CaseData[32] = {
    "title": "Case 32 - 4 year old for appendectomy", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 1.2, 
    "debriefMsg": "You must become adept at the differential diagnosis of hypotension under anesthesia. Anaphylactic reaction must be suspected in any patient with refractory hypotension. Other signs of anaphylactic reaction exhibited in this patient include tachycardia, bronchospasm, hypoxia, periorbital edema and cutaneous flushing.\n\nYou must treat aggressively by securing the airway, ventilating with 100% oxygen, rapid administration of intravenous fluids, and appropriate boluses of epinephrine.", 
    "depthCarina": 18, 
    "depthCords": 12, 
    "depthTubeInitial": 15, 
    "durationPrep": 60, 
    "durationSurgery": 2400, 
    "helpFlag": true, 
    "imageSet": 1, 
    "initialSat": 96, 
    "leanBodyMass": 18, 
    "learningObj": "\n4 year old healthy male (18 kg)\n\nThis patient has a history of hay fever and penicillin allergy so there is a slightly  increased risk for an allergic reaction. The patient may also be somewhat dehydrated and have an increased risk of aspiration with his acute abdomen.\n\nLearning Objectives\n1. List the clinical manifestations of anaphylaxis.\n2. List the goals of treatment.\n3. List the steps you will take to treat anaphylaxis.\n4. State the appropriate dose of epinephrine for anaphylaxis and risk of administering too much.\n\nAnesthetic Considerations\n1. Possible dehydration\n2. Slightly increased risk of allergic reaction\n3. Slightly increased risk of pulmonary aspiration\n\nSuggested Anesthetic Plan\n1. Routine monitoring\n2. Preoxygenate\n3. Tracheal intubation following rapid sequence induction while applying cricoid pressure.\n4. Maintain anesthesia with oxygen, narcotics, inhalation agent.\n5. Extubate after return of airway reflexes.\n\nManagement of Anaphylaxis\nAnaphylaxis is defined as a severe, life-threatening, generalized hypersensitivity reaction, mainly mediated by IgE antibodies. Prior exposure to a drug or substance caused sensitization by producing IGE antibodies. Repeated exposure results in antigen - antibody reaction, leading to a release of histamine and other vasoactive substances from mast cells and basophils. It is not possible to predict which patients will experience an anaphylactic reaction, but patients with many prior exposures to the drug and those with allergic history have an increased risk. \n\nNon-IgE mediated reactions result from release of histamine and other inflammatory mediators following administration of a drug or substance. The reaction does not require prior sensitization, but the clinical manifestations of non-IgE mediated reactions can be indistinguishable from an anaphylactic reaction. These reactions are generally related to speed of injection and amount and type of drug administered. Heparin, protamine, morphine, older neuromuscular blockers such as d-tubocaurare or atracurium, and vancomycin are examples of drugs that can cause the direct release of histamine na dother inflammatory mediators.  \n\nThe clinical manifestations of anaphylaxis usually occur within a few minutes of exposure to the triggering agent:\nHypotension: invariable\nTachycardia: invariable\nBronchospasm: common\nHypoxemia: common\nCardiac dysrhythmias: common\nLaryngeal and periorbital edema: common\nCutaneous flushing: common\nCoagulation defects: occasional\nLeukopenia: occasional\n\nNote: 75% of fatalities are due to bronchospasm\n\nGoals of Treatment\n1. Reverse arterial hypoxemia\n2. Replace intravascular volume\n3. Inhibit further release of vasoactive substances\n\nTreatment\n1. Stop administration of triggering antigen if possible\n2. Maintain airway and administer 100% oxygen\n3. Balanced salt solution or colloid - often rapid infusion of 25-50 mL/kg liters required; may need to be repeated\n4. Epinephrine (5 - 10 mcg IV boluses)\n- Beta-2 adrenergic effect inhibits degranulation and causes bronchodilation\n- Alpha effect causes vasoconstriction\n5. Discontinue anesthetic drugs\n6. Diphenhydramine (initial dose 50 - 100 mg IV) to blunt histamine effects\n7. Albuterol inhaler (initial dose 10 puffs per ETT) for bronchospasm. Ipratropium may be beneficial also.\n8. Corticosteroids - Methylprednisolone (10-15 mg/kg) - may enhance beta effects of Epi, inhibit production of leukotrienes, and reduce reactions due to activation of complement system\n9. Norepinephrine and vasopressin may be helpful for refractory hypotension.\n10. Collect a blood sample for serum mast cell tryptase\n\nTreatment of Bronchospasm\n1. Hand ventilate to rule out mechanical problem with ventilator\n2. Check anesthesia circuit and valves - if possible use ambu bag\n3. Check location of endotracheal tube - auscultate and confirm end-tidal CO2\n4. Pass suction catheter or fiberoptic scope down tube to rule out obstruction\n5. Inhaled beta-agonists\n6. Inhalation anesthetic agents are not the bronchodilators of choice in anaphylaxis\n\nReference\n1. Levy: ASA Refresher Lecture 2023:101.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of CA-Irvine \nDate of Last Modification: September, 2024\n\n", 
    "possiblePoints": 1800, 
    "preopMsg": "\n4 year old healthy, but anxious, male for appendectomy\n\nHistory of Present Illness\nThe patient complains of lower abdominal pain for the last 6 hours.\n\nPast Medical History\nIllnesses - hay fever\nSurgeries - none\nMeds - none, except occasional antihistamines\nAllergies - penicillin caused rash\n\nFamily History\nNo anesthetic complications\n\nPhysical Exam\nYoung male, anxious and in mild distress\nWeight: 18 kg\nHR 148,  BP 78/52,  RR 20,  T 37.2\nAirway - normal\nLungs - clear\nHeart - normal\n\nLabs\nHematocrit 42\nWhite blood cell count 12.2\nElectrolytes, Glucose, Blood Urea Nitrogen, creatinine - normal\n\nNPO Status\nLast ate 13 hours ago. \n\nPatient and Surgeon Requests\nGeneral anesthesia. The procedure will take 30 minutes.\n\n", 
    "volAnDsp": 40, 
    "states": [
        {
            "name": "AWAKE", 
            "recordMsg": "Awake, alert, and anxiously awaiting induction.", 
            "whatNextMsg": "Administer oxygen by mask and a sedative agent.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 78, 
            "baseBicarb": 23.8, 
            "baseHr": 148, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 39, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 180, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
			"trans": [
                {
                    "nextState": "SEDATEDIV1", 
                    "comment": "You administered an intravenous sedative agent. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.05
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "SEDATEDINH", 
                    "comment": "You administered an inhalational anesthetic. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.05
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "SEDATEDIV1", 
            "recordMsg": "Lightly sedated with intravenous agents.", 
            "whatNextMsg": "Continue induction.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 56, 
            "baseAbpS": 74, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is reduced.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient has a lethargic response to voice. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 12, 
            "spontTv": 150, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient recovered from the sedative. (Lost points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.05
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "SEDATEDIV2", 
                    "comment": "You administered enough intravenous agent to heavily sedate the patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.5
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.25
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "SEDATEDINH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.1
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "COUGH4", 
                    "comment": "You should not have tried to place the LMA in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH4", 
                    "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT4", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEDPARA", 
                    "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "SEDATEDIV2", 
            "recordMsg": "Deeply sedated with intravenous agents.", 
            "whatNextMsg": "Continue induction.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 46, 
            "baseAbpM": 54, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 146, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is reduced.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient has a lethargic response to voice. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 8, 
            "spontTv": 100, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEDIV1", 
                    "comment": "The patient recovered from the sedative. (Lost points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "SEDATEDINH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.25
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You administered enough intravenous agent to lightly anesthetize the patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPINH", 
                    "comment": "You administered enough inhalation agent to lightly anesthetize the patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.3
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "COUGH4", 
                    "comment": "You should not have tried to place the LMA in a sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH4", 
                    "comment": "You should not have tried to place the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT4", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ASLEEPIV", 
            "recordMsg": "Anesthetized with intravenous agents.", 
            "whatNextMsg": "Place the endotracheal tube.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 146, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEDIV2", 
                    "comment": "You decreased the anesthetic depth. (Lost points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPINH", 
                    "comment": "You continued to administer inhalation agent.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.3
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "AWIV", 
                    "comment": "You should place an endotracheal tube for an appendectomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWIV", 
                    "comment": "You successfully placed the endotracheal tube. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "AWIV", 
                    "comment": "An endotracheal tube was successfully placed. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "HURT3", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "AWIV", 
            "recordMsg": "Anesthetized and airway secured.", 
            "whatNextMsg": "Deepen the level of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 142, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA2IV", 
                    "comment": "You deepened the level of anesthesia. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "AWINH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "HURT1", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "HURT1", 
                    "comment": "You should not have allowed the surgeon to operate on a lightly anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "GA2IV", 
            "recordMsg": "Adequate anesthesia.", 
            "whatNextMsg": "Inform the surgeon that the patient is ready.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 50, 
            "baseAbpS": 68, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPIV", 
                    "comment": "You instructed the surgeon to make the incision at the appropriate time. (+100 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "OPIV", 
                    "comment": "You instructed the surgeon to operate.", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2INH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "SEDATEDINH", 
            "recordMsg": "Lightly sedated with inhalation agents.", 
            "whatNextMsg": "Continue induction.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is slowed.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient has a lethargic response to voice.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 22, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient recovered from the sedative. (Lost points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.05
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You administered enough intravenous agent to lightly anesthetize the patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPINH", 
                    "comment": "You administered enough inhalation agent to lightly anesthetize the patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "COUGH4", 
                    "comment": "You should not have tried to place the LMA in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH4", 
                    "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT4", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEDPARA", 
                    "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ASLEEPINH", 
            "recordMsg": "Adequately anesthetized with intravenous agents.", 
            "whatNextMsg": "Place the endotracheal tube.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 50, 
            "baseAbpS": 68, 
            "baseBicarb": 24, 
            "baseHr": 142, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEDINH", 
                    "comment": "You decreased the anesthetic depth. (Lost points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You administered intravenous anesthetic agent.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "AWINH", 
                    "comment": "You should place an endotracheal tube for an appendectomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWINH", 
                    "comment": "You successfully placed the endotracheal tube. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "AWINH", 
                    "comment": "An endotracheal tube was successfully placed. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "HURT3", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "AWINH", 
            "recordMsg": "Anesthetized and airway secured.", 
            "whatNextMsg": "Deepen the level of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 22, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA2INH", 
                    "comment": "You deepened the level of anesthesia. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "AWIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "HURT1", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "HURT1", 
                    "comment": "You should not have allowed the surgeon to operate on a lightly anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "GA2INH", 
            "recordMsg": "Adequate anesthesia.", 
            "whatNextMsg": "Inform the surgeon that the patient is ready.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPINH", 
                    "comment": "You instructed the surgeon to make the incision at the appropriate time. (+100 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "OPINH", 
                    "comment": "You instructed the surgeon to operate.", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2IV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "OPINH", 
            "recordMsg": "Maintenance anesthesia.", 
            "whatNextMsg": "Monitor closely and adjust anesthetic as needed.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TACHYINH", 
                    "comment": "The simulation forced the patient to develop anaphylaxis.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 300
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "OPIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "OPIV", 
            "recordMsg": "Maintenance anesthesia.", 
            "whatNextMsg": "Monitor closely and adjust anesthetic as needed.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 30, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TACHYIV", 
                    "comment": "The simulation forced the patient to develop anaphylaxis.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "OPINH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "TACHYIV", 
            "recordMsg": "The patient has become markedly tachycardic.", 
            "whatNextMsg": "Recheck the blood pressure before treating tachycardia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 40, 
            "baseAbpM": 52, 
            "baseAbpS": 68, 
            "baseBicarb": 24, 
            "baseHr": 154, 
            "basePot": 3.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 32, 
            "contPlateau": 30, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 10, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 93, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ANAPH1", 
                    "comment": "The simulation forced the patient to become more tachycardic and hypotensive.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 40
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "TACHYINH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "TACHYINH", 
            "recordMsg": "The patient has become markedly tachycardic.", 
            "whatNextMsg": "Recheck the blood pressure before treating tachycardia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 40, 
            "baseAbpM": 48, 
            "baseAbpS": 68, 
            "baseBicarb": 24, 
            "baseHr": 154, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 30, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 4, 
            "papM": 6, 
            "papS": 10, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 88, 
            "sat40": 92, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 22, 
            "spontTv": 460, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ANAPH1", 
                    "comment": "The simulation forced the patient to develop anaphylaxis.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 40
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "TACHYIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ANAPH1", 
            "whatNextMsg": "Examine the patient and make the diagnosis.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 38, 
            "baseAbpM": 46, 
            "baseAbpS": 58, 
            "baseBicarb": 24, 
            "baseHr": 158, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There are a few scattered wheezes present.", 
            "cardiacOutput": 2.0, 
            "contPip": 34, 
            "contPlateau": 32, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 4, 
            "papM": 6, 
            "papS": 10, 
            "papW": 4, 
            "pulseMsg": "The pulse is rapid and weak.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "The patient has become markedly tachycardic and hypotensive.", 
            "rhythm": "Sinus1", 
            "skinMsg": "There is a red rash spreading up the arm from the IV site.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 86, 
            "sat40": 90, 
            "sat100": 94, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ANAPH2", 
                    "comment": "The simulation forced the patient to become more tachycardic and hypotensive.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 40
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ANAPH2", 
            "recordMsg": "The patient has become increasingly tachycardic and hypotensive.", 
            "whatNextMsg": "The physical exam reveals hints.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 38, 
            "baseAbpS": 50, 
            "baseBicarb": 24, 
            "baseHr": 168, 
            "basePot": 1.6, 
            "breathSoundsMsg": "There are scattered wheezes present.", 
            "cardiacOutput": 2.4, 
            "contPip": 36, 
            "contPlateau": 34, 
            "cvp": 3, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 3, 
            "papM": 4, 
            "papS": 6, 
            "papW": 3, 
            "pulseMsg": "The pulse is rapid and thready.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "There is a red rash spreading up the arm from the IV site.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 85, 
            "sat40": 89, 
            "sat100": 92, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ANAPH3", 
                    "comment": "The simulation forced the patient to beome pulseless.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ANAPH3", 
            "recordMsg": "The patient has become pulseless.", 
            "whatNextMsg": "Resuscitate!", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 30, 
            "baseAbpS": 40, 
            "baseBicarb": 24, 
            "baseHr": 160, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 3, 
            "papS": 5, 
            "papW": 2, 
            "pulseMsg": "The pulse is not palpable.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled and purple.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 80, 
            "sat40": 84, 
            "sat100": 86, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You should have placed an endotracheal tube in this unstable patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": false
                        }, 
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWSECURED", 
                    "comment": "The airway is secured with an endotracheal tube. (+200 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }, 
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HARDVENT", 
            "recordMsg": "The patient has become pulseless and difficult to ventilate.", 
            "whatNextMsg": "Examine the patient and make the diagnosis.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 24, 
            "baseAbpS": 38, 
            "baseBicarb": 24, 
            "baseHr": 166, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 68, 
            "contPlateau": 66, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 4, 
            "papS": 8, 
            "papW": 2, 
            "pulseMsg": "The pulse is not palpable.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now ashen gray", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 68, 
            "sat40": 72, 
            "sat100": 76, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "The patient became severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "AWSECURED", 
            "recordMsg": "The airway is secured but the patient has become pulseless.", 
            "whatNextMsg": "Examine the patient and make the diagnosis.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 32, 
            "baseAbpS": 40, 
            "baseBicarb": 24, 
            "baseHr": 164, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is not palpable.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled and purple.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 78, 
            "sat40": 84, 
            "sat100": 86, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer epinephrine and fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "FLUID1", 
                    "comment": "You administered a bolus of intravenous fluid appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 999
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP1", 
                    "comment": "You administered an appropriate bolus of epinephrine. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "AWSECURED", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH1", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP1", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "EP1", 
            "recordMsg": "First dose of epinephrine administered.", 
            "whatNextMsg": "Now administer a 20 mL/kg bolus of intravenous fluids.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 38, 
            "baseAbpS": 50, 
            "baseBicarb": 24, 
            "baseHr": 163, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is moderate wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 38, 
            "contPlateau": 36, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is thready.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 80, 
            "sat40": 87, 
            "sat100": 90, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer epinephrine and fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "EP1FLUID1", 
                    "comment": "You administered a bolus of intravenous fluid appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 299
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP2", 
                    "comment": "You administered a second bolus of epinephrine appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP1", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH2", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "EP2", 
            "recordMsg": "Second dose of epinephrine administered.", 
            "whatNextMsg": "Now administer a 20 mL/kg bolus of intravenous fluids.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 34, 
            "baseAbpM": 42, 
            "baseAbpS": 56, 
            "baseBicarb": 24, 
            "baseHr": 162, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is mild wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 34, 
            "contPlateau": 32, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 85, 
            "sat40": 89, 
            "sat100": 91, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer intravenous fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "EP2FLUID1", 
                    "comment": "You administered a bolus of intravenous fluid appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 299
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP2", 
                    "comment": "You need to administer intravenous fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH2", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "FLUID1", 
            "recordMsg": "The first fluid bolus was administered.", 
            "whatNextMsg": "Now give an epinephrine bolus.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 38, 
            "baseAbpS": 52, 
            "baseBicarb": 24, 
            "baseHr": 159, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 2.0, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 4, 
            "papM": 6, 
            "papS": 10, 
            "papW": 4, 
            "pulseMsg": "The pulse is thready.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 80, 
            "sat40": 83, 
            "sat100": 86, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer epinephrine and fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "FLUID2", 
                    "comment": "You administered a second bolus of intravenous fluid appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 999
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP1FLUID1", 
                    "comment": "You administered an appropriate bolus of epinephrine. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "FLUID1", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH1", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP1FLUID1", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "EP1FLUID1", 
            "recordMsg": "First dose of epinephrine and fluid administered.", 
            "whatNextMsg": "Now administer a second bolus of epinephrine and fluids.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 34, 
            "baseAbpM": 42, 
            "baseAbpS": 56, 
            "baseBicarb": 24, 
            "baseHr": 160, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is moderate wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 38, 
            "contPlateau": 36, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is thready.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 84, 
            "sat40": 88, 
            "sat100": 90, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer epinephrine and fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "EP1FLUID2", 
                    "comment": "You administered a second bolus of intravenous fluid appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 999
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP2FLUID1", 
                    "comment": "You administered a second bolus of epinephrine appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP1FLUID1", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH2", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2FLUID1", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "EP2FLUID1", 
            "recordMsg": "Second dose of epinephrine and first bolus of intravenous fluid administered.", 
            "whatNextMsg": "Now administer a second 20 mL/kg bolus of intravenous fluids.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 36, 
            "baseAbpM": 44, 
            "baseAbpS": 56, 
            "baseBicarb": 24, 
            "baseHr": 158, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is mild wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 34, 
            "contPlateau": 32, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 85, 
            "sat40": 89, 
            "sat100": 91, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer intravenous fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "EP2FLUID2", 
                    "comment": "You administered a second bolus of intravenous fluid appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 699
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP2FLUID1", 
                    "comment": "You need to administer intravenous fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2FLUID1", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH2", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2FLUID1", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "FLUID2", 
            "recordMsg": "The second fluid bolus was administered.", 
            "whatNextMsg": "Now give an epinephrine bolus.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 36, 
            "baseAbpM": 44, 
            "baseAbpS": 54, 
            "baseBicarb": 24, 
            "baseHr": 158, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 2.6, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 6, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 6, 
            "papM": 9, 
            "papS": 16, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 80, 
            "sat40": 84, 
            "sat100": 86, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer epinephrine and fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "EP1FLUID2", 
                    "comment": "You administered an appropriate bolus of epinephrine. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "FLUID2", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH1", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP1FLUID2", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "EP1FLUID2", 
            "recordMsg": "First dose of epinephrine and second bolus of fluid administered.", 
            "whatNextMsg": "Now administer a second bolus of epinephrine.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 38, 
            "baseAbpM": 46, 
            "baseAbpS": 56, 
            "baseBicarb": 24, 
            "baseHr": 156, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is moderate wheezing throughout.", 
            "cardiacOutput": 2.7, 
            "contPip": 38, 
            "contPlateau": 36, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 6, 
            "papM": 10, 
            "papS": 16, 
            "papW": 5, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 85, 
            "sat40": 89, 
            "sat100": 91, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer epinephrine and fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "EP2FLUID2", 
                    "comment": "You administered a second bolus of epinephrine appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }, 
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 11
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "EP1FLUID2", 
                    "comment": "You administered an inadequate bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 2
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "EP2FLUID2", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "VTACH2", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "EP2FLUID2", 
            "recordMsg": "Second bolus of epinephrine and intravenous fluid administered.", 
            "whatNextMsg": "Administer diphenhydramine and albuterol.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 40, 
            "baseAbpM": 48, 
            "baseAbpS": 60, 
            "baseBicarb": 24, 
            "baseHr": 154, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is mild wheezing throughout.", 
            "cardiacOutput": 4, 
            "contPip": 34, 
            "contPlateau": 32, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 6, 
            "papM": 10, 
            "papS": 16, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 88, 
            "sat40": 92, 
            "sat100": 96, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HARDVENT", 
                    "comment": "You need to administer intravenous fluids faster. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 360
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "STABLE", 
                    "comment": "You administered diphenhydramine and albuterol appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Diphenhydramine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 3
                        }, 
                        {
                            "drug": "Albuterol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "VTACH2", 
                    "comment": "You administered an excessive bolus of epinephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 20
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "EP2FLUIID2", 
                    "comment": "Recommended bolus of epinephrine for anaphylaxis is 5-10 mcg. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "STABLE", 
            "recordMsg": "The patient is stable.", 
            "whatNextMsg": "You successfully resuscitated from anaphylaxis.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 56, 
            "baseAbpS": 68, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is mild wheezing throughout.", 
            "cardiacOutput": 2.6, 
            "contPip": 34, 
            "contPlateau": 32, 
            "cvp": 8, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are present.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 6, 
            "papM": 10, 
            "papS": 16, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small. There is periorbital edema.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The red rash is now mottled.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 85, 
            "sat40": 93, 
            "sat100": 96, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9
        }, 
        {
            "name": "VTACH1", 
            "recordMsg": "Excessive dose of epinephrine administered.", 
            "whatNextMsg": "Pulseless ventricular tachycardia should be treated the same as V Fib - defibrillate.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 32, 
            "baseAbpS": 40, 
            "baseBicarb": 24, 
            "baseHr": 172, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Vtach3", 
            "skinMsg": "The red rash is now mottled and purple.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 78, 
            "sat40": 82, 
            "sat100": 86, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "EP1", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "EP1", 
                    "comment": "You defibrillated for pulseless v tach appropriately. (+50 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "defib", 
                            "value": 19
                        }
                    ], 
                    "points": 50
                }
            ]
        }, 
        {
            "name": "VTACH2", 
            "recordMsg": "Excessive dose of epinephrine administered.", 
            "whatNextMsg": "Pulseless ventricular tachycardia should be treated the same as V Fib - defibrillate.", 
			"airwayStr": "restricted",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 32, 
            "baseAbpS": 40, 
            "baseBicarb": 24, 
            "baseHr": 172, 
            "basePot": 4.2, 
            "breathSoundsMsg": "There is severe wheezing throughout.", 
            "cardiacOutput": 1.4, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are distant.", 
            "hiCo2ProdFlag": true, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent. There is periorbital edema.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
 			"overdoseFlag": false,
           "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Vtach3", 
            "skinMsg": "The red rash is now mottled and purple.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 78, 
            "sat40": 82, 
            "sat100": 86, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "EP2", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "EP2", 
                    "comment": "You defibrillated for pulseless v tach appropriately. (+50 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "defib", 
                            "value": 19
                        }
                    ], 
                    "points": 50
                }
            ]
        }, 
        {
            "name": "COUGH5", 
            "recordMsg": "Upset and coughing.", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
  			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 66, 
            "baseAbpS": 84, 
            "baseBicarb": 24, 
            "baseHr": 148, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing but the breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and fast.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient stopped coughing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "The sedative agent is starting to take effect.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HURT5", 
            "recordMsg": "Screaming and writhing in pain.", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
  			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 58, 
            "baseAbpM": 66, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 148, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is screaming and writhing in pain.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is bounding.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient stopped screaming.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "The sedative agent is starting to take effect. (+25 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 25
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "AWAKEPARA", 
            "recordMsg": "Awake but paralyzed.", 
            "whatNextMsg": "Call your lawyer.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The muscle relaxant is wearing off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "SEDATEDPARA", 
                    "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }
                    ], 
                    "points": 25
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "COUGH4", 
            "recordMsg": "Upset and coughing.", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
 			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing but the breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and fast.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEDIV1", 
                    "comment": "The patient stopped coughing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "The sedative agent is starting to take effect.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HURT4", 
            "recordMsg": "Screaming and writhing in pain.", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is screaming and writhing in pain.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is bounding.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEDIV1", 
                    "comment": "The patient stopped screaming.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "The sedative agent is starting to take effect. (+25 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 25
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "SEDATEDPARA", 
            "recordMsg": "Asleep and paralyzed.", 
            "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEDIV1", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "SEDATEDIV1", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }
            ]
        }, 
        {
            "name": "HURT3", 
            "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.", 
            "whatNextMsg": "Deepen the anesthetic.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is reduced.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "The autonomic response is abating.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HURT1", 
            "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.", 
            "whatNextMsg": "Deepen the anesthetic.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is reduced.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPIV", 
                    "comment": "The autonomic response is abating.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "DESATBRADY1", 
            "recordMsg": "Hypoxic and bradycardic.", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
  			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 38, 
            "baseAbpM": 42, 
            "baseAbpS": 52, 
            "baseBicarb": 24, 
            "baseHr": 32, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and slow.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY2", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATBRADY2", 
            "recordMsg": "Hypoxic and severely bradycardic.", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
  			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 32, 
            "baseAbpS": 42, 
            "baseBicarb": 24, 
            "baseHr": 22, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Very slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and very slow.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATASYST", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATASYST", 
            "recordMsg": "Hypoxic and asystolic.", 
            "whatNextMsg": "CPR, epinephrine, atropine.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 18, 
            "baseAbpS": 18, 
            "baseBicarb": 24, 
            "baseHr": 0, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 18, 
            "papM": 18, 
            "papS": 18, 
            "papW": 18, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATDEAD", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATDEAD", 
            "recordMsg": "The patient cannot be resuscitated. End of case simulation.", 
            "whatNextMsg": "Notify the family.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 18, 
            "baseAbpS": 18, 
            "baseBicarb": 24, 
            "baseHr": 0, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": -2, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 18, 
            "papM": 18, 
            "papS": 18, 
            "papW": 18, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are fixed and dilated.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9
        }
    ]
}