Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
[]
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
Generated JSON:
{
    "1": {
        "title": "Case 1 - 47 for diagnostic laparoscopy (nohelp)",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for routine induction of general anesthesia: \n1.  Administer a small dose of anxiolytic agent such as midazolam\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation\n4.  Administer lidocaine prior to propofol to reduce pain on injection\n5.  Administer a bolus of hypnotic agent such as propofol\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation\n7.  Intubate the trachea, confirm proper position of the endotracheal tube and establish positive pressure ventilation\n8.  Administer inhalation agent\n9.  Allow the surgeon to make incision when the patient has 1-1.5 MAC of anesthetic on board.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 36,
        "durationSurgery": 1224,
        "helpFlag": false,
        "imageSet": 5,
        "initialSat": 96,
        "leanBodyMass": 54,
        "learningObj": "\n47 year old female for diagnostic laparoscopy (72 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable. \n\nThe major objective of this simulation is to learn to use the simulation program by performing a routine induction sequence through surgical incision.\n\nNote: There are many acceptable ways to practice anesthesia. The induction sequence suggested below is only one. There are over 100 drugs in this program for you to explore.\n\nLearning Objectives\n1.  Describe the monitors used for a routine anesthetic.\n2.  Describe a typical induction sequence for a routine anesthetic.\n\nMonitors for Routine Anesthesia\n1.  Monitor with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2.  Other monitors include airway pressure, tidal volume, FiO2, end-tidal anesthestic agent.\n\nSuggested Induction Sequence\n1.  Administer a small dose of anxiolytic agent such as midazolam.\n2.  Preoxygenate\n3.  Administer a small dose of opioid such as fentanyl to blunt the response to intubation.\n4.  Administer lidocaine prior to propofol to reduce pain on injection of propofol.\n5.  Administer a bolus of hypnotic agent such as propofol.\n6.  Administer succinylcholine or other neuromuscular blocking agent to facilitate intubation.\n7.  Intubate the trachea, confirm proper position of  the endotracheal tube and establish positive pressure ventilation.\n8.  Administer inhalation agent.\n9.  Allow the surgeon to make  incision when the patient has 1-1.5 MAC of anesthetic on board.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: October 25, 2023\n\n",
        "possiblePoints": 1000,
        "preopMsg": "\n47 year old female for diagnostic laparoscopy (no help)\n\nHistory of Present Illness\nThe patient has a six month history of heavy vaginal bleeding.\n\nPast Medical History\nCardiac: denies chest pain or other problems\nPulmonary: denies shortness of breath or other problems\nNo other concurrent diseases. Otherwise healthy.\nNo previous surgeries.\nNo family history of anesthetic problems.\n\nNo current medications.\nDenies smoking, alcohol, or other drugs.\nNo known drug allergies.\n\nPhysical Exam\nHealthy appearing female, mildly anxious, but otherwise in no acute distress.\nWeight: 72 kg\nHR: 82  BP: 132\/78  RR: 16 T: 36.8\nAirway: good neck extension, 3 fingerbreadth mouth opening, able to visualize uvula.\nChest auscultation: clear\n\nLabs\nHematocrit: 34%\n\nNPO Status\nThe patient has not had anything to eat or drink for at least 8 hours. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Start IV fluids before administering sedative agent. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer a small dose of an anxiolytic agent such as midazolam 2 mg.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered midazolam appropriately for anxiolysis. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 0.90000000000000002220446049250313080847263336181640625
                            },
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 2.100000000000000088817841970012523233890533447265625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "You administered an excessive initial dose of midazolam. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 2
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "MIDAZ",
                        "comment": "Midazolam prior to induction of anesthesia may provide anxiolysis. (-50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.200000000000000011102230246251565404236316680908203125
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKE",
                        "comment": "You administered an inadequate initial dose of midazolam for this patient.",
                        "conditions": [
                            {
                                "drug": "Midazolam",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 1
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "MIDAZ",
                "whatNextMsg": "Administer oxygen by mask until the end-tidal O2 is 60-80%.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 135,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed 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": "Lightly sedated.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 600,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You administered oxygen by mask prior to induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 98
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the LMA in a lightly sedated patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You should not have tried to place the endotracheal tube in a lightly sedated patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "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": "AWAKEPARA",
                        "comment": "You should not have paralyzed a lightly sedated patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia before adequately preoxygenating. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Administer fentanyl 1-2 mcg\/kg (100-200 mcg) to blunt the hemodynamic response to intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 84,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient has a slowed response to voice. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated, lightly sedated and awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "You administered fentanyl appropriately to avoid hemodynamic response to intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 251
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered excessive dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 250
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "PREO2",
                        "comment": "You administered an inadequate dose of fentanyl. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Fentanyl",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "FENT",
                "whatNextMsg": "Administer lidocaine prior to propofol to decrease pain on injection.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "You administered lidocaine appropriately to avoid painful injection of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 101
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered excessive dose of lidocaine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered an inadequate dose of lidocaine to avoid painful injection of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Lidocaine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-400 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "LIDO",
                "whatNextMsg": "Administer propofol 2-2.5 mg\/kg (140-180 mg).",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 74,
                "baseAbpM": 92,
                "baseAbpS": 132,
                "baseBicarb": 24,
                "baseHr": 76,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 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": "Ready for induction of anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 380,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate induction dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 201
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an induction agent other than propofol. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 1.5
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert a laryngeal mask airway in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "COUGH4",
                        "comment": "You tried to insert the endotracheal tube in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "HURT4",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "PARA4",
                        "comment": "You paralyzed a lightly anesthetized  patient. (-300 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.5
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA0",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (-500 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": -500
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "The patient is now unconscious.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate dose of succinylcholine to facilitate endotracheal intubation. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 59
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered excessive dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 140
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate dose of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 60
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You paralyzed with a competitive neuromuscular blocking agent. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "COUGH2",
                        "comment": "You tried to insert the endotracheal tube without muscle relaxation. (-100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT2",
                        "comment": "You should not have allowed the surgeon to make the incision in a lightly anesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1inh",
                        "comment": "You placed the endotracheal tube without muscle relaxant.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Perform laryngoscopy, place the endotracheal intubation and confirm correct position.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Unconscious and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontTv": 0,
                "spontRr": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1IV",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIDO",
                        "comment": "You waited too long to peform laryngoscopy. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 360
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make the incision before securing the airway. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA0",
                "whatNextMsg": "Induce general anesthesia and instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 94,
                "baseAbpS": 128,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 present.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is responsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are 3mm and reactive.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 12,
                "spontTv": 440,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA1IV",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA1IV",
                "whatNextMsg": "Control breathing using the Breathing options. Confirm correct position of the endotracheal tube. Instruct the surgeon to prep. Provide 1-1.5 MAC of the inhalation agent of your choice. Then inform the surgeon when the patient is ready for incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Airway secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You did not provide adequate anesthesia for this part of the surgery. (-200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the level of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You provided adequate anesthesia for this part of the surgery. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "INCISION",
                "whatNextMsg": "You met the learning objectives for the case. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 5
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 102,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Excessively deep anesthesia.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 2.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 140,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Patient is screaming and writhing in pain.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spSignal": 3,
                "spontRr": 28,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "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": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "COUGH4",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 88,
                "baseAbpM": 102,
                "baseAbpS": 158,
                "baseBicarb": 24,
                "baseHr": 98,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 460,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "HURT4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 98,
                "baseAbpM": 130,
                "baseAbpS": 198,
                "baseBicarb": 24,
                "baseHr": 118,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is moaning, but the breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 24,
                "spontTv": 420,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "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": "PARA4",
                "whatNextMsg": "Induce anesthesia immediately.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 94,
                "baseAbpM": 120,
                "baseAbpS": 176,
                "baseBicarb": 24,
                "baseHr": 108,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 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": 5,
                "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": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "FENT",
                        "comment": "The neuromuscular blocker started wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "FENT",
                        "comment": "You administered sedative agent to this paralyzed patient.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "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": "COUGH2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": true,
                "mentalStatusMsg": "The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "The patient stoppped 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": "HURT2",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 grimmacing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply sedated but grimmacing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIDO",
                        "comment": "The patient stopped grimmacing.",
                        "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": "LIGHTINCISION",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized, with autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "INCISION",
                        "comment": "You deepened the level of anesthetic appropriately. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "INCISION",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 120
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Secure the airway as soon as possible.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 not present.",
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Incision but airway not secured.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 95,
                "sat100": 96,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 640,
                "sputumAmount": 0,
                "stSegII": -0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "You successfully placed an endotracheal tube. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "Wait for the drugs to take full effect before placing an endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "LIGHTINCISION",
                        "comment": "An endotracheal tube is preferred for this case. (-50 points)",
                        "conditions": [
                            {
                                "type": "airwayLma",
                                "value": true
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You waited too long to secure the airway. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 300
                            }
                        ],
                        "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": "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 1,
        "isPro": false
    },
    "2": {
        "title": "Case 2 - 27 year old with fractured humerus",
        "badDrugs": [
            "Dantrolene"
        ],
        "coMin": 1.1999999999999999555910790149937383830547332763671875,
        "debriefMsg": "Follow the procedures for rapid sequence induction of general anesthesia: preoxygenate, apply cricoid pressure (although controversial), administer a bolus of hypnotic agent such as propofol, administer succinylcholine and intubate; release cricoid pressure after confirming correct placement of the endotracheal tube.",
        "depthCarina": 25,
        "depthCords": 18,
        "depthTubeInitial": 22,
        "durationPrep": 60,
        "durationSurgery": 1200,
        "helpFlag": true,
        "imageSet": 3,
        "initialSat": 96,
        "leanBodyMass": 60,
        "learningObj": "\n27 year old female with fractured humerus (52 kg)\n\nThis patient has no significant past medical history, allergies, or family history of  anesthetic complications. Physical exam and lab studies are unremarkable.  Her recent meal is of concern.\n\nIn this simulation you need to perform rapid sequence induction and provide adequate general anesthesia through surgical incision.\n\nLearning Objectives\n1. Describe the techniques and drugs to reduce the incidence and severity of aspiration of gastric contents.\n\nAnesthetic Considerations\n1. Full stomach - prevention of aspiration.\n\nSuggested Management\n1. Routine monitoring with electrocardiogram, non-invasive blood pressure, pulse oximeter and capnogram.\n2. Preoxygenate the patient until the end-tidal oxygen level is 60-80%.\n3. Apply cricoid pressure. Although the value of cricoid pressure is controversial, we have elected to retain this maneuver for this case scenario.\n4. Administer propofol 2 mg\/kg (150 mg) IV bolus and succinylcholine 1.5 mg\/kg (120 mg) IV bolus.\n5. After the patient becomes apneic, intubate the trachea and apply positive pressure ventilation.\n6. Listen to the breath sounds and observe the capnogram to confirm proper placement of the endotracheal tube.\n7. Remove cricoid pressure.\n8. Maintain anesthesia with oxygen, narcotics and inhalation agent.\n\nCase author: Howard A. Schwid, M.D.\nAffiliation: Department of Anesthesiology, University of Washington \nDate of Last Modification: July 25, 2013\n\n",
        "possiblePoints": 800,
        "preopMsg": "\n27 year old healthy female with fractured humerus\n\nHistory of Present Illness\nThe patient broke her arm when she ran into a parked car while jogging.\n\nPast Medical History\nIllnesses: None\nSurgeries: None\nMedications: None\nHabits: Denies cigarettes, alcohol or other drugs.\nNo known drug allergies.\n\nFamily History\nNo family history of anesthetic problems.\n\nPhysical Exam\nThin, fit appearing female in mild distress.\nWeight: 52 kg\nHR: 98     BP: 106\/60    RR: 18    T: 36.8\nAirway: good neck extension, 3 finger breadth mouth opening, able to visualize uvula\nChest auscultation: clear\n\nLabs\nHematocrit: 38%\n\nNPO Status\nThe patient ate a cheeseburger, fries, and chocolate shake 3 hours ago. \n\nPatient and Surgeon Requests\nThe surgeon states the procedure will take one hour.\n\n",
        "volAnDsp": 80,
        "states": [
            {
                "name": "START",
                "whatNextMsg": "Start an IV using the Fluids options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 160,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and anxious.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "You established IV access appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "tFluid",
                                "value": 0.1000000000000000055511151231257827021181583404541015625
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without starting the IV. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKE",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake, alert, and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "PREO2",
                        "comment": "You preoxygenated appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "CRICO",
                        "comment": "You applied cricoid pressure before the patient was preoxygenated. (+50 of 100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without preoxygenating or applying cricoid pressure. (-400 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.299999999999999988897769753748434595763683319091796875
                            }
                        ],
                        "points": -400
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "AWAKEPARA",
                "whatNextMsg": "Call your lawyer.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 124,
                "baseAbpS": 180,
                "baseBicarb": 24,
                "baseHr": 110,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is not moving, but is thinking about calling his lawyer.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Awake but paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 110,
                "spSignal": 3,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The muscle relaxant is wearing off.",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "nmb",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You sedated this patient after you administered muscle relaxant. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "PREO2",
                "whatNextMsg": "Apply cricoid pressure prior to induction. Cricoid pressure is in the Airway options.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You applied cricoid pressure appropriately. (+100 points)",
                        "conditions": [
                            {
                                "type": "doingCricoid",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without applying cricoid pressure. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "CRICO",
                "whatNextMsg": "Administer oxygen by mask prior to induction.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Cricoid pressure is being applied to this anxious patient.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "READY",
                        "comment": "You preoxygenated after applying cricoid pressure. (+50 of 100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "o2Sat",
                                "value": 97
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert a laryngeal mask airway in an unanesthetized patient. (-200 points)",
                        "conditions": [
                            {
                                "type": "tryLma",
                                "value": true
                            }
                        ],
                        "points": -200
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-1000 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced anesthesia without adequately preoxygenating. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized  patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "READY",
                "whatNextMsg": "Administer induction dose of propofol.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 80,
                "baseAbpM": 92,
                "baseAbpS": 140,
                "baseBicarb": 23.800000000000000710542735760100185871124267578125,
                "baseHr": 92,
                "basePot": 4.79999999999999982236431605997495353221893310546875,
                "breathSoundsMsg": "The breath sounds are clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 120,
                "hct": 39,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is awake and responds to voice commands. The patient is moving spontaneously.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and regular.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Preoxygenated and anxiously awaiting induction.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 144,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 92,
                "spSignal": 3,
                "spontRr": 16,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of propofol. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 99
                            },
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 151
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of etomidate. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 10
                            },
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 21
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an appropriate dose of thiopental. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 200
                            },
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 401
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You induced unconsciousness with other than bolus propofol, etomidate or thiopental. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 100
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 10
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "READY",
                        "comment": "You administered an inadequate dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 200
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of propofol. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Propofol",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 150
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of etomidate. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Etomidate",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 20
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an excessive dose of thiopental. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Thiopental",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 400
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You administered muscle relaxant before inducing unconsciousness. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "COUGH5",
                        "comment": "You tried to insert the endotracheal tube in an unanesthetized patient. (-300 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": -300
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before complete induction of anesthesia. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "COUGH5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "obstructed",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 90,
                "baseAbpM": 104,
                "baseAbpS": 160,
                "baseBicarb": 24,
                "baseHr": 100,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is coughing.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is present.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is upset and uncooperative. The patient is coughing.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong and fast.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 0,
                "rateUo": 1.5,
                "recordMsg": "Upset and coughing.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 100,
                "spSignal": 3,
                "spontRr": 18,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped coughing.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "HURT5",
                        "comment": "You should not have allowed the surgeon to make an incision in an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "AWAKEPARA",
                        "comment": "You paralyzed an unanesthetized patient. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            },
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "HURT5",
                "whatNextMsg": "Wait for the patient to settle down and induce anesthesia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 100,
                "baseAbpM": 132,
                "baseAbpS": 200,
                "baseBicarb": 24,
                "baseHr": 120,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The patient is screaming but the breath sounds seem to be clear bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 90,
                "sat40": 92,
                "sat100": 95,
                "spRate": 120,
                "spSignal": 3,
                "spontRr": 10,
                "spontTv": 320,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "AWAKE",
                        "comment": "The patient stopped screaming.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "The sedative agent is starting to take effect. (+25 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 0.59999999999999997779553950749686919152736663818359375
                            }
                        ],
                        "points": 25
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube before induction of anesthesia. (+200 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 200
                    }
                ]
            },
            {
                "name": "ASLEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+100 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "ASLEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.40000000000000002220446049250313080847263336181640625
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "ASLEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Asleep and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA1",
                        "comment": "Wait for the drugs to take full effect before placing the endotracheal tube. (+50 of 100 possible points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 50
                    }
                ]
            },
            {
                "name": "DEEP",
                "whatNextMsg": "Now administer succinylcholine to facilitate endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an appropriate amount of succinylcholine. (+50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 39
                            },
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 121
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered an excessive amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "GT",
                                "type": "bDrug",
                                "value": 120
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEP",
                        "comment": "You administered an inadequate amount of succinylcholine. (-50 points)",
                        "conditions": [
                            {
                                "drug": "Succinylcholine",
                                "op": "LT",
                                "type": "bDrug",
                                "value": 40
                            }
                        ],
                        "points": -50
                    },
                    {
                        "nextState": "DEEPPARA",
                        "comment": "You administered a competitive neuromuscular blocker. (+50 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "nmb",
                                "value": 0.8000000000000000444089209850062616169452667236328125
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "GA1",
                        "comment": "You placed the endotracheal tube without neuromuscular blockade.",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DEEPPARA",
                "whatNextMsg": "Now perform laryngoscopy and place the endotracheal intubation.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Deeply anesthetized and paralyzed.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You took too long to intubate and the patient aspirated massive quantities of acidic fluids. (-500 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 180
                            }
                        ],
                        "points": -500
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "tryLaryTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You placed the endotracheal tube in a timely fashion. (+100 points)",
                        "conditions": [
                            {
                                "type": "airwayTube",
                                "value": true
                            }
                        ],
                        "points": 100
                    }
                ]
            },
            {
                "name": "GA1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 68,
                "baseAbpM": 86,
                "baseAbpS": 142,
                "baseBicarb": 24,
                "baseHr": 86,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "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 slowed.",
                "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": "Lightly anesthetized with intravenous agents.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 86,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "HURT1",
                        "comment": "You should not have allowed the surgeon to make an incision in a lightly anesthetized patient. (-100 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You administered enough induction agent to adequately anesthetize this patient. (+100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA2",
                "whatNextMsg": "Maintenance phase - monitor the patient carefully. Tell the surgeon to make the incision when the anesthetic depth is appropriate.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 60,
                "baseAbpM": 74,
                "baseAbpS": 108,
                "baseBicarb": 24,
                "baseHr": 66,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 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": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 66,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to make the incision appropriately. (+200 points)",
                        "conditions": [
                            {
                                "type": "makeIncision",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "GA3",
                        "comment": "You instructed the surgeon to operate. (+200 points)",
                        "conditions": [
                            {
                                "type": "doingSurgery",
                                "value": true
                            }
                        ],
                        "points": 200
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA3",
                "whatNextMsg": "You reached the end of the simulation. Review the debriefing.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 66,
                "baseAbpM": 78,
                "baseAbpS": 118,
                "baseBicarb": 24,
                "baseHr": 78,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The operation is underway.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 78,
                "spSignal": 2,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA4",
                        "comment": "You administered an excessively deep anesthetic. (-100 points)",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 4
                            }
                        ],
                        "points": -100
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "GA4",
                "whatNextMsg": "Excessively deep anesthesia during maintenance. Decrease anesthetic depth.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 42,
                "baseAbpM": 50,
                "baseAbpS": 66,
                "baseBicarb": 24,
                "baseHr": 82,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 1,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is present.",
                "pupilsMsg": "The pupils are pinpoint.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Very deeply anesthetized.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 96,
                "sat40": 99,
                "sat100": 100,
                "spRate": 82,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA3",
                        "comment": "You lightened the anesthetic depth appropriately. (+50 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "doa",
                                "value": 3.79999999999999982236431605997495353221893310546875
                            }
                        ],
                        "points": 50
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "HURT1",
                "whatNextMsg": "Deepen the anesthetic.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 84,
                "baseAbpM": 112,
                "baseAbpS": 182,
                "baseBicarb": 24,
                "baseHr": 106,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 5.20000000000000017763568394002504646778106689453125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 14,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Regular rate and rhythm, without murmurs.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 0,
                "lidReflexMsg": "The lid reflex is reduced.",
                "lmaSuccessFlag": false,
                "mentalStatusMsg": "The patient is unresponsive.",
                "papD": 12,
                "papM": 16,
                "papS": 28,
                "papW": 12,
                "pulseMsg": "The pulse is strong.",
                "pupilsMsg": "The pupils are equal, round, and react to light.",
                "rateEbl": 8,
                "rateUo": 1.5,
                "recordMsg": "Lightly anesthetized but autonomic response to painful stimulus.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is warm and dry with normal capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 92,
                "sat40": 94,
                "sat100": 96,
                "spRate": 106,
                "spSignal": 2,
                "spontRr": 18,
                "spontTv": 240,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "GA1",
                        "comment": "The autonomic response is abating.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "GA2",
                        "comment": "You deepened the anesthetic.",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "doa",
                                "value": 2.20000000000000017763568394002504646778106689453125
                            }
                        ],
                        "points": 0
                    },
                    {
                        "nextState": "DESATBRADY1",
                        "comment": "You allowed the patient to become severely hypoxic. (-1000 points)",
                        "conditions": [
                            {
                                "op": "LT",
                                "type": "o2Sat",
                                "value": 63
                            }
                        ],
                        "points": -1000
                    }
                ]
            },
            {
                "name": "DESATBRADY1",
                "whatNextMsg": "Must reverse hypoxia immediately and treat bradycardia.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 48,
                "baseAbpM": 62,
                "baseAbpS": 92,
                "baseBicarb": 24,
                "baseHr": 32,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Oxygen saturation falling.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 32,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "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": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and severely bradycardic.",
                "rhythm": "Sinus1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 22,
                "spSignal": 1,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "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": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": 0,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are large.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "Hypoxic and asystolic.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic with poor capillary refill.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 62,
                "sat40": 64,
                "sat100": 66,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375,
                "trans": [
                    {
                        "nextState": "DESATDEAD",
                        "comment": "",
                        "conditions": [
                            {
                                "op": "GT",
                                "type": "time",
                                "value": 30
                            }
                        ],
                        "points": 0
                    }
                ]
            },
            {
                "name": "DESATDEAD",
                "whatNextMsg": "Notify the family.",
                "airwayStr": "nl",
                "aspirateCvpMsg": "10 mL blood was aspirated from the CVP catheter.",
                "baseAbpD": 18,
                "baseAbpM": 18,
                "baseAbpS": 18,
                "baseBicarb": 24,
                "baseHr": 0,
                "basePot": 4.20000000000000017763568394002504646778106689453125,
                "breathSoundsMsg": "The breath sounds are equal bilaterally.",
                "cardiacOutput": 0.200000000000000011102230246251565404236316680908203125,
                "contPip": 28,
                "contPlateau": 26,
                "cvp": 18,
                "finalState": -2,
                "glucose": 122,
                "hct": 38,
                "heartSoundsMsg": "Heart sounds are absent.",
                "hiCo2ProdFlag": false,
                "laryTubeSuccess": 1,
                "lidReflexMsg": "The lid reflex is absent.",
                "lmaSuccessFlag": true,
                "mentalStatusMsg": "The patient is unresponsive.",
                "overdoseFlag": false,
                "papD": 18,
                "papM": 18,
                "papS": 18,
                "papW": 18,
                "pulseMsg": "The pulse is absent.",
                "pupilsMsg": "The pupils are fixed and dilated.",
                "rateEbl": 5,
                "rateUo": 1.5,
                "recordMsg": "The patient cannot be resuscitated.",
                "rhythm": "Asystole1",
                "skinMsg": "The skin is cyanotic.",
                "skipAheadHours": 0,
                "skipAheadMsg": "",
                "sodium": 142,
                "sat20": 60,
                "sat40": 61,
                "sat100": 62,
                "spRate": 0,
                "spSignal": 0,
                "spontRr": 0,
                "spontTv": 0,
                "sputumAmount": 0,
                "stSegII": 0.200000000000000011102230246251565404236316680908203125,
                "stSegV5": -0.299999999999999988897769753748434595763683319091796875,
                "temperature": 36.89999999999999857891452847979962825775146484375
            }
        ],
        "id": 2,
        "isPro": false
    }
}
