CaseData[76] = {
    "title": "Case 135 - 8 day old premature infant for laparotomy", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 0.2, 
    "debriefMsg": "NEC based on case 36", 
    "depthCarina": 13, 
    "depthCords": 8, 
    "depthTubeInitial": 10, 
    "durationPrep": 60, 
    "durationSurgery": 1200, 
    "helpFlag": false, 
    "imageSet": 8, 
    "initialSat": 90, 
    "leanBodyMass": 1.2, 
    "learningObj": "", 
    "possiblePoints": 1000, 
    "preopMsg": "\n8 day old premature infant for laparotomy\n\nHistory of Present Illness\nThis child was born at 32 weeks gestational age. There is a history of birth asphyxia and of respiratory distress which required 2 days of C.P.A.P. Several episodes of apnea occurred which responded to stimulation. Abdominal distension was first noted 3 days ago and treated with gastric decompression, fluid therapy, and antibiotics. Condition has worsened in last 24 hours.\n\nPast Medical History\nMeds - none\nAllergies - none\n\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nWeight: 1200 gm\nHR 138,  BP 58/30,  RR 36\nAirway - normal\nLungs - clear\nHeart - no murmurs\nDistended abdomen\n\nLabs\nHematocrit 36\nPlatelets 57,000 (down from 200,000 3 days ago)\nAbdominal X-ray - pneumoperitoneum, dilated loops of bowel, gas in portal system\n\nNPO Status\nThe patient has been NPO for days.\n\nPatient and Surgeon Requests\nImmediate surgery is planned.\n\n", 
    "volAnDsp": 2, 
    "states": [
        {
            "name": "VERYDRY", 
            "whatNextMsg": "Rehydrate with at least 24 mL (20 mL/kg) of normal saline, then reassess.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 34, 
            "baseAbpS": 52, 
            "baseBicarb": 18.8, 
            "baseHr": 180, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The patient is breathing rapidly.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 68, 
            "hct": 32, 
            "heartSoundsMsg": "Rapid rate, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is restless.", 
            "papD": 2, 
            "papM": 4, 
            "papS": 6, 
            "papW": 2, 
            "pulseMsg": "The pulse is weak and rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Severely hypovolemic.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cool and has slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 1, 
            "spontRr": 36, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FLUIDS1", 
                    "comment": "You partially rehydrated the patient appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 19
                        }, 
                        {
                            "op": "LT", 
                            "type": "tFluid", 
                            "value": 39
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "FLUIDS1", 
                    "comment": "You administered a bolus of fluid greater than 20 mL/kg. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 38
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "SEDATEVERYDRY", 
                    "comment": "You administered a sedative agent before rehydration. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.2
                        }
                    ], 
                    "points": 50
                }, 
                {
                    "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": "FLUIDS1", 
                    "comment": "You waited too long to administer intravenous fluids. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 600
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PARA5", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "FLUIDS1", 
            "whatNextMsg": "Continue to administer fluids until vital signs stabilize.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 36, 
            "baseAbpS": 54, 
            "baseBicarb": 19.4, 
            "baseHr": 150, 
            "basePot": 4.4, 
            "breathSoundsMsg": "The patient is breathing rapidly.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 64, 
            "hct": 44, 
            "heartSoundsMsg": "Rapid rate, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is fussy.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is stronger but still fast.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Partially rehydrated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 30, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FLUIDS2", 
                    "comment": "You adequately rehydrated the patient . (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 40
                        }, 
                        {
                            "op": "LT", 
                            "type": "tFluid", 
                            "value": 81
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "FLUIDS2", 
                    "comment": "You administered excessive intravenous fluid. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 80
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "SEDATEFLUIDS1", 
                    "comment": "You administered a sedative agent. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "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": "PARA5", 
                    "comment": "You paralyzed an unanesthetized  patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "FLUIDS2", 
            "whatNextMsg": "Preoxygenate, induce general anesthesia and intubate.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 30, 
            "baseAbpM": 38, 
            "baseAbpS": 56, 
            "baseBicarb": 20.2, 
            "baseHr": 130, 
            "basePot": 3.6, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 62, 
            "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 crying.", 
            "papD": 6, 
            "papM": 8, 
            "papS": 12, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Adequately rehydrated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 3, 
            "spontRr": 30, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEFLUIDS2", 
                    "comment": "You administered a sedative agent. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "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": "PARA5", 
                    "comment": "You paralyzed an unanesthetized  patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "SEDATEVERYDRY", 
            "whatNextMsg": "Rehydrate this patient with 20 mL/kg.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 24, 
            "baseAbpM": 32, 
            "baseAbpS": 50, 
            "baseBicarb": 15.8, 
            "baseHr": 178, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 48, 
            "hct": 46, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is sedated but responsive.", 
            "papD": 2, 
            "papM": 4, 
            "papS": 6, 
            "papW": 2, 
            "pulseMsg": "The pulse is fast but weak.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Sedated but hypovolemia untreated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 1, 
            "spontRr": 20, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPVERYDRY", 
                    "comment": "You induced anesthesia before replacing intravascular volume. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEFLUIDS1", 
                    "comment": "You partially rehydrated the patient appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 19
                        }, 
                        {
                            "op": "LT", 
                            "type": "tFluid", 
                            "value": 39
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "SEDATEFLUIDS1", 
                    "comment": "You administered a bolus of fluid greater than 20 mL/kg. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 38
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "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": "PARA5", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "SEDATEFLUIDS1", 
            "whatNextMsg": "Administer additional intravenous fluids.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 36, 
            "baseAbpS": 52, 
            "baseBicarb": 16.2, 
            "baseHr": 148, 
            "basePot": 4.3, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 60, 
            "hct": 44, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is sedated but responsive.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is fast and weak.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Partially rehydrated and sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 20, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATEFLUIDS2", 
                    "comment": "You adequately rehydrated the patient . (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 40
                        }, 
                        {
                            "op": "LT", 
                            "type": "tFluid", 
                            "value": 81
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "SEDATEFLUIDS2", 
                    "comment": "You administered excessive intravenous fluid. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 80
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPFLUIDS1", 
                    "comment": "You induced anesthesia prior to adequately replacing volume. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -400
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an under anesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "PARA5", 
                    "comment": "You administered muscle relaxant before completely inducing unconsciousness. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an under anesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "SEDATEFLUIDS2", 
            "whatNextMsg": "Preoxygenate, induce anesthesia and intubate.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 36, 
            "baseAbpS": 54, 
            "baseBicarb": 18.2, 
            "baseHr": 128, 
            "basePot": 3.6, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 58, 
            "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 sedated but responsive.", 
            "papD": 6, 
            "papM": 8, 
            "papS": 12, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Adequately rehydrated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 3, 
            "spontRr": 20, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1", 
                    "comment": "You induced anesthesia after adequately treating hypovolemia.  (+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": "COUGH5", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 36, 
            "baseAbpS": 56, 
            "baseBicarb": 15.6, 
            "baseHr": 182, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The patient is coughing.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 58, 
            "hct": 48, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is coughing and bucking.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is 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 with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 42, 
            "spontTv": 5, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "VERYDRY", 
                    "comment": "The patient stopped coughing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPVERYDRY", 
                    "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. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "PARA5", 
                    "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": "Administer narcotic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 30, 
            "baseAbpM": 40, 
            "baseAbpS": 58, 
            "baseBicarb": 15.6, 
            "baseHr": 184, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 58, 
            "hct": 48, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is writhing in pain.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is fast.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Writhing in pain.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 42, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "VERYDRY", 
                    "comment": "The patient stopped screaming.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPVERYDRY", 
                    "comment": "You induced anesthesia before adequately replacing volume. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "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": "PARA5", 
            "whatNextMsg": "You are lucky this kid can't talk.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 38, 
            "baseAbpS": 56, 
            "baseBicarb": 15.6, 
            "baseHr": 182, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 68, 
            "hct": 48, 
            "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.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 3, 
            "pulseMsg": "The pulse is fast", 
            "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": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "VERYDRY", 
                    "comment": "The muscle relaxant is wearing off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPVERYDRY", 
                    "comment": "You induced anesthesia without adequately replacing volume. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "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": "ASLEEPVERYDRY", 
            "whatNextMsg": "Resuscitate with volume replacement (20 mL/kg) and pressors.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 22, 
            "baseAbpM": 30, 
            "baseAbpS": 48, 
            "baseBicarb": 15.6, 
            "baseHr": 176, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.4, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 2, 
            "finalState": 0, 
            "glucose": 58, 
            "hct": 48, 
            "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": 2, 
            "papM": 4, 
            "papS": 6, 
            "papW": 2, 
            "pulseMsg": "The pulse is weak.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized without adequate resuscitation. The patient is now hypotensive.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 94, 
            "sat100": 98, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPFLUIDS1", 
                    "comment": "You partially rehydrated the patient after induction. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 19
                        }, 
                        {
                            "op": "LT", 
                            "type": "tFluid", 
                            "value": 39
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPFLUIDS1", 
                    "comment": "You administered a bolus of fluid greater than 20 mL/kg. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "tFluid", 
                            "value": 38
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You should have administered IV fluids sooner. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "ASLEEPFLUIDS1", 
            "whatNextMsg": "Administer another 20 mL/kg fluids and secure the airway.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 24, 
            "baseAbpM": 32, 
            "baseAbpS": 50, 
            "baseBicarb": 22.4, 
            "baseHr": 146, 
            "basePot": 3.6, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 64, 
            "hct": 46, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized but only partially rehydrated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1SECURE", 
                    "comment": "You successfully intubated the patient. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1SECURE", 
                    "comment": "You successfully placed a laryngeal mask airway. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1SECURE", 
                    "comment": "A laryngeal mask airway was placed. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1SECURE", 
                    "comment": "An endotracheal tube was placed. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You delayed securing the airway for too long. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "VFIB", 
            "whatNextMsg": "Call for help and call your lawyer.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 18, 
            "baseAbpS": 18, 
            "baseBicarb": 15.6, 
            "baseHr": 0, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.1, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 48, 
            "hct": 46, 
            "heartSoundsMsg": "Heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 4, 
            "papM": 4, 
            "papS": 4, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Cardiac arrest!", 
            "rhythm": "Vfib2", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0, 
            "stSegV5": 0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DEAD", 
                    "comment": "The rhythm degenerated to asystole. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": -100
                }
            ]
        }, 
        {
            "name": "GA1", 
            "whatNextMsg": "Intubate using direct laryngoscopy.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 26, 
            "baseAbpM": 34, 
            "baseAbpS": 52, 
            "baseBicarb": 22.4, 
            "baseHr": 122, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 64, 
            "hct": 46, 
            "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": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly anesthetized.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1SECURE", 
                    "comment": "You successfully intubated the patient. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1SECURE", 
                    "comment": "You successfully placed a laryngeal mask airway. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1SECURE", 
                    "comment": "A laryngeal mask airway was placed. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayLma", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1SECURE", 
                    "comment": "An endotracheal tube was placed. (+100 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "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": "GA1SECURE", 
            "whatNextMsg": "Deepen the anesthetic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 36, 
            "baseAbpS": 54, 
            "baseBicarb": 22.4, 
            "baseHr": 124, 
            "basePot": 3.6, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 64, 
            "hct": 46, 
            "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": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly anesthetized and airway secured.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spRate": 124, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "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": -200
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "You administered adequate anesthetic for 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": "HURT1", 
            "whatNextMsg": "Deepen the anesthetic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 30, 
            "baseAbpM": 38, 
            "baseAbpS": 58, 
            "baseBicarb": 22.4, 
            "baseHr": 186, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 64, 
            "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": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "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": 88, 
            "sat40": 93, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 24, 
            "spontTv": 6, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1SECURE", 
                    "comment": "The autonomic response is abating.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "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": "GA2", 
            "whatNextMsg": "Inform the surgeon when the patient is ready for surgery.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 24, 
            "baseAbpM": 34, 
            "baseAbpS": 52, 
            "baseBicarb": 22.4, 
            "baseHr": 122, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 0, 
            "glucose": 64, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "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": 88, 
            "sat40": 93, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "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": "Deep maintenance anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 22, 
            "baseAbpM": 32, 
            "baseAbpS": 50, 
            "baseBicarb": 22.4, 
            "baseHr": 124, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 1, 
            "glucose": 64, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Deeply anesthetized.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 88, 
            "sat40": 93, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA4", 
                    "comment": "You administered an excessively deep anesthetic. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 3.6
                        }
                    ], 
                    "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": "GA4", 
            "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 20, 
            "baseAbpM": 30, 
            "baseAbpS": 48, 
            "baseBicarb": 22.4, 
            "baseHr": 126, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 4, 
            "finalState": 1, 
            "glucose": 64, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 4, 
            "papM": 6, 
            "papS": 8, 
            "papW": 4, 
            "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": 88, 
            "sat40": 93, 
            "sat100": 97, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You lightened the anesthetic depth appropriately. (+50 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 2.8
                        }
                    ], 
                    "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": "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": 15.6, 
            "baseHr": 32, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 48, 
            "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": -0.1, 
            "stSegV5": -0.2, 
            "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": 15.6, 
            "baseHr": 22, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 48, 
            "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": -0.1, 
            "stSegV5": -0.2, 
            "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": 15.6, 
            "baseHr": 0, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": 0, 
            "glucose": 48, 
            "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": -0.1, 
            "stSegV5": -0.2, 
            "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": 15.6, 
            "baseHr": 0, 
            "basePot": 3.5, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": -2, 
            "glucose": 48, 
            "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": -0.1, 
            "stSegV5": -0.2, 
            "temperature": 36.9
        }
    ]
}