CaseData[23] = {
    "title": "Case 23 - 24 yr old male with penetrating eye injury", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 1.2, 
    "debriefMsg": "\nFollow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure, administer a bolus of hypnotic agent such as propofol, administer rocuronium and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube. \n\n", 
    "depthCarina": 25, 
    "depthCords": 18, 
    "depthTubeInitial": 22, 
    "durationPrep": 60, 
    "durationSurgery": 1200, 
    "helpFlag": true, 
    "imageSet": 2, 
    "initialSat": 96, 
    "leanBodyMass": 76, 
    "learningObj": "\n24 yr old male with penetrating eye injury and full stomach (76 kg)\n\nThis patient has a full stomach and a penetrating eye injury.\n\nLearning Objectives\n1.  Describe anesthetic concerns for the patient with an open eye injury.\n2.  Describe the management of a patient with an open eye injury and a full stomach.\n\nAnesthetic Considerations\n1.  Full stomach - prevention of aspiration\n2.  Describe the management of a patient with an open eye injury and a full stomach.\n3.  Penetrating eye injury - avoid ketamine, etomidate and succinylcholine since these medications can increase intraocular pressure..\n4.  Rocuronium is probably the best choice for rapid sequence induction in this case.\n\nSuggested Anesthetic Plan\n1.  Routine monitoring\n2.  Preoxygenate\n3.  Tracheal intubation following rapid sequence induction with propofol and rocuronium while applying cricoid pressure.\n\nNote:\nAwake intubation requires extremely thorough topical anesthesia to avoid coughing.\n\nReferences\n1.  Libotani: Succinylcholine in open eye surgery. Anesthesiology 1985; 62: 637\n2.  Berry, Merin: Etomidate myoclonus and the open globe. Anesth Analg 1989; 69: 256  \n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 2025\n\n", 
    "possiblePoints": 1200, 
    "preopMsg": "\n24 year old male with penetrating eye injury and full stomach\n\nHistory of Present Illness\nThe patient sustained a penetrating eye injury one hour ago.\n\nPast Medical History\nIllnesses - None\nSurgeries - None\nMedications - None\nHabits - Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, anxious male in pain\nWeight: 76 kg\nHR 108,  BP 142/86,  RR 20\nAirway - normal\nLungs - clear \nHeart - normal\nNumerous scars\n\nLabs\nHematocrit 40%\nLytes, Glucose, Bun, Cr - normal\n\nNPO Status\nLast ate a large meal 2 hours ago.  \n\nPatient and Surgeon Requests\nThe procedure requires general anesthesia. \nThe surgeon states the procedure will take one hour.\n\n", 
    "volAnDsp": 80, 
    "states": [
        {
            "name": "AWAKE", 
            "whatNextMsg": "Administer oxygen by mask prior to induction.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 140, 
            "baseBicarb": 23.8, 
            "baseHr": 92, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "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": 95, 
            "sat40": 98, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 360, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PREO2", 
                    "comment": "You preoxygenated appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "o2Sat", 
                            "value": 97
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "CRICO", 
                    "comment": "You applied cricoid pressure before the patient was preoxygenated. (Lost points)", 
                    "conditions": [
                        {
                            "type": "doingCricoid", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "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
                }
            ]
        }, 
        {
            "name": "AWAKEPARA", 
            "whatNextMsg": "Call your lawyer.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 100, 
            "baseAbpM": 124, 
            "baseAbpS": 180, 
            "baseBicarb": 24, 
            "baseHr": 110, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "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": 93, 
            "sat40": 96, 
            "sat100": 98, 
            "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": "ASLEEPPARA", 
                    "comment": "You sedated this patient after you administered muscle relaxant. (+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": "PREO2", 
            "whatNextMsg": "Apply cricoid pressure prior to induction.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 82, 
            "baseAbpM": 94, 
            "baseAbpS": 144, 
            "baseBicarb": 23.8, 
            "baseHr": 94, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Preoxygenated and anxiously awaiting induction.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 95, 
            "sat40": 98, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 340, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "READY", 
                    "comment": "You applied cricoid pressure appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "type": "doingCricoid", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "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
                }
            ]
        }, 
        {
            "name": "CRICO", 
            "whatNextMsg": "Administer oxygen by mask prior to induction.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 88, 
            "baseAbpM": 100, 
            "baseAbpS": 148, 
            "baseBicarb": 23.8, 
            "baseHr": 96, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Cricoid pressure is being applied to this anxious patient.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 95, 
            "sat40": 98, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 20, 
            "spontTv": 320, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "READY", 
                    "comment": "You preoxygenated after applying cricoid pressure.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "o2Sat", 
                            "value": 97
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "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
                }
            ]
        }, 
        {
            "name": "READY", 
            "whatNextMsg": "Administer induction dose of propofol.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 92, 
            "baseAbpM": 112, 
            "baseAbpS": 150, 
            "baseBicarb": 23.8, 
            "baseHr": 98, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Preoxygenated and anxiously awaiting induction.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 95, 
            "sat40": 98, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 20, 
            "spontTv": 320, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEP", 
                    "comment": "You administered an appropriate dose of propofol. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 119
                        }, 
                        {
                            "drug": "Propofol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You administered an appropriate dose of thiopental. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Thiopental", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 199
                        }, 
                        {
                            "drug": "Thiopental", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 501
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You should not administer etomidate with an open eye injury. (-500 points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 5
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You should not administer ketamine with an open eye injury. (-500 points)", 
                    "conditions": [
                        {
                            "drug": "Ketamine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 5
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced unconsciousness with other than bolus propofol or thiopental. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "READY", 
                    "comment": "You administered an inadequate dose of propofol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 120
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "READY", 
                    "comment": "You administered an inadequate dose of thiopental. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Thiopental", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DEEP", 
                    "comment": "You administered an excessive dose of propofol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DEEP", 
                    "comment": "You administered an excessive dose of etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 26
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DEEP", 
                    "comment": "You administered an excessive dose of thiopental. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Thiopental", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 500
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "COUGH5", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 90, 
            "baseAbpM": 104, 
            "baseAbpS": 160, 
            "baseBicarb": 24, 
            "baseHr": 100, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing but the breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "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": 92, 
            "sat40": 96, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 320, 
            "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": "ASLEEP", 
                    "comment": "The sedative agent is starting to take effect.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HURT5", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 100, 
            "baseAbpM": 132, 
            "baseAbpS": 200, 
            "baseBicarb": 24, 
            "baseHr": 120, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "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": 91, 
            "sat40": 94, 
            "sat100": 96, 
            "spSignal": 3, 
            "spontRr": 10, 
            "spontTv": 320, 
            "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": "ASLEEP", 
                    "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": "ASLEEP", 
            "whatNextMsg": "Now administer rocuronium to facilitate endotracheal intubation.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 60, 
            "baseAbpM": 74, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 66, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Asleep.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 94, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                 {
                    "nextState": "ASLEEPPARA", 
                    "comment": "You should not have administered succinylcholine. (-500 points)", 
                    "conditions": [
                        {
                            "drug": "Succinylcholine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }
                    ], 
                    "points": -500
                }, 
               {
                    "nextState": "ASLEEPPARA", 
                    "comment": "You administered rocuronium to facilitate intubation. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Rocuronium", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 69
                        }, 
                        {
                            "drug": "Rocuronium", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 151
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "ASLEEPPARA", 
                    "comment": "You administered an excessive amount of rocuronium. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Rocuronium", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 150
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPPARA", 
                    "comment": "You administered an inadequate amount of rocuronium. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Rocuronium", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 70
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPPARA", 
                    "comment": "You administered a competitive neuromuscular blocker other than rocuronium. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "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": "ASLEEPPARA", 
            "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 62, 
            "baseAbpM": 76, 
            "baseAbpS": 110, 
            "baseBicarb": 24, 
            "baseHr": 68, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Asleep and paralyzed.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 91, 
            "sat40": 94, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (Lost possible points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DEEP", 
            "whatNextMsg": "Now administer rocuronium to facilitate endotracheal intubation.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 40, 
            "baseAbpM": 58, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 86, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Deeply anesthetized.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 91, 
            "sat40": 94, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                 {
                    "nextState": "DEEPPARA", 
                    "comment": "You administered succinylcholine. (-500 points)", 
                    "conditions": [
                        {
                            "drug": "Succinylcholine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1
                        }
                    ], 
                    "points": -500
                }, 
               {
                    "nextState": "DEEPPARA", 
                    "comment": "You administered rocuronium to facilitate intubation. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Rocuronium", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 69
                        }, 
                        {
                            "drug": "Rocuronium", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 151
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "DEEPPARA", 
                    "comment": "You administered an excessive amount of rocuronium. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Rocuronium", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 150
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DEEPPARA", 
                    "comment": "You administered an inadequate amount of rocuronium. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Rocuronium", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 70
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DEEPPARA", 
                    "comment": "You administered a competitive neuromuscular blocker other than rocuronium. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "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": "DEEPPARA", 
            "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 40, 
            "baseAbpM": 58, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 86, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Deeply anesthetized and paralyzed.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 91, 
            "sat40": 94, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }
            ]
         }, 
        {
            "name": "GA1", 
            "whatNextMsg": "Deepen the anesthetic.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 68, 
            "baseAbpM": 86, 
            "baseAbpS": 142, 
            "baseBicarb": 24, 
            "baseHr": 86, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is minimal.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly anesthetized with intravenous agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 91, 
            "sat40": 94, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "HURT1", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.2
                        }
                    ], 
                    "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": "GA2", 
            "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 60, 
            "baseAbpM": 74, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 66, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Adequately anesthetized.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 97, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "GA3", 
                    "comment": "You instructed the surgeon to operate. (+200 points)", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "GA3", 
            "whatNextMsg": "You reached the end of the simulation. Review the debriefing.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 66, 
            "baseAbpM": 78, 
            "baseAbpS": 118, 
            "baseBicarb": 24, 
            "baseHr": 78, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "The operation is underway.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 92, 
            "sat40": 96, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA4", 
                    "comment": "You administered an excessively deep anesthetic. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 4
                        }
                    ], 
                    "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": "GA4", 
            "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 50, 
            "baseAbpS": 66, 
            "baseBicarb": 24, 
            "baseHr": 82, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "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": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Very deeply anesthetized.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 93, 
            "sat40": 96, 
            "sat100": 99, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You lightened the anesthetic depth appropriately. (+50 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 3.8
                        }
                    ], 
                    "points": 50
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HURT1", 
            "whatNextMsg": "Deepen the anesthetic.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 84, 
            "baseAbpM": 112, 
            "baseAbpS": 182, 
            "baseBicarb": 24, 
            "baseHr": 106, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is reduced.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 91, 
            "sat40": 94, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 20, 
            "spontTv": 240, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1", 
                    "comment": "The autonomic response is abating.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "You deepened the anesthetic.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "DESATBRADY1", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 62, 
            "baseAbpS": 92, 
            "baseBicarb": 24, 
            "baseHr": 32, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and slow.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "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": 38, 
            "baseAbpM": 50, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 22, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Very slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and very slow.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "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
        }
    ]
}