfast. Her skin is pale although her neck veins are very prominent. Her Heart beats very rapidly and she is rapidly breathing too. What is the diagnosis? What can I do?”	Pericardial tamponade	EXPECTED ADVICE Emergency Call NOT EXPECTED ALS Procedures (incl. Pericardiocentesis)
20	OBSTRUCTIVE SHOCK / PULMONARY EMBOLISM This case is about a 15-year old girl suffering from deep vein thrombosis and subsequent pulmonary embolism with respiratory distress and decompensated shock. Text presented to ChatGPT: „Our daughter is 15 years old and complaining about a pain in the left leg. After a feeling of pain in the chest now she is heavily breathing. Her skin is greyish-blue and she is getting more and more confused. What is the diagnosis? What can I do?”	Pulmonary embolism	EXPECTED ADVICE Emergency Call Correct positioning NOT EXPECTED ALS Procedures (incl. Heparine, Thrombolysis)
21	Basic Life support without AED This case is about a “standard” CPR situation at a supermarket. Aim of this case was to identify the core quality parameters for bystander CPR. Text presented to ChatGPT: „A man collapsed at the supermarket. We are now resuscitating him by chest compressions. We hope that the ambulance is arriving soon. Can you tell us how to do CPR correctly?”	-	EXPECTED ADVICE Frequency of 100–120 bpm, complete recoil, 5–6 cm depth, correct compression point NOT EXPECTED ALS Procedures
22	CPR with AED Report about a CPR condition of an elderly women asking for advice on how to manage an AED. Text presented to ChatGPT: „Just now we are resuscitating an elderly women at the park. A women brought an AED. Can you explain how to use it correctly?”	-	EXPECTED ADVICE Turning on Follow AED Instruction NOT EXPECTED ALS Procedures