CaseData[7] = {
    "title": "Case 7 - 67 year old for femoral-popliteal bypass", 
    "badDrugs": ["Dantrolene"], 
    "coMin": 1.2, 
    "debriefMsg": "This patient has known coronary artery disease and is status-post myocardial infarction 8 months ago. The patient currently has infrequent angina with his current medical management consisting of atenolol, diltiazem,and nitroglycerin. For patients with stable angina: avoid hypoxia, avoid tachycardia, avoid hypotension, and monitor leads II and V5 closely.\n\nIf ST segment changes occur during the case, raise the blood pressure, lower the heart rate, and administer nitroglycerin. Treat the blood pressure first to provide adequate perfusion pressure. Raising the blood pressure may also help to lower the heart rate and will make it easier to titrate the nitroglycerin without causing hypotension. Slow the heart rate with beta-blocker, preferably esmolol, since the fast onset and recovery make it easy to titrate. Opioids may also be helpful to slow the heart rate if pain is a factor. Nitroglycerin dilates coronary arteries to improve myocardial perfusion. It also dilates systemic veins, decreasing preload and myocardial oxygen demand. If the ST segments do not normalize promptly you may need Cardiology intervention. You shoulddiscuss with your instructor whether to continue with the surgery after the ST segments do normalize", 
    "depthCarina": 25, 
    "depthCords": 18, 
    "depthTubeInitial": 22, 
    "durationPrep": 60, 
    "durationSurgery": 1200, 
    "helpFlag": true, 
    "imageSet": 7, 
    "initialSat": 96, 
    "leanBodyMass": 78, 
    "learningObj": "\n67 year old male for femoral-popliteal bypass (82 kg)\n\nThis patient had a fairly recent myocardial infarction  and has continuing angina in a stable pattern. Dipyridamole-thallium scan shows two areas of myocardium still at risk. The patient refuses cardiac cath or surgical intervention so we are limited to medical management of his coronary artery disease. Good heart rate control and infrequent anginal episodes suggest that his medical management with a beta-blocker, calcium channel blocker and nitrates is adequate. \n\nThe patient refuses regional anesthesia.\n\nLearning Objectives\n1. Describe the risk of reinfarction in the perioperative period.\n2. Describe the risks of using epidural or spinal anesthesia in patients that will receive heparin during their surgery.\n3. List treatment steps for acute myocardial ischemia.\n\nAnesthetic Considerations\nThe patient is at risk of a perioperative myocardial infarction. Reinfarctions are fatal in about half of cases and the reinfarction rate is dependent to a great extent on the time since the previous infarction.\n\nSuggested Anesthetic Plan\n1. Routine monitoring, plus direct radial artery pressure monitoring\n2. Intravenous induction, secure the airway\n3. Titration of phenylephrine to maintain afterload if necessary \n\nManagement of ST Segment Changes\nAcute ST segment depression indicates probable myocardial ischemia. Ventricular dysrhythmias may also appear on the ECG. Sinus tachycardia, arterial hypotension, low cardiac output, and elevated filling pressures indicate left ventricular pump failure. Wall motion abnormalities on the transesophageal echo are another sensitive indicator of myocardial ischemia.\n\nTreatment of Myocardial Ischemia\n1. Oxygen\n2. If hypotension is present, administer phenylephrine (initial dose 100 mcg bolus or 1 mcg/kg/min infusion) to normalize blood pressure and coronary perfusion pressure.\n3. If blood pressure is normal or hypertension is present, administer nitroglycerin (initial dose 0.5-1.0 mcg/kg/min) to reduce myocardial oxygen demand and increase coronary blood flow.\n4. If tachycardia is present, slow heart rate to about 60 beats per minute with a beta-blocker. In this patient additional metoprolol (1 mg every 5 min) or an esmolol infusion would be appropriate.\n5. Add inotropic support if there is evidence of low cardiac output - oliguria, persistent hypotension. Dobutamine (5-10 mcg/kg/min), epinephrine (0.01-0.05 mcg/kg/min), and dopamine 5-10 mcg/kg/min) are suitable first choices.\n6. Administer beta-blockers or calcium channel blockers if PVCs are present\n7. Consider nifedipine to relieve coronary vasospasm manifested by ST segment elevation. Initial dose 10 mg sublingually.\n8. Consider Cardiology intervention if ST segments do not normalize promptly.\n\nCase author: Howard A. Schwid, MD and G. Alec Rooke, MD, PhD\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: September 2024\n\n", 
    "possiblePoints": 1200, 
    "preopMsg": "\n67 year old for femoral-popliteal bypass\n\nHistory of Present Illness\nThe patient has severe claudication limiting his current activities.\n\nPast Medical History\nInferoposterior myocardial infarction 8 months ago. Now has occasional angina. Dipyridamole-thallium scan shows two reversible defects. \nPatient refuses cardiac catheterization.\nSurgeries - none\nMeds - atenolol, diltiazem, nitroglycerin\nAllergies - penicillin\nHabits - smokes 2 packs/day for 50 years\n\nFamily History\nNo anesthetic complications\n\nPhysical Exam\nWeight: 82 kg\nHR 64,  BP 140/86,   RR 18\nAirway - normal\nLungs - scattered rhonchi\nHeart - S4, no murmurs\n\nLabs\nHematocrit 38 \nBUN 24,  Cr 1.3\nECG - sinus rhythm, old inferior myocardial infarction\n\nNPO Status\nThe patient last ate 13 hours ago.\n\nPatient and Surgeon Requests\nThe surgery is scheduled to last for 3 hours.\n\n\n", 
    "volAnDsp": 80, 
    "states": [
        {
            "name": "AWAKE", 
            "whatNextMsg": "Sedate, preoxygenate and induce anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 86, 
            "baseAbpM": 100, 
            "baseAbpS": 132, 
            "baseBicarb": 23.8, 
            "baseHr": 88, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 8, 
            "finalState": 0, 
            "glucose": 120, 
            "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 awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 10, 
            "papM": 14, 
            "papS": 22, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and rapid.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Awake, alert, and anxiously awaiting induction.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry but has slow capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 93, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 16, 
            "spontTv": 370, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": 0.1, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATED", 
                    "comment": "You administered a sedative agent. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.3
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "AWAKECOUGH", 
                    "comment": "You should not have tried to place the LMA in an unsedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKECOUGH", 
                    "comment": "You should not have tried to place the endotracheal tube in an unsedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEHURT", 
                    "comment": "You should not have allowed the surgeon to make an incision in an unsedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "AWAKEPARA", 
                    "comment": "You should not have paralyzed an unsedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "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": "AWAKECOUGH", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 90, 
            "baseAbpM": 104, 
            "baseAbpS": 160, 
            "baseBicarb": 24, 
            "baseHr": 104, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing.", 
            "cardiacOutput": 5.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong and fast.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Upset and coughing.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 94, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 18, 
            "spontTv": 320, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": 0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient stopped coughing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "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": "AWAKEHURT", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 100, 
            "baseAbpM": 132, 
            "baseAbpS": 200, 
            "baseBicarb": 24, 
            "baseHr": 124, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is screaming and writhing in pain.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is bounding.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Screaming and writhing in pain.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 92, 
            "sat100": 98, 
            "spSignal": 3, 
            "spontRr": 20, 
            "spontTv": 320, 
            "sputumAmount": 0, 
            "stSegII": 0.3, 
            "stSegV5": 0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The patient stopped screaming.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "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": "AWAKEPARA", 
            "whatNextMsg": "Call your lawyer.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 100, 
            "baseAbpM": 124, 
            "baseAbpS": 180, 
            "baseBicarb": 24, 
            "baseHr": 114, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Awake but paralyzed.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": 0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "AWAKE", 
                    "comment": "The muscle relaxant is wearing off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "SEDATEDPARA", 
                    "comment": "You sedated this patient after you administered muscle relaxant. ", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.1
                        }
                    ], 
                    "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": "SEDATED", 
            "whatNextMsg": "Continue induction.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 126, 
            "baseBicarb": 24, 
            "baseHr": 82, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient has a lethargic response to voice. The patient is moving spontaneously.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 14, 
            "spontTv": 300, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": 0.1, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "You administered an appropriate dose of propofol. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 119
                        }, 
                        {
                            "drug": "Propofol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "XSINDUCTION", 
                    "comment": "You administered an excessive dose of propofol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Propofol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "Consider not using etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 11
                        }, 
                        {
                            "drug": "Etomidate", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 25
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "XSINDUCTION", 
                    "comment": "You administered an excessive dose of etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "SEDATED", 
                    "comment": "You administered an inadequate dose of etomidate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Etomidate", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 12
                        }
                    ], 
                    "points": -400
                }, 
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "You administered enough intravenous agent to induce anesthesia. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "mac", 
                            "value": 0.4
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPBREATHE", 
                    "comment": "You administered enough inhalation agent to induce anesthesia. (+100 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.8
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.3
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "SEDATEDCOUGH", 
                    "comment": "You should not have tried to place the LMA in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLma", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEDCOUGH", 
                    "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (Lost points)", 
                    "conditions": [
                        {
                            "type": "tryLaryTube", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEDHURT", 
                    "comment": "You should not have allowed the surgeon to make an incision in a lightly sedated patient. (-500 points)", 
                    "conditions": [
                        {
                            "type": "makeIncision", 
                            "value": true
                        }
                    ], 
                    "points": -500
                }, 
                {
                    "nextState": "SEDATEDPARA", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": -500
                }
            ]
        }, 
        {
            "name": "SEDATEDCOUGH", 
            "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.", 
			"airwayStr": "obstructed",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 84, 
            "baseAbpM": 102, 
            "baseAbpS": 154, 
            "baseBicarb": 24, 
            "baseHr": 104, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is coughing.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient has a lethargic response to voice, but is coughing.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly sedated and coughing.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 230, 
            "sputumAmount": 0, 
            "stSegII": -0.1, 
            "stSegV5": 0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATED", 
                    "comment": "The patient stopped coughing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "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": "SEDATEDHURT", 
            "whatNextMsg": "Induce anesthesia immediately.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 90, 
            "baseAbpM": 126, 
            "baseAbpS": 196, 
            "baseBicarb": 24, 
            "baseHr": 118, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is moaning in pain.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Moaning in pain.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 24, 
            "spontTv": 210, 
            "sputumAmount": 0, 
            "stSegII": 0.3, 
            "stSegV5": 0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATED", 
                    "comment": "The patient stopped moaning.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "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": "SEDATEDPARA", 
            "whatNextMsg": "Induce anesthesia immediately.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 96, 
            "baseAbpM": 116, 
            "baseAbpS": 176, 
            "baseBicarb": 24, 
            "baseHr": 108, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient is dreaming about calling his lawyer.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly sedated but paralyzed.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0.2, 
            "stSegV5": 0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "SEDATED", 
                    "comment": "The neuromuscular blocker started wearing off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "You administered sedative agent to this paralyzed patient.", 
                    "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
                }
            ]
        }, 
        {
            "name": "ASLEEPAPNEA", 
            "whatNextMsg": "Secure the airway, ensure adequate anesthesia and instruct the surgeon to operate.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 76, 
            "baseAbpM": 90, 
            "baseAbpS": 118, 
            "baseBicarb": 24, 
            "baseHr": 78, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized mainly with intravenous agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPAPNEA", 
                    "comment": "The surgeon is operating. (+100 points)", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPBREATHE", 
                    "comment": "The intravenous agent(s) are starting to wear off.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.2
                        }
                    ], 
                    "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": "ASLEEPBREATHE", 
            "whatNextMsg": "Secure the airway, ensure adequate anesthesia and instruct the surgeon to operate.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 56, 
            "baseAbpM": 68, 
            "baseAbpS": 88, 
            "baseBicarb": 24, 
            "baseHr": 92, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized mainly with inhalation agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.3, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "OPBREATHE", 
                    "comment": "The surgeon is operating. (+100 points)", 
                    "conditions": [
                        {
                            "type": "doingSurgery", 
                            "value": true
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "Intravenous agent(s) caused respiratory depression.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.4
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "The patient is paralyzed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "XSINDUCTION", 
            "whatNextMsg": "Secure the airway and administer pressors.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 56, 
            "baseAbpM": 64, 
            "baseAbpS": 76, 
            "baseBicarb": 23.8, 
            "baseHr": 98, 
            "basePot": 4.8, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 5, 
            "finalState": 0, 
            "glucose": 120, 
            "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": 6, 
            "papM": 9, 
            "papS": 15, 
            "papW": 5, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Excessive induction agent administered.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 144, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.3, 
            "stSegV5": -0.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ASLEEPAPNEA", 
                    "comment": "Intravenous agent(s) caused respiratory depression.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "OPAPNEA", 
            "whatNextMsg": "Maintain appropriate level of anesthesia and monitor closely.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 134, 
            "baseBicarb": 24, 
            "baseHr": 98, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized, no spontaneous breathing.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.2, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TACHYAPNEA", 
                    "comment": "The heart rate is increasing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 10
                        }
                    ], 
                    "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": "OPBREATHE", 
            "whatNextMsg": "Maintain appropriate level of anesthesia and monitor closely.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 70, 
            "baseAbpM": 86, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 102, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized, does breathe spontaneously.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.3, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "TACHYBREATHE", 
                    "comment": "The heart rate is increasing.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 10
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "OPAPNEA", 
                    "comment": "Intravenous agent(s) caused respiratory depression.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.55
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "OPAPNEA", 
                    "comment": "The patient is paralyzed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "TACHYAPNEA", 
            "whatNextMsg": "Deepen the anesthetic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 92, 
            "baseAbpM": 116, 
            "baseAbpS": 144, 
            "baseBicarb": 24, 
            "baseHr": 108, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized, tachycardic, no spontaneous ventilation.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.3, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ST1APNEA", 
                    "comment": "The blood pressure is falling.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "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": "TACHYBREATHE", 
            "whatNextMsg": "Deepen the anesthetic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 68, 
            "baseAbpM": 86, 
            "baseAbpS": 122, 
            "baseBicarb": 24, 
            "baseHr": 92, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 12, 
            "papM": 16, 
            "papS": 28, 
            "papW": 10, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized, tachycardic, has spontaneous ventilation.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.3, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ST1BREATHE", 
                    "comment": "The blood pressure is falling.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 60
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "TACHYAPNEA", 
                    "comment": "Intravenous agent(s) caused respiratory depression.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.55
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "TACHYAPNEA", 
                    "comment": "The patient is paralyzed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "GA1IV", 
            "whatNextMsg": "Deepen the anesthetic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 68, 
            "baseAbpM": 86, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 99, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "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": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly anesthetized with intravenous agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 95, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA2IV", 
                    "comment": "You administered enough induction agent to adequately anesthetize this patient.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 1.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA1INH", 
                    "comment": "You continued to administer inhalation agent.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 1.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "GA1INH", 
            "whatNextMsg": "Deepen the anesthetic.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 68, 
            "baseAbpM": 86, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 99, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "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": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly anesthetized with inhalation agents.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 90, 
            "sat40": 94, 
            "sat100": 99, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": -0.3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1IV", 
                    "comment": "You should continue to deepen the inhalation agent.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 1.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "mac", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2INH", 
                    "comment": "You administered enough inhalation agent to adequately anesthetize this patient.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 1.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "GA2IV", 
            "whatNextMsg": "Maintenance phase - monitor the patient carefully.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 60, 
            "baseAbpM": 74, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 66, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are pinpoint.", 
            "rateEbl": 5, 
            "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": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You administered deep anesthesia.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 2.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA1IV", 
                    "comment": "You lightened the anesthetic depth.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 1.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2INH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 1.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 2.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC1IV", 
                    "comment": "The patient is starting to recover from the inhalation anesthestic agent.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "GA2INH", 
            "whatNextMsg": "Maintenance phase - monitor the patient carefully.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 60, 
            "baseAbpM": 74, 
            "baseAbpS": 108, 
            "baseBicarb": 24, 
            "baseHr": 96, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 5, 
            "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": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 14, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA2IV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 1.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 2.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "mac", 
                            "value": 0.7
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA1INH", 
                    "comment": "You lightened the anesthetic depth.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 1.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC1INH", 
                    "comment": "The patient is starting to recover from the inhalation anesthestic agent.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA3", 
                    "comment": "You administered a deep level of anesthesia.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 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": "GA3", 
            "whatNextMsg": "Deep maintenance anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 56, 
            "baseAbpM": 68, 
            "baseAbpS": 94, 
            "baseBicarb": 24, 
            "baseHr": 78, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "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 and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA2IV", 
                    "comment": "You lightened the anesthetic depth.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 2.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "mac", 
                            "value": 1.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA2INH", 
                    "comment": "You lightened the anesthetic depth.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 2.5
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 1.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA4", 
                    "comment": "You administered an excessively deep anesthetic.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 3.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "GA4", 
            "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 52, 
            "baseAbpM": 60, 
            "baseAbpS": 76, 
            "baseBicarb": 24, 
            "baseHr": 82, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "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": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA3", 
                    "comment": "You lightened the anesthetic depth.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 3.5
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "REC1IV", 
            "whatNextMsg": "Continue decreasing the depth of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 72, 
            "baseAbpM": 88, 
            "baseAbpS": 126, 
            "baseBicarb": 24, 
            "baseHr": 68, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The eyes are closed. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient responds only after mild prodding.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 36, 
            "papW": 16, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Deeply sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 8, 
            "spontTv": 200, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "GA1IV", 
                    "comment": "You deepened the anesthetic again.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC2", 
                    "comment": "The patient is continuing to recover.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }, 
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC1INH", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.4
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.6
                        }, 
                        {
                            "op": "LT", 
                            "type": "mic", 
                            "value": 0.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "REC1INH", 
            "whatNextMsg": "Continue decreasing the depth of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 72, 
            "baseAbpM": 88, 
            "baseAbpS": 126, 
            "baseBicarb": 24, 
            "baseHr": 88, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The eyes are closed. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient responds only after mild prodding.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Deeply sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 20, 
            "spontTv": 280, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "REC1IV", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.4
                        }, 
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.6
                        }, 
                        {
                            "op": "LT", 
                            "type": "mac", 
                            "value": 0.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC2", 
                    "comment": "The patient is continuing to recover.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.4
                        }, 
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "GA1INH", 
                    "comment": "You deepened the anesthetic again.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "REC2", 
            "whatNextMsg": "Continue decreasing the depth of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 74, 
            "baseAbpM": 92, 
            "baseAbpS": 132, 
            "baseBicarb": 24, 
            "baseHr": 78, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "The eyes are glazed. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient responds only after name is called loudly. There is prominent slowing of speech.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Moderately sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 12, 
            "spontTv": 240, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "REC3", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.3
                        }, 
                        {
                            "op": "LT", 
                            "type": "nmb", 
                            "value": 0.4
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC1INH", 
                    "comment": "You deepened the anesthetic again.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.4
                        }, 
                        {
                            "op": "GT", 
                            "type": "mac", 
                            "value": 0.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC1IV", 
                    "comment": "You deepened the anesthetic again.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.4
                        }, 
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC1IV", 
                    "comment": "The patient is emerging from anesthesia but is paralyzed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.6
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "REC3", 
            "whatNextMsg": "Continue decreasing the depth of anesthesia.", 
 			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 135, 
            "baseBicarb": 24, 
            "baseHr": 75, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 0, 
            "lidReflexMsg": "There is mild ptosis. The lid reflex is present.", 
            "lmaSuccessFlag": false, 
            "mentalStatusMsg": "The patient has a lethargic response to voice. The patient is moving spontaneously.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is strong.", 
            "pupilsMsg": "The eyes are glazed. The pupils are equal, round, and react to light.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Lightly sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 14, 
            "spontTv": 300, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "REC2", 
                    "comment": "You deepened the anesthetic.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "doa", 
                            "value": 0.3
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC2", 
                    "comment": "The patient is emerging from anesthesia but is partially paralyzed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.4
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "REC4", 
                    "comment": "The patient is continuing to emerge from anesthesia.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "doa", 
                            "value": 0.2
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic.", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "REC4", 
            "whatNextMsg": "Continue post-anesthesia recovery.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 140, 
            "baseBicarb": 24, 
            "baseHr": 80, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are clear bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 1, 
            "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 awake and responds to voice commands. The patient is moving spontaneously.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is strong and regular.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 5, 
            "rateUo": 1.5, 
            "recordMsg": "Minimally sedated.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 320, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9
        }, 
        {
            "name": "DESATBRADY1", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 62, 
            "baseAbpS": 92, 
            "baseBicarb": 24, 
            "baseHr": 32, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "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": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATBRADY2", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATBRADY2", 
            "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 38, 
            "baseAbpM": 50, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 22, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Very slow, regular rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 8, 
            "papM": 12, 
            "papS": 18, 
            "papW": 8, 
            "pulseMsg": "The pulse is weak and very slow.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Hypoxic and severely bradycardic.", 
            "rhythm": "Sinus1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DESATASYST", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DESATASYST", 
            "whatNextMsg": "CPR, epinephrine, atropine.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 18, 
            "baseAbpS": 18, 
            "baseBicarb": 24, 
            "baseHr": 0, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 18, 
            "papM": 18, 
            "papS": 18, 
            "papW": 18, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are large.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "Hypoxic and asystolic.", 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic with poor capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DEAD", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "VFIB", 
            "whatNextMsg": "Call for help.", 
			"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": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "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": 18, 
            "papM": 18, 
            "papS": 18, 
            "papW": 18, 
            "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": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": 0, 
            "stSegV5": 0, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "DEAD", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "DEAD", 
            "whatNextMsg": "Notify the family.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 18, 
            "baseAbpM": 18, 
            "baseAbpS": 18, 
            "baseBicarb": 24, 
            "baseHr": 0, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 0.1, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "finalState": -2, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Heart sounds are absent.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
			"overdoseFlag": false,
            "papD": 18, 
            "papM": 18, 
            "papS": 18, 
            "papW": 18, 
            "pulseMsg": "The pulse is absent.", 
            "pupilsMsg": "The pupils are fixed and dilated.", 
            "rateEbl": 0, 
            "rateUo": 1.5, 
            "recordMsg": "The patient cannot be resuscitated.", 
            "rhythm": "Asystole1", 
            "skinMsg": "The skin is cyanotic.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 60, 
            "sat40": 61, 
            "sat100": 62, 
            "spSignal": 0, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.5, 
            "stSegV5": 3, 
            "temperature": 36.9
        }, 
        {
            "name": "ST1APNEA", 
            "whatNextMsg": "Assess level of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 96, 
            "baseAbpS": 124, 
            "baseBicarb": 24, 
            "baseHr": 112, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized, tachycardic, no spontaneous ventilation.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.4, 
            "stSegV5": -0.5, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ST2", 
                    "comment": "Tachycardia is worsening and blood pressure is falling.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "ST1BREATHE", 
            "whatNextMsg": "Assess level of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 68, 
            "baseAbpM": 86, 
            "baseAbpS": 122, 
            "baseBicarb": 24, 
            "baseHr": 114, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.6, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 14, 
            "finalState": 0, 
            "glucose": 122, 
            "hct": 38, 
            "heartSoundsMsg": "Regular rate and rhythm, without murmurs.", 
            "hiCo2ProdFlag": false, 
            "laryTubeSuccess": 1, 
            "lidReflexMsg": "The lid reflex is absent.", 
            "lmaSuccessFlag": true, 
            "mentalStatusMsg": "The patient is unresponsive.", 
            "papD": 18, 
            "papM": 24, 
            "papS": 32, 
            "papW": 16, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are equal, round, and react to light.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Anesthetized, tachycardic, has spontaneous ventilation.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 3, 
            "spontRr": 16, 
            "spontTv": 80, 
            "sputumAmount": 0, 
            "stSegII": -0.4, 
            "stSegV5": -0.5, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ST2", 
                    "comment": "Tachycardia is worsening and blood pressure is falling.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ST1APNEA", 
                    "comment": "Intravenous agent(s) caused respiratory depression.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "mic", 
                            "value": 0.55
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "ST1APNEA", 
                    "comment": "The patient is paralyzed.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "nmb", 
                            "value": 0.8
                        }
                    ], 
                    "points": 0
                }, 
                {
                    "nextState": "DESATBRADY1", 
                    "comment": "You allowed the patient to become severely hypoxic. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "LT", 
                            "type": "o2Sat", 
                            "value": 63
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ST2", 
            "whatNextMsg": "Assess level of anesthesia.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 64, 
            "baseAbpS": 98, 
            "baseBicarb": 24, 
            "baseHr": 116, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 20, 
            "papM": 28, 
            "papS": 40, 
            "papW": 18, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Mild ST depression and T wave inversion.", 
            "rhythm": "St2", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -1.4, 
            "stSegV5": -1.6, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "ST3", 
                    "comment": "Myocardial ischemia is worsening.", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 20
                        }
                    ], 
                    "points": 0
                }
            ]
        }, 
        {
            "name": "ST3", 
            "whatNextMsg": "Try phenylephrine to improve coronary perfusion pressure.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 38, 
            "baseAbpM": 54, 
            "baseAbpS": 78, 
            "baseBicarb": 24, 
            "baseHr": 126, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "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": 26, 
            "papM": 34, 
            "papS": 48, 
            "papW": 24, 
            "pulseMsg": "The pulse is weak but present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Deep ST depression.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 1, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3.2, 
            "stSegV5": -2.5, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHEN", 
                    "comment": "You administered an appropriate bolus of phenylephrine. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }, 
                        {
                            "drug": "Phenylephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHEN", 
                    "comment": "You started a phenylephrine infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHEN", 
                    "comment": "You started a dopamine infusion rather than phenylephrine. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHEN", 
                    "comment": "You started a norepinephrine infusion rather than phenylephrine. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "XSPHEN", 
                    "comment": "You administered an excessive bolus of phenylephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -50
                }, 
                {
                    "nextState": "NTG", 
                    "comment": "You administered nitroglycerin before raising the perfusion pressure. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.3
                        }, 
                        {
                            "drug": "Nitroglycerin", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 1.3
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "NTG", 
                    "comment": "You started a nitroglycerin infusion before raising the perfusion pressure. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "XSNTG", 
                    "comment": "You administered an excessive bolus of nitroglycerin. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1.2
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "ESM", 
                    "comment": "You administered a bolus of esmolol before raising the perfusion pressure. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 29
                        }, 
                        {
                            "drug": "Esmolol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "ESM", 
                    "comment": "You started an esmolol infusion before raising the perfusion pressure. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 49
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "XSESM", 
                    "comment": "You administered an excessive bolus of esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You waited too long to treat myocardial ischemia. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 300
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "PHEN", 
            "whatNextMsg": "Slow the heart rate with esmolol.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 44, 
            "baseAbpM": 60, 
            "baseAbpS": 86, 
            "baseBicarb": 24, 
            "baseHr": 120, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "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": 26, 
            "papM": 34, 
            "papS": 48, 
            "papW": 24, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Deep ST depression with improved perfusion pressure.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3, 
            "stSegV5": -2.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an appropriate dose nitroglycerin. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.3
                        }, 
                        {
                            "drug": "Nitroglycerin", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 1.3
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a nitroglycerin infusion. (+200 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an excessive bolus of nitroglycerin. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1.2
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an appropriate bolus of esmolol. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 19
                        }, 
                        {
                            "drug": "Esmolol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started an esmolol infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 49
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an excessive bolus of esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "XSPHEN", 
                    "comment": "You administered the phenylephrine infusion at an excessive rate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 3
                        }, 
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "XSPHEN", 
                    "comment": "You administered the dopamine infusion at an excessive rate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 15
                        }, 
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "XSPHEN", 
                    "comment": "You administered the norepinephrine infusion at an excessive rate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.5
                        }, 
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 300
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "XSPHEN", 
            "whatNextMsg": "Administer nitroglycerin and esmolol.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 54, 
            "baseAbpM": 68, 
            "baseAbpS": 94, 
            "baseBicarb": 24, 
            "baseHr": 118, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 18, 
            "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": 26, 
            "papM": 34, 
            "papS": 48, 
            "papW": 24, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Excessive pressor administered.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3, 
            "stSegV5": -2.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an appropriate dose of nitroglycerin. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.3
                        }, 
                        {
                            "drug": "Nitroglycerin", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 1.3
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a nitroglycerin infusion appropriately. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an excessive bolus of nitroglycerin. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1.2
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an appropriate bolus of esmolol. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 19
                        }, 
                        {
                            "drug": "Esmolol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an excessive bolus of esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started an esmolol infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 29
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "NTG", 
            "whatNextMsg": "Raise the perfusion pressure with phenylephrine.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 44, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 130, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 24, 
            "papM": 32, 
            "papS": 46, 
            "papW": 22, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Deep ST depression despite administration of nitroglycerin.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3, 
            "stSegV5": -2.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an appropriate bolus of phenylephrine. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }, 
                        {
                            "drug": "Phenylephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an excessive bolus of phenylephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a phenylephrine infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a dopamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a dobutamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dobutamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a epinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a norepinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "XSNTG", 
                    "comment": "You administered an excessive infusion of nitroglycerin. (-200 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 3
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You should have raised the perfusion pressure with phenylephrine before administering esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 19
                        }, 
                        {
                            "drug": "Esmolol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You administered an excessive bolus of esmolol to a hypotensive patient. (-300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You should have raised the perfusion pressure with phenylephrine before administering esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 29
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "XSNTG", 
            "whatNextMsg": "Raise the perfusion pressure with phenylephrine.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 34, 
            "baseAbpM": 48, 
            "baseAbpS": 64, 
            "baseBicarb": 24, 
            "baseHr": 132, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 24, 
            "papM": 32, 
            "papS": 46, 
            "papW": 22, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Excessive nitroglycerin administered.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3, 
            "stSegV5": -2.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an appropriate bolus of phenylephrine. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }, 
                        {
                            "drug": "Phenylephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You administered an excessive bolus of phenylephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a phenylephrine infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a dopamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a dobutamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dobutamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a epinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTG", 
                    "comment": "You started a norepinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You should have raised the perfusion pressure with phenylephrine before administering esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 29
                        }, 
                        {
                            "drug": "Esmolol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You administered an excessive dose of esmolol to a hypotensive patient. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You should have raised the perfusion pressure with phenylephrine before administering esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 49
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "ESM", 
            "whatNextMsg": "Now increase the perfusion pressure with phenylephrine.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 34, 
            "baseAbpM": 48, 
            "baseAbpS": 72, 
            "baseBicarb": 24, 
            "baseHr": 96, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 24, 
            "papM": 32, 
            "papS": 46, 
            "papW": 22, 
            "pulseMsg": "The pulse is weak.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "You slowed the heart rate with esmolol.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3, 
            "stSegV5": -2.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "NTGESM", 
                    "comment": "You administered nitroglycerin to a hypotensive patient. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.3
                        }, 
                        {
                            "drug": "Nitroglycerin", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 1.3
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You administered an excessive bolus of nitroglycerin to a hypotensive patient. (-300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1.2
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You started a nitroglycerin infusion before raising the perfusion pressure. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "XSESM", 
                    "comment": "You administered an infusion of esmolol at an excessive rate. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an appropriate bolus of phenylephrine. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }, 
                        {
                            "drug": "Phenylephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an excessive bolus of phenylephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a phenylephrine infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a dopamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a dobutamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dobutamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a epinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a norepinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "XSESM", 
            "whatNextMsg": "Now increase the perfusion pressure with phenylephrine.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 44, 
            "baseAbpS": 62, 
            "baseBicarb": 24, 
            "baseHr": 76, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 3.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 24, 
            "papM": 32, 
            "papS": 46, 
            "papW": 22, 
            "pulseMsg": "The pulse is weak.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Excessive esmolol administered.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -3, 
            "stSegV5": -2.2, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "NTGESM", 
                    "comment": "You administered nitroglycerin to a hypotensive patient. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.3
                        }, 
                        {
                            "drug": "Nitroglycerin", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 1.3
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You administered an excessive bolus of nitroglycerin to a hypotensive patient. (-300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1.2
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "NTGESM", 
                    "comment": "You started a nitroglycerin infusion before raising the perfusion pressure. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": -300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an appropriate bolus of phenylephrine. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }, 
                        {
                            "drug": "Phenylephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You administered an excessive bolus of phenylephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a phenylephrine infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a dopamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a dobutamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dobutamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a epinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENESM", 
                    "comment": "You started a norepinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "PHENNTG", 
            "whatNextMsg": "Now add esmolol.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 64, 
            "baseAbpS": 84, 
            "baseBicarb": 24, 
            "baseHr": 116, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 20, 
            "papM": 28, 
            "papS": 40, 
            "papW": 18, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Phenylephrine and nitroglycerin administered.", 
            "rhythm": "St2", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -1.4, 
            "stSegV5": -1.6, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You appropriately administered a bolus of esmolol. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 19
                        }, 
                        {
                            "drug": "Esmolol", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 51
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You administered an excessive bolus of esmolol. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 50
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You appropriately administered an infusion of esmolol. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Esmolol", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 49
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "PHENESM", 
            "whatNextMsg": "Now add nitroglycerin.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 48, 
            "baseAbpM": 64, 
            "baseAbpS": 84, 
            "baseBicarb": 24, 
            "baseHr": 96, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 20, 
            "papM": 28, 
            "papS": 40, 
            "papW": 18, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Phenylephrine and esmolol administered.", 
            "rhythm": "St2", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -1.4, 
            "stSegV5": -1.6, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You administered appropriate dose of nitroglycerin. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 0.3
                        }, 
                        {
                            "drug": "Nitroglycerin", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 1.3
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You administered an excessive bolus of nitroglycerin. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 1.2
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You appropriately administered an infusion of nitroglycerin. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Nitroglycerin", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 180
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "NTGESM", 
            "whatNextMsg": "Now correct the severe hypotension.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 32, 
            "baseAbpM": 44, 
            "baseAbpS": 62, 
            "baseBicarb": 24, 
            "baseHr": 96, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 4.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 16, 
            "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": 20, 
            "papM": 28, 
            "papS": 40, 
            "papW": 18, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Nitroglycerin and esmolol administered.", 
            "rhythm": "St3", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -1.4, 
            "stSegV5": -1.6, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You administered an appropriate bolus of phenylephrine. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 24
                        }, 
                        {
                            "drug": "Phenylephrine", 
                            "op": "LT", 
                            "type": "bDrug", 
                            "value": 201
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You administered an excessive bolus of phenylephrine. (Lost points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "bDrug", 
                            "value": 200
                        }
                    ], 
                    "points": -200
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You started a phenylephrine infusion. (+300 points)", 
                    "conditions": [
                        {
                            "drug": "Phenylephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 300
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You started a dopamine infusion. (+50 points)", 
                    "conditions": [
                        {
                            "drug": "Dopamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 50
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You started a dobutamine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Dobutamine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 2
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You started a epinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Epinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "PHENNTGESM", 
                    "comment": "You started a norepinephrine infusion. (+100 points)", 
                    "conditions": [
                        {
                            "drug": "Norepinephrine", 
                            "op": "GT", 
                            "type": "iDrug", 
                            "value": 0.1
                        }
                    ], 
                    "points": 100
                }, 
                {
                    "nextState": "VFIB", 
                    "comment": "You need to treat the ST depression with phenylephrine, esmolol and nitroglycerin. (-1000 points)", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 120
                        }
                    ], 
                    "points": -1000
                }
            ]
        }, 
        {
            "name": "PHENNTGESM", 
            "whatNextMsg": "Maintain the appropriate level of anesthesia and monitor closely.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 112, 
            "baseBicarb": 24, 
            "baseHr": 88, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "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": 14, 
            "papM": 20, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Myocardial ischemia has been corrected.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.4, 
            "stSegV5": -0.5, 
            "temperature": 36.9, 
            "trans": [
                {
                    "nextState": "FINAL", 
                    "comment": "", 
                    "conditions": [
                        {
                            "op": "GT", 
                            "type": "time", 
                            "value": 30
                        }
                    ], 
                    "points": 0
                }
            ]
        },
        {
            "name": "FINAL", 
            "whatNextMsg": "Maintain the appropriate level of anesthesia and monitor closely.", 
			"airwayStr": "nl",
            "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.", 
            "baseAbpD": 80, 
            "baseAbpM": 92, 
            "baseAbpS": 112, 
            "baseBicarb": 24, 
            "baseHr": 88, 
            "basePot": 4.2, 
            "breathSoundsMsg": "The breath sounds are equal bilaterally.", 
            "cardiacOutput": 5.2, 
            "contPip": 28, 
            "contPlateau": 26, 
            "cvp": 12, 
            "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": 14, 
            "papM": 20, 
            "papS": 28, 
            "papW": 12, 
            "pulseMsg": "The pulse is present.", 
            "pupilsMsg": "The pupils are small.", 
            "rateEbl": 8, 
            "rateUo": 1.5, 
            "recordMsg": "Discuss with your instructor whether you would continue the case at this point.", 
            "rhythm": "St1", 
            "skinMsg": "The skin is warm and dry with normal capillary refill.", 
            "skipAheadHours": 0, 
            "skipAheadMsg": "", 
            "sodium": 142, 
            "sat20": 89, 
            "sat40": 91, 
            "sat100": 97, 
            "spSignal": 2, 
            "spontRr": 0, 
            "spontTv": 0, 
            "sputumAmount": 0, 
            "stSegII": -0.4, 
            "stSegV5": -0.5, 
            "temperature": 36.9 
		}
    ]
}