CaseData[39] = {
    "title": "Case 39 - 32 year old G8P5 with post-partum hemorrhage", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 1.2, 
    "debriefMsg": "\nYou must resuscitate the patient quickly with fluid replacement. Consider transfusion early. Administer oxytocin. Consider adding methylergonovine or carboprost. This version of the simulator does include massive transfusion protocol or coagulopathies.\n\n", 
    "depthCarina": 25, 
    "depthCords": 18, 
    "depthTubeInitial": 22, 
    "durationPrep": 6, 
    "durationSurgery": 1200, 
    "helpFlag": true, 
    "imageSet": 3, 
    "initialSat": 96, 
    "leanBodyMass": 80, 
    "learningObj": "\n32 year old G8P5 with post-partum hemorrhage (87 kg)\n\nThe patient experienced a very fast labor with vaginal delivery a few minutes after arrival to the hospital. She started bleeding profusely immediately after delivery. The obstetrician requests assistance resuscitating the patient.\n\nLearning Objectives\n1. List predisposing conditions that lead to postpartum hemorrhage (PPH).\n2. List the presenting signs of PPH.\n3. List the differential diagnosis of PPH.\n4. Describe acute management of PPH.\n\nPredisposing Conditions Leading to PPH\n1. Abnormal placenta - previa, accreta\n2. Multiple pregnancies\n3. Previous cesarean section\n4. Preeclampsia\n5. Instrumental delivery\n6. Cesarean delivery\n7. Prolonged labor\n8. Labor augmentation with oxytocin\n\nPresenting Signs of Postpartum Hemorrhage\n1. Uncontrolled vaginal hemorrhage (not always externally apparent)\n2. Maternal hemodynamic instability\n3. Decreased arterial oxygen saturation or acidosis\n\nDifferential Diagnosis of Postpartum Hemorrhage\n1. Uterine atony\n2. Cervical or vaginal lacerations\n3. Retained placenta\n4. Placenta Accreta\n5. Coagulopathy (secondary to DIC, severe preeclampsia, preexisting hematologic disease)\n6. Uterine inversion\n\nTreatment of Uterine Atony\n1. Oxytocin - first line treatment\n     a. Initial dose for elective c-section: 1 unit\n     b. Initial dose for intrapartum c-section: 3 units\n     c. Maintenance infusion: 2.5-15 units/hr unit\n     d. Oxytocin can cause peripheral vasodilation causing worsened hypotension\n2. Second line treatment if oxytocin fails\n     a. Methylergonovine 0.2 mg IM. Avoid if hypertensive orpreeclamptic.\n     b. Carboprost 0.25mg IM. Avoid if asthma, hypertension, hepatic, pulmonary or cardiac disease.\n3. Third line treatment - Misoprostol 600-1000 mcg oral, sublingual or rectal. Slow onset. Can cause severe hyperthermia.\n\nTreatment of Uterine Inversion\n1. Obstetric reduction of inversion sometimes requires anesthesia for reinversion.\n2. Immediate discontinuation of uterine stimulants.\n3. Large bore intravenous access to facilitate volume resuscitation.\n4. General anesthesia to allow uterine relaxation, enable uterine replacement, and provide analgesia while uterine tone is restored.\n5. Restart uterine stimulants after uterine reinversion.\n6. Acute resuscitation as appropriate including fluids, oxygen, ventilation, replacement of blood products, and maintenance of body temperature.\n\nTransfusion and hemodynamic support\n1. Massive transfusion protocol (varies by institution): Type O or type-specific RBCs 6 units, Plasma 4 units, Platelets 1 unit\n2. Maintain platelet count > 50,000\n3. Maintain fibrinogen > 200 mg/dl\n4. The World Health Organization recommends use of tranexamic acid within 3 hours of birth for all women with postpartum hemorrhage in undeveloped countries. There is little evidence to support use in developed countries.\n\nNote: The current version of the simulator does not include massive transfusion or management of coagulaopathy.\n\nReference: Butwick, 2023 ASA Refresher Course 305.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 2024\n\n", 
    "possiblePoints": 800, 
    "preopMsg": "\n32 year old G8P5 with post-partum hemorrhage\n\nHistory of Present Illness\nThe patient is G8 P5 Ab 2. The patient experienced a very fast labor with vaginal delivery a few minutes after arrival to the hospital. She started bleeding profusely immediately after delivery. The obstetrician requests assistance resuscitating the patient.\n\nPast Medical History\nIllnesses - None\nSurgeries - previous cesarean section for fetal distress\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\nWeight: 87 kg\nHR 110,  BP 105/65,  RR 20\nAirway - good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula\nChest auscultation - clear\n\nLabs\nHematocrit - pending\n\nNPO Status\nLast ate 8 hours ago.\n\nPatient and Surgeon Requests\nAfter one push the obstetrician effects spontaneous vaginal delivery of a vigorous term baby. The patient is bleeding profusely. The obstetrician requests assistance with resuscitation.\n\n", 
    "volAnDsp": 80, 
    "states": [
        {
            "name": "PPH1", 
            "whatNextMsg": "The patient is bleeding profusely. Establish IV access and begin fluid resuscitation. Administer oxytocin.", 
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
			"airwayStr": "nl",
            "baseAbpD": 75, 
            "baseAbpM": 90, 
            "baseAbpS": 115, 
            "baseBicarb": 22, 
            "baseHr": 108, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 36, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 4, 
            "papM": 7, 
            "papS": 12, 
            "papW": 4, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 50, 
            "rateUo": 1.5, 
            "recordMsg": "Extremely anxious and bleeding profusely.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 340, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OXY1", 
                    "comment": "You administered intravenous fluids and oxytocin appropriately. (+400 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1499
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.5
                        }
                    ], 
                    "points": 400
                }, 
                {
                    "nextState": "OXY1", 
                    "comment": "You administered intravenous fluids and oxytocin appropriately. (+400 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1499
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 4
                        }
                    ], 
                    "points": 400
                }, 
                {
                    "nextState": "PPH2", 
                    "comment": "You should have administered intravenous fluids and oxytocin sooner. (-200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
            ]
        }, 
        {
            "name": "PPH2", 
            "whatNextMsg": "The patient is bleeding profusely. Establish IV access and begin fluid resuscitation. Administer oxytocin.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 66, 
            "baseAbpS": 94, 
            "baseBicarb": 20, 
            "baseHr": 120, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 34, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 4, 
            "papM": 8, 
            "papS": 14, 
            "papW": 2, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 50, 
            "rateUo": 1.5, 
            "recordMsg": "Delayed treatment for profuse post-partum hemorrhage.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 20, 
            "spontTv": 280, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OXY2", 
                    "comment": "You administered intravenous fluids and oxytocin appropriately. (+300 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1599
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.5
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "OXY2", 
                    "comment": "You administered intravenous fluids and oxytocin appropriately. (+300 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1599
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 4
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PPH3", 
                    "comment": "You should have administered intravenous fluids and oxytocin much sooner. (-300 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "PPH1", 
                    "comment": "You administered intravenous fluids appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1999
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
            ]
        }, 
        {
            "name": "PPH3", 
            "whatNextMsg": "The patient is bleeding profusely. Establish IV access and begin fluid resuscitation. Administer oxytocin.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 36, 
            "baseAbpM": 46, 
            "baseAbpS": 68, 
            "baseBicarb": 18, 
            "baseHr": 144, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 2.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 1, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 30, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 2, 
            "papM": 5, 
            "papS": 10, 
            "papW": 2, 
            "pulseMsg": "The pulse is rapid and weak.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 50, 
            "rateUo": 1.5, 
            "recordMsg": "Double-delayed treatment for profuse post-partum hemorrhage.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool with very slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 24, 
            "spontTv": 240, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OXY3", 
                    "comment": "You administered intravenous fluids and oxytocin appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1699
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.5
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "OXY3", 
                    "comment": "You administered intravenous fluids and oxytocin appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1699
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 4
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "PPH4", 
                    "comment": "You should have administered intravenous fluids and oxytocin much much sooner. (-400 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -400
                }, 
                {
                    "nextState": "PPH2", 
                    "comment": "You administered intravenous fluids appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1899
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
            ]
        }, 
        {
            "name": "PPH4", 
            "whatNextMsg": "The patient is bleeding to death. Begin fluid resuscitation and administer oxytocin.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 26, 
            "baseAbpS": 38, 
            "baseBicarb": 16, 
            "baseHr": 160, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 0, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 24, 
            "heartSoundsMsg": "The heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is lethargic.", 
            "papD": 2, 
            "papM": 4, 
            "papS": 6, 
            "papW": 2, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 50, 
            "rateUo": 1.5, 
            "recordMsg": "Triple-delayed treatment for profuse post-partum hemorrhage.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool with no capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spRate": 98, 
            "spSignal": 1, 
            "spontRr": 30, 
            "spontTv": 220, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OXY4", 
                    "comment": "You administered intravenous fluids and oxytocin after a long delay. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1799
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.5
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "OXY4", 
                    "comment": "You administered intravenous fluids and oxytocin after a long delay. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1799
                        },
                        {
                            "drug": "Oxytocin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 4
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PPH3", 
                    "comment": "You administered intravenous fluids appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 1799
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should have administered intravenous fluids and oxytocin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
            ]
        }, 
        {
            "name": "OXY1", 
            "whatNextMsg": "Continue fluid resuscitation and administer methylergonovine or carboprost.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 65, 
            "baseAbpM": 82, 
            "baseAbpS": 105, 
            "baseBicarb": 22, 
            "baseHr": 116, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 34, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is sedated.", 
            "papD": 4, 
            "papM": 7, 
            "papS": 12, 
            "papW": 4, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 30, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation started and oxytocin administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 12, 
            "spontTv": 300, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SECOND1", 
                    "comment": "You administered methylergonovine appropriately. (+400 points)", 
                    "conditions": [
                        {
                            "drug": "Methylergonovine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 400
                }, 
                {
                    "nextState": "SECOND1", 
                    "comment": "You administered carboprost appropriately. (+400 points)", 
                    "conditions": [
                        {
                            "drug": "Carboprost", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 400
                }, 
                {
                    "nextState": "OXY2", 
                    "comment": "You should have administered methylergonovine or carboprost sooner. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
            ]
        }, 
        {
            "name": "OXY2", 
            "whatNextMsg": "Continue fluid resuscitation and administer methylergonovine or carboprost.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 46, 
            "baseAbpM": 62, 
            "baseAbpS": 86, 
            "baseBicarb": 20, 
            "baseHr": 128, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 32, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is sedated.", 
            "papD": 4, 
            "papM": 8, 
            "papS": 14, 
            "papW": 4, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 30, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation started and oxytocin administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 10, 
            "spontTv": 180, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
               {
                    "nextState": "SECOND2", 
                    "comment": "You administered methylergonovine appropriately. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Methylergonovine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "SECOND2", 
                    "comment": "You administered carboprost appropriately. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Carboprost", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "OXY3", 
                    "comment": "You should have administered methylergonovine or carboprost sooner. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "OXY1", 
                    "comment": "You administered intravenous fluids appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 2999
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
            ]
        }, 
        {
            "name": "OXY3", 
            "whatNextMsg": "Continue fluid resuscitation and administer methylergonovine or carboprost.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 40, 
            "baseAbpS": 60, 
            "baseBicarb": 18, 
            "baseHr": 152, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 2.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 3, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 28, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is sedated.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is rapid and weak.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 30, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation started and oxytocin administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool with very slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spRate": 140, 
            "spSignal": 2, 
            "spontRr": 14, 
            "spontTv": 160, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
               {
                    "nextState": "SECOND3", 
                    "comment": "You administered methylergonovine appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Methylergonovine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "SECOND3", 
                    "comment": "You administered carboprost appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Carboprost", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "OXY4", 
                    "comment": "You should have administered methylergonovine or carboprost sooner. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -400
                }, 
                {
                    "nextState": "OXY2", 
                    "comment": "You administered intravenous fluids appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 2899
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
			]
        }, 
        {
            "name": "OXY4", 
            "whatNextMsg": "Continue fluid resuscitation and administer methylergonovine or carboprost.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 16, 
            "baseAbpM": 22, 
            "baseAbpS": 36, 
            "baseBicarb": 16, 
            "baseHr": 162, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 0, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 22, 
            "heartSoundsMsg": "The heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is lethargic.", 
            "papD": 2, 
            "papM": 4, 
            "papS": 6, 
            "papW": 2, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 30, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation started and oxytocin administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool with no capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 1, 
            "spontRr": 16, 
            "spontTv": 160, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
               {
                    "nextState": "SECOND4", 
                    "comment": "You administered methylergonovine appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Methylergonovine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "SECOND4", 
                    "comment": "You administered carboprost appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Carboprost", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.05
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should have administered methylergonovine or carboprost sooner. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -400
                }, 
                {
                    "nextState": "OXY3", 
                    "comment": "You administered intravenous fluids appropriately. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 2799
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
			]
        }, 
        {
            "name": "SECOND1", 
            "whatNextMsg": "Bleeding controlled. Measure hematocrit. Continue resuscitation.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 70, 
            "baseAbpM": 82, 
            "baseAbpS": 105, 
            "baseBicarb": 22, 
            "baseHr": 118, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 34, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 12, 
            "papM": 18, 
            "papS": 30, 
            "papW": 10, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 10, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation continuing and second line uterotonic med administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 280, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINAL", 
                    "comment": "Continue to monitor and resuscitate as needed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                },
                {
                    "nextState": "FINAL", 
                    "comment": "You administered intravenous fluids appropriately. ", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 3999
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
			]	
        }, 
        {
            "name": "SECOND2", 
            "whatNextMsg": "Bleeding controlled. Measure hematocrit. Continue resuscitation.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 68, 
            "baseAbpS": 92, 
            "baseBicarb": 20, 
            "baseHr": 122, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 32, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 10, 
            "papM": 16, 
            "papS": 28, 
            "papW": 8, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 10, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation continuing and second line uterotonic med administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 20, 
            "spontTv": 200, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINAL", 
                    "comment": "Continue to monitor and resuscitate as needed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                },
                {
                    "nextState": "FINAL", 
                    "comment": "You administered intravenous fluids appropriately. ", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 3999
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
			]	
        }, 
        {
            "name": "SECOND3", 
            "whatNextMsg": "Bleeding controlled. Measure hematocrit. Continue resuscitation.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 62, 
            "baseAbpS": 90, 
            "baseBicarb": 18, 
            "baseHr": 124, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 6, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 30, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 6, 
            "pulseMsg": "The pulse is rapid and weak.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 10, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation continuing and second line uterotonic med administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool with very slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 24, 
            "spontTv": 180, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINAL", 
                    "comment": "Continue to monitor and resuscitate as needed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                },
                {
                    "nextState": "FINAL", 
                    "comment": "You administered intravenous fluids appropriately.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 3999
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
			]	
        }, 
        {
            "name": "SECOND4", 
            "whatNextMsg": "Bleeding controlled. Measure hematocrit. Continue resuscitation.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 62, 
            "baseAbpS": 88, 
            "baseBicarb": 16, 
            "baseHr": 126, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 28, 
            "heartSoundsMsg": "The heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is lethargic.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 2, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 10, 
            "rateUo": 1.5, 
            "recordMsg": "Fluid resucitation continuing and second line uterotonic med administered.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool with no capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 1, 
            "spontRr": 30, 
            "spontTv": 180, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINAL", 
                    "comment": "Continue to monitor and resuscitate as needed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                },
                {
                    "nextState": "FINAL", 
                    "comment": "You administered intravenous fluids appropriately.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 3999
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have paralyzed this patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "DESATASYST", 
                    "comment": "You should not have induced anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }
                    ], 
                    "points": -1000
                } 
			]
        }, 
        {
            "name": "FINAL", 
            "whatNextMsg": "Scenario completed.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 75, 
            "baseAbpM": 92, 
            "baseAbpS": 115, 
            "baseBicarb": 22, 
            "baseHr": 108, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 1, 
            "glucose": 120, 
            "hct": 34, 
            "heartSoundsMsg": "Rapid rate without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is extremely agitated.", 
            "papD": 12, 
            "papM": 18, 
            "papS": 30, 
            "papW": 10, 
            "pulseMsg": "The pulse is rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 1, 
            "rateUo": 1.5, 
            "recordMsg": "You successfully managed this case which did not include massive transfusion protocol and coagulaopathy.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 98, 
            "sat40": 99, 
            "sat100": 100, 
            "spRate": 92, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 280, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9 
        }, 
        {
            "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.", 
			"overdoseFlag": false,
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and slow.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 5, 
            "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, 
            "spRate": 32, 
            "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.", 
			"overdoseFlag": false,
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and very slow.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 5, 
            "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, 
            "spRate": 22, 
            "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.", 
			"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": 5, 
            "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, 
            "spRate": 0, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DEAD", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DEAD", 
            "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": 5, 
            "rateUo": 1.5, 
            "recordMsg": "The patient cannot be resuscitated. End of case simulation.", 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spRate": 0, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9
        }
    ]
}