CaseData[34] = {
    "title": "Case 34- 4 year old for tonsillectomy and adenoidectomy", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 1.2, 
    "debriefMsg": "\nFrom the history of sleep apnea and the physical exam, this patient has a potentially difficult intubation. It may be difficult to perform this surgery with a laryngeal mask airway, plus it may be difficult to insert in this patient with large tonsils. Sedation with maintenance of spontaneous ventilation followed by topical anesthesia of the airway and fiberoptic intubation may be the safest approach to managing this patient.\n\n", 
    "depthCarina": 18, 
    "depthCords": 12, 
    "depthTubeInitial": 15, 
    "durationPrep": 60, 
    "durationSurgery": 1200, 
    "helpFlag": true, 
    "imageSet": 1, 
    "initialSat": 96, 
    "leanBodyMass": 25, 
    "learningObj": "\n4 year old for tonsillectomy and adenoidectomy (35 kg)\n\nThis patient has a significant history of sleep apnea. \n\nLearning Objectives\n1.  Understand the syndrome of sleep apnea.\n2.  Understand how sleep apnea affects induction of anesthesia.\n3.  Understand the postoperative management of sleep apnea.\n\nSuggested Anesthetic Plan\n1.  Routine monitoring\n2.  Establish intravenous access\n3.  Preoxygenate\n4.  Consider awake fiberoptic intubation since airway appears to be difficult. You can also consider intubation following inhalation induction while maintaining spontaneous ventilation.\n5.  Maintain anesthesia with oxygen and inhalation agent\n6.  Awake extubation is indicated.\n\nClinical Points\n1.  Children with obstructive sleep apnea are scheduled for surgery because they have significant problems with airway obstruction. \n2.  Obesity, pauses in breathing, and daytime somnolence suggest moderate to severe sleep apnea and obstruction.\n3.  Avoid premedication as may be more sensitive to respiratory depression.\n4.  Establish intravenous access prior to inhalation induction.\n5.  Oral airway may relieve airway obstruction.\n6.  Opioids should be avoided and titrated carefully if needed in the postoperative period.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: September 2024\n\n", 
    "possiblePoints": 600, 
    "preopMsg": "\n4 year old for tonsillectomy and adenoidectomy\n\nHistory of Present Illness\nThe patient is an obese 4 year old, scheduled for T&A because of significant sleep apnea. He snores at night and has \"long pauses\" in his breathing. He has daytime somnolence.\n\nPast Medical History\nIllnesses - obesity, sleep apnea\nSurgeries - none\nMeds - none\nAllergies - none\n\nFamily History\nNo anesthetic complications\n\nPhysical Exam\nObese child\nWeight: 35 kg\nHR - 108,  BP 110/60,  RR 20\nAirway - unable to visualize posterior pharynx beyond large tongue\nLungs - clear\nHeart - normal\n\nLabs\nHematocrit 48%\n\nNPO Status\nLast ate 8 hours ago.\n\nPatient and Surgeon Requests\nThe procedure requires general anesthesia. \nThe surgeon states the procedure will take 30 minutes.\n\n", 
    "volAnDsp": 20, 
    "states": [
        {
            "name": "AWAKE", 
            "whatNextMsg": "Provide oxygen by mask and administer 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, 
            "recordMsg": "Awake, alert, and anxiously awaiting induction.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 96, 
            "sat40": 98, 
            "sat100": 99, 
            "spSignal": 3, 
            "spontRr": 22, 
            "spontTv": 90, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEIV", 
                    "comment": "You sedated this patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.05
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "SEDATEINH", 
                    "comment": "You administered inhalation agent to sedate this patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.05
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "TUBED", 
                    "comment": "You should have sedated the patient before performing fiberoptic intubation. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "AWAKECOUGH", 
                    "comment": "You should not have tried to place the LMA in this awake patient.  (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKECOUGH", 
                    "comment": "You should not have tried to perform laryngoscopy in an awake patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEHURT", 
                    "comment": "You allowed the surgeon to make the incision before the patient was adequately anesthetized. (Lost points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You should not have administered neuromuscular blocker to an awake patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "AWAKECOUGH", 
            "whatNextMsg": "Wait for the patient to settle down and sedate.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 64, 
            "baseAbpS": 84, 
            "baseBicarb": 24, 
            "baseHr": 164, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing.", 
            "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, 
            "recordMsg": "Upset and coughing.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 94, 
            "sat100": 96, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 60, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "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": "TUBED", 
                    "comment": "You should have sedated the patient before performing fiberoptic intubation. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "AWAKEHURT", 
                    "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": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "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": "AWAKEHURT", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 60, 
            "baseAbpM": 72, 
            "baseAbpS": 92, 
            "baseBicarb": 24, 
            "baseHr": 168, 
            "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": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Screaming and writhing in pain.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 34, 
            "spontTv": 70, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "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. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "TUBED", 
                    "comment": "You should have sedated the patient before performing fiberoptic intubation. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "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": "AWAKEPARA", 
            "whatNextMsg": "Call your lawyer.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 56, 
            "baseAbpM": 68, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 166, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 8, 
            "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 not moving, but is thinking about asking his parents to call their 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, 
            "recordMsg": "Awake but paralyzed.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 96, 
            "sat40": 98, 
            "sat100": 99, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The muscle relaxant is wearing off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "SEDATEPARA", 
                    "comment": "You sedated this patient after you administered muscle relaxant. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "TUBED", 
                    "comment": "You intubated using the fiberoptic bronchoscope. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "LMAIV", 
                    "comment": "You inserted the LMA to rescue the airway. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "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": "TUBED", 
            "whatNextMsg": "Induce anesthesia and observe closely.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 56, 
            "baseAbpS": 76, 
            "baseBicarb": 24, 
            "baseHr": 150, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 30, 
            "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, 
            "recordMsg": "Fiberoptic intubation.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 96, 
            "sat40": 98, 
            "sat100": 99, 
            "spSignal": 3, 
            "spontRr": 26, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TUBEHURT", 
                    "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": "TUBEDIV", 
                    "comment": "You induced anesthesia primarily with intravenous agents. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "TUBEDINH", 
                    "comment": "You induced anesthesia primarily with inhalation anesthetics. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "TUBEHURT", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 64, 
            "baseAbpS": 86, 
            "baseBicarb": 24, 
            "baseHr": 156, 
            "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": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Writhing in pain.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 32, 
            "spontTv": 72, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TUBED", 
                    "comment": "You induced anesthesia. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "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": "SEDATEIV", 
            "whatNextMsg": "Secure the airway with fiberoptic intubation. The simulator assumes you appropriately applied topical anesthetic to the airway.", 
			"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, 
            "recordMsg": "Sedated with intravenous agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 96, 
            "sat40": 98, 
            "sat100": 99, 
            "spSignal": 3, 
            "spontRr": 12, 
            "spontTv": 90, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You should have secured the airway before inducing anesthesia. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "TUBED", 
                    "comment": "You performed fiberoptic intubation. (+200 points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "SEDATECOUGH", 
                    "comment": "You should not have tried to place the LMA in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "SEDATECOUGH", 
                    "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": "SEDATEHURT", 
                    "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": "SEDATEPARA", 
                    "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "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": "SEDATEINH", 
            "whatNextMsg": "Secure the airway with fiberoptic intubation. The simulator assumes you appropriately applied topical anesthetic to the airway.", 
			"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, 
            "recordMsg": "Lightly sedated with inhalation agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 30, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You should not have induced anesthesia before securing the airway in this patient. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "ASLEEPINH", 
                    "comment": "You should not have induced anesthesia before securing the airway in this patient. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "TUBED", 
                    "comment": "You performed fiberoptic intubation in this sedated patient. (+200 points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "SEDATECOUGH", 
                    "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": "SEDATECOUGH", 
                    "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": "SEDATEHURT", 
                    "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": "SEDATEPARA", 
                    "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "SEDATECOUGH", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 78, 
            "baseBicarb": 24, 
            "baseHr": 152, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing.", 
            "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, 
            "recordMsg": "Upset and coughing.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 94, 
            "sat100": 96, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 70, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEIV", 
                    "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": "AWAKEHURT", 
                    "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": "SEDATEHURT", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 66, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 152, 
            "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, 
            "recordMsg": "Screaming and writhing in pain.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 95, 
            "sat40": 97, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 70, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEIV", 
                    "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. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "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": "SEDATEPARA", 
            "whatNextMsg": "Now perform quick fiberoptic bronchoscopy.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 64, 
            "baseAbpS": 86, 
            "baseBicarb": 24, 
            "baseHr": 150, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 48, 
            "contPlateau": 46, 
            "cvp": 8, 
            "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.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Sedated and paralyzed.", 
            "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": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TUBEDIV", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "LMAIV", 
                    "comment": "You rescued the airway with an LMA. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You deepened the anesthetic. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "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
                }
            ]
        }, 
        {
            "name": "ASLEEPIV", 
            "whatNextMsg": "Perform quick fiberoptic intubation, or rescue the airway with LMA. Perform cricothyroidotomy if unable to otherwise rescue.", 
			"airwayStr": "obstructed",
            "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 distant bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 68, 
            "contPlateau": 66, 
            "cvp": 8, 
            "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.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized. Unable to intubate, unable to ventilate.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 70, 
            "sat40": 73, 
            "sat100": 77, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "LMAIV", 
                    "comment": "You placed the LMA to establish an emergent airway. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "TUBEDIV", 
                    "comment": "You performed fiberoptic intubation in a deeply sedated patient with a difficult airway. Better to lightly sedate and maintain spontaneous ventilation. (+200 points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You attempted oral laryngoscopy unsuccessfully.", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "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
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You waited too long to establish the airway. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "ASLEEPINH", 
            "whatNextMsg": "Perform quick fiberoptic intubation, or rescue the airway with LMA. Perform cricothyroidotomy if unable to otherwise rescue.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 50, 
            "baseAbpS": 68, 
            "baseBicarb": 24, 
            "baseHr": 148, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 88, 
            "contPlateau": 86, 
            "cvp": 8, 
            "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.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized with inhalation agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 70, 
            "sat40": 73, 
            "sat100": 77, 
            "spSignal": 2, 
            "spontRr": 26, 
            "spontTv": 60, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You administered intravenous anesthetic agent.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPIV", 
                    "comment": "You administered a NMB agent.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "LMAINH", 
                    "comment": "You placed the LMA to establish an emergent airway. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPINH", 
                    "comment": "You unsuccessfully attempted oral laryngoscopy. ", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "TUBEDINH", 
                    "comment": "You successfully placed the endotracheal tube with the fiberoptic bronchoscope. (+200 points)", 
                    "conditions": [
                        {
                            "type": "tryFo", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "CRIC", 
                    "comment": "It wasn't necesary to perform cricothyroidotomy. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayCrico", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You should have established an airway faster. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "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": "LMAIV", 
            "whatNextMsg": "Provide adequate anesthesia and instruct the surgeon to make the incision.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 144, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are distant bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 32, 
            "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, 
            "recordMsg": "LMA in place.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 88, 
            "sat40": 90, 
            "sat100": 92, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPLMAIV", 
                    "comment": "You instructed the surgeon to make the incision at the appropriate time. (+100 points). Endotracheal tube is preferred over LMA. Do this case again.", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "OPLMAIV", 
                    "comment": "You instructed the surgeon to operate.  Endotracheal tube is preferred over LMA. Do this case again.", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "TUBEDIV", 
            "whatNextMsg": "Provide adequate anesthesia and instruct the surgeon to make the incision.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 46, 
            "baseAbpM": 54, 
            "baseAbpS": 74, 
            "baseBicarb": 24, 
            "baseHr": 152, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 30, 
            "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, 
            "recordMsg": "Anesthetized and intubated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 96, 
            "sat100": 98, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "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": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "TUBEDINH", 
            "whatNextMsg": "Provide adequate anesthesia and instruct the surgeon to make the incision.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 54, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 154, 
            "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, 
            "recordMsg": "Anesthetized and intubated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 86, 
            "sat40": 90, 
            "sat100": 92, 
            "spSignal": 2, 
            "spontRr": 28, 
            "spontTv": 60, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "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": "TUBEDIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "TUBEDIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "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": "LMAINH", 
            "whatNextMsg": "Provide adequate anesthesia and instruct the surgeon to make the incision.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 146, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 32, 
            "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, 
            "recordMsg": "LMA placed.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 22, 
            "spontTv": 60, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPLMAINH", 
                    "comment": "You instructed the surgeon to make the incision at the appropriate time. (+100 points).  Endotracheal tube is preferred over LMA for colectomy. Do this case again.", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "OPLMAINH", 
                    "comment": "You instructed the surgeon to operate.  Endotracheal tube is preferred over LMA. Do this case again.", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "OPLMAIV", 
            "whatNextMsg": "The surgeon would have preferred endotracheal tube over LMA for this procedure.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 62, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 146, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are distant bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 32, 
            "cvp": 8, 
            "finalState": -1, 
            "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": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Surgery proceeding with LMA.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 85, 
            "sat40": 90, 
            "sat100": 92, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9
        }, 
        {
            "name": "OPIV", 
            "whatNextMsg": "Monitor closely and adjust anesthetic as needed.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 64, 
            "baseAbpS": 82, 
            "baseBicarb": 24, 
            "baseHr": 156, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 30, 
            "contPlateau": 28, 
            "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": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Maintenance anesthesia.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINALIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "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", 
            "whatNextMsg": "Monitor closely and adjust anesthetic as needed.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 62, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 158, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 30, 
            "contPlateau": 28, 
            "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": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Maintenance anesthesia.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 60, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINALINH", 
                    "comment": "You completed the learning objectives for this case.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "OPIV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "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": "OPLMAINH", 
            "whatNextMsg": "The surgeon would have preferred endotracheal tube over LMA for this procedure.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 58, 
            "baseAbpS": 78, 
            "baseBicarb": 24, 
            "baseHr": 148, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 32, 
            "contPlateau": 30, 
            "cvp": 8, 
            "finalState": -1, 
            "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": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Surgery proceeding with LMA.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 98, 
            "spSignal": 2, 
            "spontRr": 20, 
            "spontTv": 50, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9
        }, 
        {
            "name": "FINALIV", 
            "whatNextMsg": "Do what you think is best.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 78, 
            "baseAbpM": 92, 
            "baseAbpS": 150, 
            "baseBicarb": 24, 
            "baseHr": 80, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "The heart sounds are normal.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is brisk.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is awake and alert, and is moving spontaneously.", 
            "papD": 12, 
            "papM": 14, 
            "papS": 28, 
            "papW": 15, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are 2mm and reactive.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm, dry and pink with brisk capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 40, 
            "sputumAmount": 0, 
            "stSegII": 0.4, 
            "stSegV5": 0.3, 
            "temperature": 36.8
        }, 
        {
            "name": "FINALINH", 
            "whatNextMsg": "Do what you think is best.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 78, 
            "baseAbpM": 92, 
            "baseAbpS": 150, 
            "baseBicarb": 24, 
            "baseHr": 80, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "The heart sounds are normal.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is brisk.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is awake and alert, and is moving spontaneously.", 
            "papD": 12, 
            "papM": 14, 
            "papS": 28, 
            "papW": 15, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are 2mm and reactive.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm, dry and pink with brisk capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 20, 
            "spontTv": 60, 
            "sputumAmount": 0, 
            "stSegII": 0.4, 
            "stSegV5": 0.3, 
            "temperature": 36.8
        }, 
        {
            "name": "CRIC", 
            "whatNextMsg": "Do what you think is best.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 78, 
            "baseAbpM": 92, 
            "baseAbpS": 150, 
            "baseBicarb": 24, 
            "baseHr": 80, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": -1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "The heart sounds are normal.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is brisk.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is awake and alert, and is moving spontaneously.", 
            "papD": 12, 
            "papM": 14, 
            "papS": 28, 
            "papW": 15, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are 2mm and reactive.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm, dry and pink with brisk capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 95, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 50, 
            "sputumAmount": 0, 
            "stSegII": 0.4, 
            "stSegV5": 0.3, 
            "temperature": 36.8
        }, 
        {
            "name": "DESATBRADY1", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 36, 
            "baseAbpM": 44, 
            "baseAbpS": 58, 
            "baseBicarb": 24, 
            "baseHr": 62, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 1.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "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": 10, 
            "papM": 12, 
            "papS": 16, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and slow.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Hypoxic and bradycardic.", 
            "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": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY2", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATBRADY2", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 38, 
            "baseAbpS": 46, 
            "baseBicarb": 24, 
            "baseHr": 22, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "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": 10, 
            "papM": 12, 
            "papS": 16, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and very slow.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Hypoxic and severely bradycardic.", 
            "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": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATASYST", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATASYST", 
            "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, 
            "recordMsg": "Hypoxic and asystolic.", 
            "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": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATDEAD", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATDEAD", 
            "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, 
            "recordMsg": "The patient cannot be resuscitated.", 
            "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": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9
        }
    ]
}