CaseData[30] = {
    "title": "Case 30 - 4 year old with fractured humerus", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 1.2, 
    "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: start an IV, preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer rocuronium and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.", 
    "depthCarina": 18, 
    "depthCords": 12, 
    "depthTubeInitial": 15, 
    "durationPrep": 60, 
    "durationSurgery": 2400, 
    "helpFlag": true, 
    "imageSet": 1, 
    "initialSat": 96, 
    "leanBodyMass": 16, 
    "learningObj": "\n4 year old male with fractured humerus (16 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  His recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Obtain IV access.\n3. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n4. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n5. Administer propofol 2 mg/kg (35-40 mg) IV bolus and rocuronium 1 mg/kg (20 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of California-Irvine \nDate of Last Modification: July 2025\n\n", 
    "possiblePoints": 1000, 
    "preopMsg": "\n4 year old healthy male with fractured humerus\n\nHistory of Present Illness\nThe patient broke his arm when he ran into a parked car while playing.\n\nPast Medical History\nIllnesses - None\nSurgeries - none\nMeds - none\nAllergies - none\n\nFamily History\nNo known anesthetic problems\n\nPhysical Exam\nHealthy appearing child, but upset and crying\nWeight: 16 kg\nHR 140,  BP 80/54,  RR 20\nAirway - normal\nLungs - clear\nHeart - normal\n\nLabs\nNone ordered\n\nNPO Status\nThe patient ate a full breakfast 2 hours ago just before the accident. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n", 
    "volAnDsp": 40, 
    "states": [
        {
            "name": "AWAKE", 
            "whatNextMsg": "Administer oxygen by mask prior to induction.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 78, 
            "baseBicarb": 23.8, 
            "baseHr": 148, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 39, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 100, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PREO2", 
                    "comment": "You preoxygenated appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "o2Sat", 
                            "value": 97.9
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "CRICO", 
                    "comment": "You applied cricoid pressure before the patient was fully preoxygenated. (Lost points)", 
                    "conditions": [
                        {
                            "type": "doingCricoid", 
                            "value": true
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced anesthesia without fully preoxygenating or applying cricoid pressure. (Lost points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.3
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before induction of anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "AWAKEPARA", 
            "whatNextMsg": "Call your lawyer.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 90, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The muscle relaxant is wearing off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPPARA", 
                    "comment": "You sedated this patient after you administered muscle relaxant.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before induction of anesthesia. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "PREO2", 
            "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 23.8, 
            "baseHr": 150, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 39, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 100, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "READY", 
                    "comment": "You applied cricoid pressure appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "type": "doingCricoid", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized  patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before induction of anesthesia. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "CRICO", 
            "whatNextMsg": "Administer oxygen by mask prior to induction.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 84, 
            "baseBicarb": 23.8, 
            "baseHr": 154, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 39, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 100, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "READY", 
                    "comment": "You preoxygenated after applying cricoid pressure.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "o2Sat", 
                            "value": 98
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized  patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before induction of anesthesia. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "READY", 
            "whatNextMsg": "Administer induction dose of propofol.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 84, 
            "baseBicarb": 23.8, 
            "baseHr": 154, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "hct": 39, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 100, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEP", 
                    "comment": "You administered an appropriate dose of propofol. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 29
                        }, 
                        {
                            "drug": "Propofol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "Consider not using etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 3
                        }, 
                        {
                            "drug": "Etomidate", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 10.1
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You administered an appropriate dose of thiopental. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Thiopental", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 49
                        }, 
                        {
                            "drug": "Thiopental", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 101
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "READY", 
                    "comment": "You administered an inadequate dose of propofol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 30
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "READY", 
                    "comment": "You administered an inadequate dose of etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 4
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "READY", 
                    "comment": "You administered an inadequate dose of thiopental. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Thiopental", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DEEP", 
                    "comment": "You administered an excessive dose of propofol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "DEEP", 
                    "comment": "You administered an excessive dose of etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 10
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "DEEP", 
                    "comment": "You administered an excessive dose of thiopental. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Thiopental", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 100
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "COUGH5", 
                    "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before complete induction of anesthesia. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "COUGH5", 
            "whatNextMsg": "Wait for the patient to settle down, then induce anesthesia.", 
  			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 66, 
            "baseAbpS": 84, 
            "baseBicarb": 24, 
            "baseHr": 148, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing but the breath sounds are clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong and fast.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 90, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient stopped coughing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "The sedative agent is starting to take effect.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "HURT5", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You paralyzed an unanesthetized patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before induction of anesthesia. (Lost points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "HURT5", 
            "whatNextMsg": "Wait for the patient to settle down, then induce anesthesia.", 
  			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 58, 
            "baseAbpM": 66, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 148, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is screaming and writhing in pain.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is bounding.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 20, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient stopped screaming.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEP", 
                    "comment": "The sedative agent is starting to take effect. )", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
	   {
		  "name": "ASLEEP",
		  "whatNextMsg": "Now administer rocuronium or succinylcholine to facilitate endotracheal intubation.",
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 146, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
		  "trans": [
			{
			  "nextState": "DESATBRADY1",
			  "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
			  "conditions": [
				{
				  "op": "GT",
				  "type": "time",
				  "value": 180
				}
			  ],
			  "points": -500
			},
			{
			  "nextState": "ASLEEPPARA",
			  "comment": "You administered an appropriate amount of rocuronium. (+100 points)",
			  "conditions": [
				{
				  "drug": "Rocuronium",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 9
				},
				{
				  "drug": "Rocuronium",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 31
				}
			  ],
			  "points": 100
			},
			{
			  "nextState": "ASLEEPPARA",
			  "comment": "You administered an excessive amount of rocuronium. (Lost points)",
			  "conditions": [
				{
				  "drug": "Rocuronium",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 30
				}
			  ],
			  "points": -50
			},
			{
			  "nextState": "ASLEEP",
			  "comment": "You administered an inadequate amount of rocuronium. (Lost points)",
			  "conditions": [
				{
				  "drug": "Rocuronium",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 10
				}
			  ],
			  "points": -100
			},
			{
			  "nextState": "ASLEEPPARA",
			  "comment": "You administered an appropriate dose of succinylcholine. (+100 points)",
			  "conditions": [
				{
				  "drug": "Succinylcholine",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 9
				},
				{
				  "drug": "Succinylcholine",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 41
				}
			  ],
			  "points": 100
			},
			{
			  "nextState": "ASLEEPPARA",
			  "comment": "You administered an excessive dose of succinylcholine. (Lost points)",
			  "conditions": [
				{
				  "drug": "Succinylcholine",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 40
				}
			  ],
			  "points": -50
			},
			{
			  "nextState": "ASLEEP",
			  "comment": "You administered an inadequate dose of succinylcholine. (Lost points)",
			  "conditions": [
				{
				  "drug": "Succinylcholine",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 10
				}
			  ],
			  "points": -100
			},
			{
			  "nextState": "ASLEEPPARA",
			  "comment": "You administered a competitive neuromuscular blocker other than rocuronium. (+100 points)",
			  "conditions": [
				{
				  "op": "GT",
				  "type": "nmb",
				  "value": 0.4
				}
			  ],
			  "points": 0
			},
			{
				"nextState": "GA1", 
				"comment": "You placed the endotracheal tube without neuromuscular blockade. (Lost points)", 
				"conditions": [
					{
						"type": "tryLaryTube", 
						"value": true
					}
				], 
				"points": -500
			}, 
			{
			  "nextState": "GA1",
			  "comment": "",
			  "conditions": [
				{
				  "type": "airwayTube",
				  "value": true
				}
			  ],
			  "points": 0
			}
		  ]
		},
        {
            "name": "ASLEEPPARA", 
            "whatNextMsg": "Now perform laryngoscopy and place the endotracheal tube.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 146, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA1", 
                    "comment": "", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
		{
		  "name": "DEEP",
		  "whatNextMsg": "Now administer rocuronium or succinylcholine to facilitate endotracheal intubation.",
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 20, 
            "baseAbpM": 28, 
            "baseAbpS": 46, 
            "baseBicarb": 24, 
            "baseHr": 82, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 2.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
		  "trans": [
			{
			  "nextState": "DESATBRADY1",
			  "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
			  "conditions": [
				{
				  "op": "GT",
				  "type": "time",
				  "value": 180
				}
			  ],
			  "points": -500
			},
			{
			  "nextState": "DEEPPARA",
			  "comment": "You administered an appropriate amount of rocuronium. (+100 points)",
			  "conditions": [
				{
				  "drug": "Rocuronium",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 39
				},
				{
				  "drug": "Rocuronium",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 151
				}
			  ],
			  "points": 100
			},
			{
			  "nextState": "DEEPPARA",
			  "comment": "You administered an excessive amount of rocuronium. (Lost points)",
			  "conditions": [
				{
				  "drug": "Rocuronium",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 150
				}
			  ],
			  "points": -50
			},
			{
			  "nextState": "DEEP",
			  "comment": "You administered an inadequate amount of rocuronium. (Lost points)",
			  "conditions": [
				{
				  "drug": "Rocuronium",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 40
				}
			  ],
			  "points": -50
			},
			{
			  "nextState": "DEEPPARA",
			  "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
			  "conditions": [
				{
				  "op": "GT",
				  "type": "nmb",
				  "value": 0.4
				}
			  ],
			  "points": 100
			},
			{
			  "nextState": "DEEPPARA",
			  "comment": "You administered an appropriate dose of succinylcholine. (+100 points)",
			  "conditions": [
				{
				  "drug": "Succinylcholine",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 59
				},
				{
				  "drug": "Succinylcholine",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 151
				}
			  ],
			  "points": 100
			},
			{
			  "nextState": "DEEPPARA",
			  "comment": "You administered an excessive dose of succinylcholine. (Lost points)",
			  "conditions": [
				{
				  "drug": "Succinylcholine",
				  "op": "GT",
				  "type": "bDrug",
				  "value": 150
				}
			  ],
			  "points": -50
			},
			{
			  "nextState": "DEEP",
			  "comment": "You administered an inadequate dose of succinylcholine. (Lost points)",
			  "conditions": [
				{
				  "drug": "Succinylcholine",
				  "op": "LT",
				  "type": "bDrug",
				  "value": 60
				}
			  ],
			  "points": -100
			},
			{
				"nextState": "GA2", 
				"comment": "You placed the endotracheal tube without neuromuscular blockade. (Lost points)", 
				"conditions": [
					{
						"type": "tryLaryTube", 
						"value": true
					}
				], 
				"points": -500
			}, 
			{
			  "nextState": "GA2",
			  "comment": "",
			  "conditions": [
				{
				  "type": "airwayTube",
				  "value": true
				}
			  ],
			  "points": 0
			}
		  ]
		},
        {
            "name": "DEEPPARA", 
            "whatNextMsg": "Now perform laryngoscopy and place the endotracheal tube.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 20, 
            "baseAbpM": 28, 
            "baseAbpS": 46, 
            "baseBicarb": 24, 
            "baseHr": 82, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 2.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "", 
                    "conditions": [
                        {
                            "type": "airwayTube", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "GA1", 
            "whatNextMsg": "Deepen the anesthetic.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 52, 
            "baseAbpS": 70, 
            "baseBicarb": 24, 
            "baseHr": 142, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "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": -100
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "You administered adequate anesthesia for surgery. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "GA2", 
            "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision now that the anesthetic depth is appropriate.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 52, 
            "baseAbpS": 66, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": 200
                }, 
                {
                    "nextState": "GA3", 
                    "comment": "The surgeon is operating.", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "GA3", 
            "whatNextMsg": "You reached the end of the simulation. Review the debriefing.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 42, 
            "baseAbpM": 52, 
            "baseAbpS": 66, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
        }, 
        {
            "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": 28, 
            "baseAbpS": 46, 
            "baseBicarb": 24, 
            "baseHr": 82, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 2.8, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 97, 
            "sat40": 99, 
            "sat100": 100, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You lightened the anesthetic depth appropriately. (+50 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 3.8
                        }
                    ], 
                    "points": 50
                }, 
                {
                    "nextState": "GA3", 
                    "comment": "The surgeon is operating.", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "HURT1", 
            "whatNextMsg": "Deepen the anesthetic.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 50, 
            "baseAbpM": 60, 
            "baseAbpS": 80, 
            "baseBicarb": 24, 
            "baseHr": 140, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is reduced.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 6, 
            "papM": 9, 
            "papS": 14, 
            "papW": 6, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 94, 
            "sat40": 96, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 28, 
            "spontTv": 140, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1", 
                    "comment": "The autonomic response is abating.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2", 
                    "comment": "You deepened the anesthetic.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "DESATBRADY1", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
  			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 38, 
            "baseAbpM": 42, 
            "baseAbpS": 52, 
            "baseBicarb": 24, 
            "baseHr": 32, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and slow.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY2", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATBRADY2", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
  			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 28, 
            "baseAbpM": 32, 
            "baseAbpS": 42, 
            "baseBicarb": 24, 
            "baseHr": 22, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Very slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and very slow.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATASYST", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATASYST", 
            "whatNextMsg": "CPR, epinephrine, atropine.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 18, 
            "baseAbpS": 18, 
            "baseBicarb": 24, 
            "baseHr": 0, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 18, 
            "papM": 18, 
            "papS": 18, 
            "papW": 18, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 2, 
            "rateUo": 1.5, 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.0, 
            "stSegV5": 0.0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATDEAD", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATDEAD", 
            "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.", 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9
        }
    ]
}