Info [Show/Hide]

<product variant="azure" lang="" id="kirk" catalog="http://csn.contentservice.net/blob/catalog?access=466A1669-3FD1-E711-80C4-00155D7499B9|636474869130080000|bfd3e3b8ead9f349&sco=ChrisWatkins"/>
<metainfo>
    <score pointsoutof="0029" points="0019" percentage="038"/>
    <patient id="PALSLaryngitisdistress-20100909" name="¤Jason Nguyen"/>
    <recording date="2017-11-28-11:33:16"/>
</metainfo>
<evaluation showflags="0" status="" playtime="348" bugzilla="0" comment="" debrieftime="00000"/>

Complaint [Show/Hide]

<complain affiliation="Children's Hospital of Wisconsin" contentServiceUrl="http://csn.contentservice.net/launch_aicc?AICC_SID=d2b13cbf-16ea-4e1c-972c-4da08207d6c11%7C168f5c75-293f-e211-8311-001517135721%7CFalse&AICC_URL=http%3A//www.healthstream.com/HLCSCP/ProcessAiccRequest.aspx" email="[email protected]" guidelines="false" wantReply="true" contentServiceHost="csn.contentservice.net" clinicalPractice="false" fullName="Laurie Klett">
    <address>

         1447 Wolf Den Ct&#13;Hubertus, Wi 53033
        
    </address>
    <description>

         I understand that placing a PIV would agitate the baby, but if I was thinking about administering steriods and would not be safe to do so enterally. Since the oxygen sats were acceptable, I left the oxymask as it was at 6 L. I also humidified it. Every intervention that I did ended up in helping the patient get better. Therefore I should have passed this
        
    </description>
    <topErrors>
        <error>

             Disagree (severity: 3, time: 01:49:00): You obtained IV access in the arm. Do not agitate the infant with this procedure as it may cause the situation to deteriorate even further.
            
        </error>
        <error>

             Agree (severity: 1, time: 02:09:40): Remember to ask the parent about allergies before administering drugs.
            
        </error>
        <error>

             Disagree (severity: 1, time: 00:47:20): You placed an oxygen mask on the infant. It is correct to give oxygen. However, you should use a mask type that enables a higher oxygen concentration.
            
        </error>
        <error>

             Agree (severity: 1, time: 03:19:00): You should consider administering steroids here.
            
        </error>
    </topErrors>
</complain>

Debriefing [Show/Hide]

Jason Nguyen
Age: 8 months
Diagnosis: Upper airway obstruction secondary to croup
0:00 You arrived at the infant.
0:02 ✓ You attached the pulse oximeter. It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the infant continuously.
0:10 Infant status - ECG: Sinus rhythm. Heart rate: 162. Pulse: Present. Blood pressure: 78/55 mmHg. Respiration: 28. Conscious state: Appropriate. SpO2: 97%. Temp: 38.1 °C
0:19 ✓ You listened to the lungs of the infant. There is nasal flaring and a lot of high-pitched noises are coming from the airway.
0:23 You performed head tilt/chin lift.
0:25 ✓ You asked the parent: What happened. The parent replied: 'He has been feeling sick since yesterday. But now it has gotten worse'
0:31 ✓ You asked the parent: When the problems started. The parent replied: 'Yesterday'
0:35 ✓ You asked the parent: Have you noticed any change in behavior and mood? The parent replied: 'He has been sick and cranky since he woke up yesterday'
0:41 You asked the parent: Has he been coughing or had a hoarse voice? The parent replied: 'Yes, both. And he has a strange barking cough'
0:47 ! You placed an oxygen mask on the infant. It is correct to give oxygen. However, you should use a mask type that enables a higher oxygen concentration.
0:51 You turned the oxygen on.
0:52 ✓ You started giving the infant warm, humidified oxygen. This is correct. Infants should get warm and humidified oxygen to avoid hypothermia and obstruction of small airways with dried secretions.
0:59 ✓ You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This is correct. This will allow you to reassess the infant frequently.
1:09 ✓ You checked the capillary refill time. The capillary refill time was less than 2 seconds. It is correct to assess the peripheral circulation.
1:10 Infant status - ECG: Sinus rhythm. Heart rate: 165. Pulse: Present. Blood pressure: 80/56 mmHg. Respiration: 33. Conscious state: Appropriate. SpO2: 96%. Temp: 38.1 °C
1:15 ✓ You examined the infant's skin. He appears flushed and his skin is warm and dry.
1:23 ✓ You applied the Color-Coded Length-Based Resuscitation Tape. Please note that the tape shows doses based on the average of the weight range for this length category.
1:29 You asked the parent: Has he wet his diapers within the last twelve hours? The parent replied: 'Yes. It has been as usual.'
1:35 You asked the parent: When did he last have anything to eat or drink? The parent replied: 'He drank about an hour ago'
1:41 ✓ You checked the temperature at the ear. The temperature was 38.1 °C. It is correct to measure the temperature.
1:49 xxx You obtained IV access in the arm. Do not agitate the infant with this procedure as it may cause the situation to deteriorate even further.
2:09 ✓ You placed a 0.25 mL dose of racemic epinephrine in a nebulizer. This is part of the correct treatment here.
2:09 x Remember to ask the parent about allergies before administering drugs.
2:10 Infant status - ECG: Sinus rhythm. Heart rate: 166. Pulse: Present. Blood pressure: 79/55 mmHg. Respiration: 36. Conscious state: Appropriate. SpO2: 96%. Temp: 38.1 °C
2:37 ✓ You listened to the lungs of the infant. There is nasal flaring and a lot of high-pitched noises are coming from the airway.
3:10 Infant status - ECG: Sinus rhythm. Heart rate: 165. Pulse: Present. Blood pressure: 78/55 mmHg. Respiration: 37. Conscious state: Appropriate. SpO2: 97%. Temp: 38.2 °C
3:15 You stopped the nebulized racemic epinephrine
3:19 ✓ You placed a 0.25 mL dose of racemic epinephrine in a nebulizer.
x You should consider administering steroids here.
3:39 ✓ You took a blood gas sample. It is reasonable to check the arterial blood gases here.
3:44 ✓ You checked blood glucose. It was 87 mg/dL.
3:55 ✓ You ordered a chest X-ray. This is correct.
4:10 Infant status - ECG: Sinus rhythm. Heart rate: 156. Pulse: Present. Blood pressure: 80/56 mmHg. Respiration: 32. Conscious state: Appropriate. SpO2: 98%. Temp: 38.2 °C
4:27 ✓ You listened to the lungs of the infant. A lot of noises are coming from the airway.
4:56 ✓ You listened to the lungs of the infant. The breath sounds are normal.
5:01 ✓ You listened to the lungs of the infant. The breath sounds are normal.
5:10 Infant status - ECG: Sinus rhythm. Heart rate: 154. Pulse: Present. Blood pressure: 77/54 mmHg. Respiration: 25. Conscious state: Appropriate. SpO2: 98%. Temp: 38.2 °C
5:48 ✓ You transferred the infant. It was reasonable to transfer the infant at this point.
Unboosted: You got 19 points out of 29 possible points and 31 percent deduction.
You got 38%
Read more about the management of this case in the PALS Provider Manual: Management of Respiratory Distress and Failure

Show detail in debriefing: Essentials Details

Debriefing XML [Show/Hide]

<debriefing id="debriefing">
    <com time="00:00:00">
Jason Nguyen
        <flags prio="intro"/>
    </com>
    <com time="00:00:00">
Age:
        <span class="black">
8 months
        </span>
        <flags prio="age"/>
    </com>
    <com time="00:00:00">
        <span class="red">
Diagnosis:
        </span>
        <span class="black">
Upper airway obstruction secondary to croup
        </span>
        <flags sp="1" prio="diag"/>
    </com>
    <com time="00:00:00">
You arrived at the infant.
        <flags sp="1" printtime="1" indent="1" prio="normal"/>
    </com>
    <com time="00:02:20">
You attached the
        <span class="link" keyword="Pulseoximeter">
pulse oximeter.
        </span>
It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the infant continuously.
        <flags sp="1" printtime="1" mark="check" prio="normal"/>
        <panel type="match" index="1" action="pulseOximeter"/>
    </com>
    <com time="00:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
162
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
78/55 mmHg
        </span>
. Respiration:
        <span class="black">
28
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
97%
        </span>
. Temp:
        <span class="black">
38.1 °C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="00:19:20">
You listened to the lungs of the infant. There is nasal flaring and a lot of high-pitched noises are coming from the airway.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="2" action="auscultateLungs"/>
    </com>
    <com time="00:23:40">
You performed head tilt/chin lift.
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="3" action="headTilt"/>
    </com>
    <com time="00:25:80">
You asked the parent: What happened. The parent replied: 'He has been feeling sick since yesterday. But now it has gotten worse'
        <flags sp="1" printtime="1" mark="check" prio="details" outof="1" points="1"/>
        <panel type="match" index="4" action="askQuestion"/>
    </com>
    <com time="00:31:40">
You asked the parent: When the problems started. The parent replied: 'Yesterday'
        <flags sp="1" printtime="1" mark="check" prio="details" outof="1" points="1"/>
        <panel type="match" index="5" action="askQuestion"/>
    </com>
    <com time="00:35:00">
You asked the parent: Have you noticed any change in behavior and mood? The parent replied: 'He has been sick and cranky since he woke up yesterday'
        <flags sp="1" printtime="1" mark="check" prio="details" outof="1" points="1"/>
        <panel type="match" index="6" action="askQuestion"/>
    </com>
    <com time="00:41:40">
You asked the parent: Has he been coughing or had a hoarse voice? The parent replied: 'Yes, both. And he has a strange barking cough'
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="7" action="askQuestion"/>
    </com>
    <com time="00:47:20">
You placed an oxygen mask on the infant. It is correct to give oxygen. However, you should use a mask type that enables a higher oxygen concentration.
        <flags sp="1" printtime="1" mark="note" prio="normal" outof="1" points="0"/>
        <panel type="note" index="8" action="hudson"/>
    </com>
    <com time="00:51:00">
You turned the oxygen on.
        <flags sp="1" printtime="1" indent="1" prio="normal"/>
    </com>
    <com time="00:52:80">
You started giving the infant warm, humidified oxygen. This is correct. Infants should get warm and humidified oxygen to avoid hypothermia and obstruction of small airways with dried secretions.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="9" action="humidWarmOxygen"/>
    </com>
    <com time="00:59:40">
You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This is correct. This will allow you to reassess the infant frequently.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="10" action="attachNIBP"/>
    </com>
    <com time="01:09:80">
You checked the capillary refill time. The capillary refill time was less than 2 seconds. It is correct to assess the peripheral circulation.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="11" action="capillResponse"/>
    </com>
    <com time="01:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
165
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
80/56 mmHg
        </span>
. Respiration:
        <span class="black">
33
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
96%
        </span>
. Temp:
        <span class="black">
38.1 °C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="01:15:40">
You examined the infant's skin. He appears flushed and his skin is warm and dry.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="12" action="skinCheck"/>
    </com>
    <com time="01:23:00">
You applied the Color-Coded Length-Based Resuscitation Tape. Please note that the tape shows doses based on the average of the weight range for this length category.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="13" action="broselowTape"/>
    </com>
    <com time="01:29:20">
You asked the parent: Has he wet his diapers within the last twelve hours? The parent replied: 'Yes. It has been as usual.'
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="14" action="askQuestion"/>
    </com>
    <com time="01:35:00">
You asked the parent: When did he last have anything to eat or drink? The parent replied: 'He drank about an hour ago'
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="15" action="askQuestion"/>
    </com>
    <com time="01:41:80">
You checked the
        <span class="link" keyword="Temperature">
temperature
        </span>
at the ear. The temperature was 38.1 °C. It is correct to measure the temperature.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="16" action="temperature"/>
    </com>
    <com time="01:49:00">
You obtained
        <span class="link" keyword="IV_access">
IV access
        </span>
in the arm. Do not agitate the infant with this procedure as it may cause the situation to deteriorate even further.
        <flags sp="1" printtime="1" mark="cross" prio="normal" deduction="31" outof="5" points="0"/>
        <panel type="superfluous" action="insertIVArm"/>
    </com>
    <com time="02:09:20">
You placed a 0.25 mL dose of racemic epinephrine in a nebulizer. This is part of the correct treatment here.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="2" points="2"/>
        <panel type="match" index="17" action="racemicepinephrine"/>
    </com>
    <com time="02:09:40">
Remember to ask the parent about allergies before administering drugs.
        <flags sp="1" printtime="1" mark="cross" prio="normal" outof="2" points="0"/>
    </com>
    <com time="02:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
166
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
79/55 mmHg
        </span>
. Respiration:
        <span class="black">
36
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
96%
        </span>
. Temp:
        <span class="black">
38.1 °C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="02:37:60">
You listened to the lungs of the infant. There is nasal flaring and a lot of high-pitched noises are coming from the airway.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="18" action="auscultateLungs"/>
    </com>
    <com time="03:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
165
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
78/55 mmHg
        </span>
. Respiration:
        <span class="black">
37
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
97%
        </span>
. Temp:
        <span class="black">
38.2 °C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="03:15:20">
You stopped the nebulized racemic epinephrine
        <flags sp="1" printtime="1" indent="1" prio="details"/>
    </com>
    <com time="03:19:00">
You placed a 0.25 mL dose of racemic epinephrine in a nebulizer.
        <flags sp="1" printtime="1" mark="check" prio="normal"/>
        <panel type="match" index="19" action="racemicepinephrine"/>
    </com>
    <com time="03:19:00">
You should consider administering steroids here.
        <flags sp="1" mark="cross" prio="normal" outof="2" points="0" miss="1"/>
        <panel type="missing" index="20" action="budesonide"/>
    </com>
    <com time="03:39:20">
You took a blood gas sample. It is reasonable to check the arterial blood gases here.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="21" action="cbg"/>
    </com>
    <com time="03:44:40">
You checked blood glucose. It was 87 mg/dL.
        <flags sp="1" printtime="1" mark="check" prio="normal"/>
        <panel type="match" index="22" action="bloodGlucose"/>
    </com>
    <com time="03:55:20">
You ordered a chest X-ray. This is correct.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="23" action="chestXRay"/>
    </com>
    <com time="04:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
156
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
80/56 mmHg
        </span>
. Respiration:
        <span class="black">
32
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
98%
        </span>
. Temp:
        <span class="black">
38.2 °C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="04:27:00">
You listened to the lungs of the infant. A lot of noises are coming from the airway.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="24" action="auscultateLungs"/>
    </com>
    <com time="04:56:00">
You listened to the lungs of the infant. The breath sounds are normal.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="25" action="auscultateLungs"/>
    </com>
    <com time="05:01:40">
You listened to the lungs of the infant. The breath sounds are normal.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="26" action="auscultateLungs"/>
    </com>
    <com time="05:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
154
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
77/54 mmHg
        </span>
. Respiration:
        <span class="black">
25
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
98%
        </span>
. Temp:
        <span class="black">
38.2 °C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="05:48:80">
You transferred the infant. It was reasonable to transfer the infant at this point.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match"/>
    </com>
    <com time="00:00:00">
Unboosted: You got 19 points out of 29 possible points and 31 percent deduction.
        <flags sp="1" prio="debug"/>
    </com>
    <com time="00:00:00">
You got 38%
        <flags sp="1" prio="essential"/>
    </com>
    <com time="00:00:00">
Read more about the management of this case in the
        <span class="link" keyword="PALS_RD_MGMT">
PALS Provider Manual: Management of Respiratory Distress and Failure
        </span>
        <flags prio="title" booklink="12"/>
    </com>
</debriefing>
<debriefing id="simtest">
    <com time="00:00:00">
        <span class="red">
            <span class="header">
Debriefing
            </span>
        </span>
        <flags prio="title"/>
    </com>
    <com time="00:00:00">
Jason Nguyen
        <flags prio="intro"/>
    </com>
    <com time="00:00:00">
        <span class="red">
Age:
        </span>
        <flags prio="age"/>
    </com>
    <com time="00:00:00">
Age:
        <span class="black">
8 months
        </span>
        <flags prio="age"/>
    </com>
    <com time="00:00:00">
        <span class="red">
Diagnosis:
        </span>
        <span class="black">
Upper airway obstruction secondary to croup
        </span>
        <flags sp="1" prio="diag"/>
    </com>
    <com time="00:00:00">
You arrived at the infant.
        <flags sp="1" printtime="1" indent="1" prio="normal"/>
    </com>
    <com time="00:02:20">
You attached the
        <span class="link" keyword="Pulseoximeter">
pulse oximeter.
        </span>
It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the infant continuously.
        <flags sp="1" printtime="1" mark="check" prio="normal"/>
        <panel type="match" index="1" action="pulseOximeter"/>
    </com>
    <com time="00:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
162
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
78/55 mmHg
        </span>
. Respiration:
        <span class="black">
28
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
97%
        </span>
. Temp:
        <span class="black">
38.1 C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="00:19:20">
You listened to the lungs of the infant. There is nasal flaring and a lot of high-pitched noises are coming from the airway.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="2" action="auscultateLungs"/>
    </com>
    <com time="00:23:40">
You performed head tilt/chin lift.
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="3" action="headTilt"/>
    </com>
    <com time="00:25:80">
You asked the parent: What happened. The parent replied: 'He has been feeling sick since yesterday. But now it has gotten worse'
        <flags sp="1" printtime="1" mark="check" prio="details" outof="1" points="1"/>
        <panel type="match" index="4" action="askQuestion"/>
    </com>
    <com time="00:31:40">
You asked the parent: When the problems started. The parent replied: 'Yesterday'
        <flags sp="1" printtime="1" mark="check" prio="details" outof="1" points="1"/>
        <panel type="match" index="5" action="askQuestion"/>
    </com>
    <com time="00:35:00">
You asked the parent: Have you noticed any change in behavior and mood? The parent replied: 'He has been sick and cranky since he woke up yesterday'
        <flags sp="1" printtime="1" mark="check" prio="details" outof="1" points="1"/>
        <panel type="match" index="6" action="askQuestion"/>
    </com>
    <com time="00:41:40">
You asked the parent: Has he been coughing or had a hoarse voice? The parent replied: 'Yes. Both. And he has a strange barky cough'
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="7" action="askQuestion"/>
    </com>
    <com time="00:47:20">
You placed an oxygen mask on the infant. It is correct to give oxygen. However, you should use a mask type that enables a higher oxygen concentration.
        <flags sp="1" printtime="1" mark="note" prio="normal" outof="1" points="0"/>
        <panel type="note" index="8" action="hudson"/>
    </com>
    <com time="00:51:00">
You turned the oxygen on.
        <flags sp="1" printtime="1" indent="1" prio="normal"/>
    </com>
    <com time="00:52:80">
You started giving the infant warm, humidified oxygen. This is correct. Infants should get warm and humidified oxygen to avoid hypothermia and obstruction of small airways with dried secretions.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="9" action="humidWarmOxygen"/>
    </com>
    <com time="00:59:40">
You attached the automatic noninvasive blood pressure (NIBP) measurement cuff. This is correct. This will allow you to reassess the infant frequently.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="10" action="attachNIBP"/>
    </com>
    <com time="01:09:80">
You checked the capillary refill time. The capillary refill time was less than 2 seconds. It is correct to assess the peripheral circulation.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="11" action="capillResponse"/>
    </com>
    <com time="01:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
165
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
80/56 mmHg
        </span>
. Respiration:
        <span class="black">
33
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
96%
        </span>
. Temp:
        <span class="black">
38.1 C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="01:15:40">
You examined the infant's skin. He appears flushed and his skin is warm and dry.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="12" action="skinCheck"/>
    </com>
    <com time="01:23:00">
You applied the Color-Coded Length-Based Resuscitation Tape. Please note that the tape shows doses based on the average of the weight range for this length category.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="13" action="broselowTape"/>
    </com>
    <com time="01:29:20">
You asked the parent: Has he wet his diapers within the last twelve hours? The parent replied: 'Yes. It has been as usual.'
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="14" action="askQuestion"/>
    </com>
    <com time="01:35:00">
You asked the parent: When did he last have anything to eat or drink? The parent replied: 'He drank about an hour ago'
        <flags sp="1" printtime="1" indent="1" prio="details"/>
        <panel type="match" index="15" action="askQuestion"/>
    </com>
    <com time="01:41:80">
You checked the
        <span class="link" keyword="Temperature">
temperature
        </span>
at the ear. The temperature was 38.1 C. It is correct to measure the temperature.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="16" action="temperature"/>
    </com>
    <com time="01:49:00">
You obtained
        <span class="link" keyword="IV_access">
IV access
        </span>
in the arm. Do not agitate the infant with this procedure as it may cause the situation to deteriorate even further.
        <flags sp="1" printtime="1" mark="cross" prio="normal" deduction="31" outof="5" points="0"/>
        <panel type="superfluous" action="insertIVArm"/>
    </com>
    <com time="02:09:20">
You placed a 0.25 mL dose of racemic epinephrine in a nebulizer. This is part of the correct treatment here.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="2" points="2"/>
        <panel type="match" index="17" action="racemicepinephrine"/>
    </com>
    <com time="02:09:40">
Remember to ask the parent about allergies before administering drugs.
        <flags sp="1" printtime="1" mark="cross" prio="normal" outof="2" points="0"/>
    </com>
    <com time="02:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
166
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
79/55 mmHg
        </span>
. Respiration:
        <span class="black">
36
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
96%
        </span>
. Temp:
        <span class="black">
38.1 C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="02:37:60">
You listened to the lungs of the infant. There is nasal flaring and a lot of high-pitched noises are coming from the airway.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="18" action="auscultateLungs"/>
    </com>
    <com time="03:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
165
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
78/55 mmHg
        </span>
. Respiration:
        <span class="black">
37
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
97%
        </span>
. Temp:
        <span class="black">
38.2 C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="03:15:20">
You stopped the nebulized racemic epinephrine
        <flags sp="1" printtime="1" indent="1" prio="details"/>
    </com>
    <com time="03:19:00">
You placed a 0.25 mL dose of racemic epinephrine in a nebulizer.
        <flags sp="1" printtime="1" mark="check" prio="normal"/>
        <panel type="match" index="19" action="racemicepinephrine"/>
    </com>
    <com time="03:19:00">
You should consider administering steroids here.
        <flags sp="1" mark="cross" prio="normal" outof="2" points="0" miss="1"/>
        <panel type="missing" index="20" action="budesonide"/>
    </com>
    <com time="03:39:20">
You took a blood gas sample. It is reasonable to check the arterial blood gases here.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="21" action="cbg"/>
    </com>
    <com time="03:44:40">
You checked blood glucose. It was 1 g/L.
        <flags sp="1" printtime="1" mark="check" prio="normal"/>
        <panel type="match" index="22" action="bloodGlucose"/>
    </com>
    <com time="03:55:20">
You ordered a chest X-ray. This is correct.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="23" action="chestXRay"/>
    </com>
    <com time="04:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
156
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
80/56 mmHg
        </span>
. Respiration:
        <span class="black">
32
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
98%
        </span>
. Temp:
        <span class="black">
38.2 C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="04:27:00">
You listened to the lungs of the infant. A lot of noises are coming from the airway.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="24" action="auscultateLungs"/>
    </com>
    <com time="04:56:00">
You listened to the lungs of the infant. The breath sounds are normal.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="25" action="auscultateLungs"/>
    </com>
    <com time="05:01:40">
You listened to the lungs of the infant. The breath sounds are normal.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match" index="26" action="auscultateLungs"/>
    </com>
    <com time="05:10:40">
Infant status - ECG:
        <span class="black">
Sinus rhythm
        </span>
. Heart rate:
        <span class="black">
154
        </span>
. Pulse:
        <span class="black">
Present
        </span>
. Blood pressure:
        <span class="black">
77/54 mmHg
        </span>
. Respiration:
        <span class="black">
25
        </span>
. Conscious state:
        <span class="black">
Appropriate
        </span>
. SpO2:
        <span class="black">
98%
        </span>
. Temp:
        <span class="black">
38.2 C
        </span>
        <flags sp="1" printtime="1" indent="1" prio="status"/>
    </com>
    <com time="05:48:80">
You transferred the infant. It was reasonable to transfer the infant at this point.
        <flags sp="1" printtime="1" mark="check" prio="normal" outof="1" points="1"/>
        <panel type="match"/>
    </com>
    <com time="05:48:80">
Upper airway obstruction causes respiratory distress that is most apparent during inspiration. The primary goal of initial treatment for respiratory distress or failure is to support or restore adequate airway, oxygenation and ventilation. To achieve this goal, you should anticipate and recognize respiratory distress or failure and begin treatment as soon as possible.
        <flags prio="essential"/>
    </com>
    <com time="00:00:00">
Unboosted: You got 19 points out of 29 possible points and 31 percent deduction.
        <flags sp="1" prio="debug"/>
    </com>
    <com time="00:00:00">
You got 38%
        <flags sp="1" prio="essential"/>
    </com>
    <com time="00:00:00">
Read more about the management of this case in the
        <span class="link" keyword="PALS_RD_MGMT">
PALS Provider Manual: Management of Respiratory Distress and Failure
        </span>
        <flags prio="title" booklink="12"/>
    </com>
</debriefing>

Model Trace [Show/Hide]

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        <mold value="1" var="adrenalinetrachealAllowed" time="0"/>
        <mold value="1" var="adrenalineivAllowed" time="0"/>
        <mold value="1" var="adrenalineinfuseAllowed" time="0"/>
        <mold value="1" var="adrenalineimAllowed" time="0"/>
        <mold value="1" var="adrenalinescAllowed" time="0"/>
        <mold value="1" var="fentanylivAllowed" time="0"/>
        <mold value="1" var="flumazenilivAllowed" time="0"/>
        <mold value="1" var="glucoseivAllowed" time="0"/>
        <mold value="1" var="glucoseivAllowed" time="0"/>
        <mold value="1" var="hydrocortisoneivAllowed" time="0"/>
        <mold value="1" var="ipratropiumnebulisorAllowed" time="0"/>
        <mold value="1" var="lidocainivAllowed" time="0"/>
        <mold value="1" var="lidocaininfuseAllowed" time="0"/>
        <mold value="1" var="longrelaxantnodoseAllowed" time="0"/>
        <mold value="1" var="magnesiumivAllowed" time="0"/>
        <mold value="1" var="magnesiuminfuseAllowed" time="0"/>
        <mold value="1" var="longsedationinfuseAllowed" time="0"/>
        <mold value="1" var="methylprednisolonivAllowed" time="0"/>
        <mold value="1" var="methylprednisolonimAllowed" time="0"/>
        <mold value="1" var="methylprednisolonoralAllowed" time="0"/>
        <mold value="1" var="milrinoneivAllowed" time="0"/>
        <mold value="1" var="milrinoneinfuseAllowed" time="0"/>
        <mold value="1" var="morphineivAllowed" time="0"/>
        <mold value="1" var="nahco3ivAllowed" time="0"/>
        <mold value="1" var="naloxontrachealAllowed" time="0"/>
        <mold value="1" var="naloxonivAllowed" time="0"/>
        <mold value="1" var="naloxonimAllowed" time="0"/>
        <mold value="1" var="norepinephrineinfuseAllowed" time="0"/>
        <mold value="1" var="procainamideivAllowed" time="0"/>
        <mold value="1" var="procainamideinfuseAllowed" time="0"/>
        <mold value="1" var="racemicepinephrinenebulisorAllowed" time="0"/>
        <mold value="1" var="ringerivAllowed" time="0"/>
        <mold value="1" var="ringerinfuseAllowed" time="0"/>
        <mold value="1" var="salbutamolsprayAllowed" time="0"/>
        <mold value="1" var="salbutamolnebulisorAllowed" time="0"/>
        <mold value="1" var="salineivAllowed" time="0"/>
        <mold value="1" var="salineinfuseAllowed" time="0"/>
        <mold value="1" var="shortrelaxantnodoseAllowed" time="0"/>
        <mold value="1" var="shortsedationnodoseAllowed" time="0"/>
        <mold value="1" var="vasopressinivAllowed" time="0"/>
        <mold value="¤r|Charcoal" var="charcoalgastrictube" time="0"/>
        <mold value="¤r|Charcoal" var="charcoaloral" time="0"/>
        <mold value="¤r|Adenosine" var="adenosiniv" time="0"/>
        <mold value="¤r|Amiodarone" var="amiodaroneiv" time="0"/>
        <mold value="¤r|Amiodarone" var="amiodaroneinfuse" time="0"/>
        <mold value="¤r|Antibiotics" var="antibioticsnodose" time="0"/>
        <mold value="¤r|Antibiotics" var="antibioticsinfuse" time="0"/>
        <mold value="¤r|Antipyretics" var="antipyreticsnodose" time="0"/>
        <mold value="¤r|Atropine" var="atropinetracheal" time="0"/>
        <mold value="¤r|Atropine" var="atropineiv" time="0"/>
        <mold value="¤r|Calcium chloride" var="calciumiv" time="0"/>
        <mold value="¤r|Dexamethasone" var="dexamethasonelixir" time="0"/>
        <mold value="¤r|Dexamethasone" var="dexamethasoniv" time="0"/>
        <mold value="¤r|Dexamethasone" var="dexamethasonim" time="0"/>
        <mold value="¤r|Dexamethasone" var="dexamethasonoral" time="0"/>
        <mold value="¤r|Diphenhydramine" var="diphenhydraminiv" time="0"/>
        <mold value="¤r|Diphenhydramine" var="diphenhydraminim" time="0"/>
        <mold value="¤r|Diphenhydramine" var="diphenhydraminoral" time="0"/>
        <mold value="¤r|Dobutamine" var="dobutamininfuse" time="0"/>
        <mold value="¤r|Dopamine" var="dopamininfuse" time="0"/>
        <mold value="¤r|Epinephrine" var="adrenalinetracheal" time="0"/>
        <mold value="¤r|Epinephrine" var="adrenalineiv" time="0"/>
        <mold value="¤r|Epinephrine" var="adrenalineinfuse" time="0"/>
        <mold value="¤r|Epinephrine" var="adrenalineim" time="0"/>
        <mold value="¤r|Epinephrine" var="adrenalinesc" time="0"/>
        <mold value="¤r|Fentanyl" var="fentanyliv" time="0"/>
        <mold value="¤r|Flumazenil" var="flumazeniliv" time="0"/>
        <mold value="¤r|Dextrose" var="glucoseiv" time="0"/>
        <mold value="¤r|Dextrose" var="glucoseiv" time="0"/>
        <mold value="¤r|Hydrocortisone" var="hydrocortisoneiv" time="0"/>
        <mold value="¤r|Ipratropium" var="ipratropiumnebulisor" time="0"/>
        <mold value="¤r|Lidocaine" var="lidocainiv" time="0"/>
        <mold value="¤r|Lidocaine" var="lidocaininfuse" time="0"/>
        <mold value="¤r|Muscle relaxant, long-acting" var="longrelaxantnodose" time="0"/>
        <mold value="¤r|Magnesium" var="magnesiumiv" time="0"/>
        <mold value="¤r|Magnesium" var="magnesiuminfuse" time="0"/>
        <mold value="¤r|Sedation, long-acting" var="longsedationinfuse" time="0"/>
        <mold value="¤r|Methylprednisolone" var="methylprednisoloniv" time="0"/>
        <mold value="¤r|Methylprednisolone" var="methylprednisolonim" time="0"/>
        <mold value="¤r|Methylprednisolone" var="methylprednisolonoral" time="0"/>
        <mold value="¤r|Milrinone" var="milrinoneiv" time="0"/>
        <mold value="¤r|Milrinone" var="milrinoneinfuse" time="0"/>
        <mold value="¤r|Morphine" var="morphineiv" time="0"/>
        <mold value="¤r|Sodium bicarbonate" var="nahco3iv" time="0"/>
        <mold value="¤r|Naloxone" var="naloxontracheal" time="0"/>
        <mold value="¤r|Naloxone" var="naloxoniv" time="0"/>
        <mold value="¤r|Naloxone" var="naloxonim" time="0"/>
        <mold value="¤r|Norepinephrine" var="norepinephrineinfuse" time="0"/>
        <mold value="¤r|Procainamide" var="procainamideiv" time="0"/>
        <mold value="¤r|Procainamide" var="procainamideinfuse" time="0"/>
        <mold value="¤r|Racemic epinephrine" var="racemicepinephrinenebulisor" time="0"/>
        <mold value="¤r|Lactated Ringer's solution" var="ringeriv" time="0"/>
        <mold value="¤r|Lactated Ringer's solution" var="ringerinfuse" time="0"/>
        <mold value="¤r|Albuterol" var="salbutamolspray" time="0"/>
        <mold value="¤r|Albuterol" var="salbutamolnebulisor" time="0"/>
        <mold value="¤r|Normal saline" var="salineiv" time="0"/>
        <mold value="¤r|Normal saline" var="salineinfuse" time="0"/>
        <mold value="¤r|Muscle relaxant, short-acting" var="shortrelaxantnodose" time="0"/>
        <mold value="¤r|Sedation, short-acting" var="shortsedationnodose" time="0"/>
        <mold value="¤r|Vasopressin" var="vasopressiniv" time="0"/>
        <mold value="50" var="amiodaroneConcentration" time="0"/>
        <mold value="1" var="dobutaminConcentration" time="0"/>
        <mold value="40" var="dopamineConcentration" time="0"/>
        <mold value="1" var="epinephrineConcentration" time="0"/>
        <mold value="10" var="lidoConcentration" time="0"/>
        <mold value="100" var="magnesiumConcentration" time="0"/>
        <mold value="0.2" var="milrinoneConcentration" time="0"/>
        <mold value="1" var="norepinephrineConcentration" time="0"/>
        <mold value="100" var="procainamideConcentration" time="0"/>
        <mold value="8.4" var="ringerConcentration" time="0"/>
        <mold value="8.99976" var="saltWaterInfusionConcentration" time="0"/>
        <mold value="Stopped" var="time" time="0"/>
    <endw time="0"/>
    <mold value="1" var="defibPowerOnAuto" time="0"/>
    <mold value="1" var="defibPowerOn" time="0"/>
    <mold value="0" var="defibIsAnAed" time="0"/>
    <mold value="Monitor" var="genericDefibMode" time="0"/>
    <mold value="Started" var="time" time="0"/>
    <mold value="Stopped" var="time" time="200"/>
    <mold value="Started" var="time" time="200"/>
    <aidb time="220" id="87" iv2="0" iv1="0" name="pulseOximeter" dv="0"/>
        <mold value="1" var="attachPulseOximeter" time="220"/>
    <aide time="220"/>
    <wait value="¤r|The {patient} has increased work of breathing and an occasional harsh, barky cough." var="rescuerSpeak" time="400"/>
        <mold value="0" var="patientDelayedSpeak" time="400"/>
        <mold value="0" var="speakFX" time="400"/>
        <mold value="" var="rescuerSpeak" time="400"/>
        <wait value="" var="rescuerSpeak" time="400"/>
            <mold value="0" var="patientDelayedSpeak" time="400"/>
            <mold value="0" var="speakFX" time="400"/>
        <endw time="400"/>
    <endw time="400"/>
    <mold value="1" var="auscultateLungs" time="1420"/>
    <aidb time="1920" id="37" iv2="0" iv1="0" name="auscultateLungs" dv="0"/>
        <mold value="0" var="auscultateLungs" time="1920"/>
    <aide time="1920"/>
    <mold value="Stopped" var="time" time="2320"/>
    <mold value="Started" var="time" time="2320"/>
    <aidb time="2340" id="3" iv2="0" iv1="0" name="headTilt" dv="0"/>
        <mold value="1" var="headTilt" time="2340"/>
    <aide time="2340"/>
    <mold value="Stopped" var="time" time="2580"/>
    <mold value="disable" var="chatter" time="2580"/>
    <aidb time="2580" id="14" iv2="300" iv1="1" name="askQuestion" dv="0"/>
        <mold value="300" var="question" time="2580"/>
        <mold value="1" var="gotPCKPatientAnswer" time="2580"/>
    <endw time="2580"/>
<aide time="2580"/>
<mold value="Started" var="time" time="2580"/>
<mold value="disable" var="chatter" time="3140"/>
<aidb time="3140" id="14" iv2="301" iv1="1" name="askQuestion" dv="0"/>
    <mold value="301" var="question" time="3140"/>
    <mold value="1" var="gotPCKPatientAnswer" time="3140"/>
<endw time="3140"/>
<aide time="3140"/>
<mold value="disable" var="chatter" time="3500"/>
<aidb time="3500" id="14" iv2="303" iv1="1" name="askQuestion" dv="0"/>
    <mold value="303" var="question" time="3500"/>
    <mold value="1" var="gotPCKPatientAnswer" time="3500"/>
<endw time="3500"/>
<aide time="3500"/>
<mold value="disable" var="chatter" time="4140"/>
<aidb time="4140" id="14" iv2="304" iv1="1" name="askQuestion" dv="0"/>
    <mold value="304" var="question" time="4140"/>
    <mold value="1" var="gotPCKPatientAnswer" time="4140"/>
<endw time="4140"/>
<aide time="4140"/>
<mold value="Stopped" var="time" time="4700"/>
<mold value="Started" var="time" time="4700"/>
<aidb time="4720" id="59" iv2="0" iv1="0" name="hudson" dv="0"/>
    <mold value="none" var="maskType" time="4720"/>
    <mold value="hudsonMask" var="maskType" time="4720"/>
<aide time="4720"/>
<mold value="5" var="oxygenRate" time="5100"/>
<aidb time="5280" id="139" iv2="0" iv1="0" name="humidWarmOxygen" dv="0"/>
    <mold value="1" var="inhalationOfWarmAir" time="5280"/>
<aide time="5280"/>
<aidb time="5940" id="107" iv2="0" iv1="0" name="attachNIBP" dv="0"/>
    <mold value="1" var="attachNIBPCuff" time="5940"/>
<aide time="5940"/>
<aidb time="6980" id="25" iv2="0" iv1="1" name="capillResponse" dv="0"/>
    <mold value="1" var="checkCapillaryReturn" time="6980"/>
<aide time="6980"/>
<mold value="0" var="checkCapillaryReturn" time="7280"/>
<aidb time="7540" id="23" iv2="0" iv1="1" name="skinCheck" dv="0"/>
    <mold value="1" var="examineSkinColorEvent" time="7540"/>
<aide time="7540"/>
<mold value="0" var="examineSkinColorEvent" time="7640"/>
<aidb time="8300" id="728" iv2="0" iv1="0" name="broselowTape" dv="0"/>
    <mold value="1" var="applyBroselow" time="8300"/>
<aide time="8300"/>
<mold value="Stopped" var="time" time="8920"/>
<mold value="disable" var="chatter" time="8920"/>
<aidb time="8920" id="14" iv2="305" iv1="1" name="askQuestion" dv="0"/>
    <mold value="305" var="question" time="8920"/>
<aide time="8920"/>
<mold value="Started" var="time" time="8920"/>
<mold value="disable" var="chatter" time="9500"/>
<aidb time="9500" id="14" iv2="308" iv1="1" name="askQuestion" dv="0"/>
    <mold value="308" var="question" time="9500"/>
    <mold value="1" var="gotPCKPatientAnswer" time="9500"/>
<endw time="9500"/>
<aide time="9500"/>
<mold value="Stopped" var="time" time="10160"/>
<mold value="Started" var="time" time="10160"/>
<aidb time="10180" id="100" iv2="0" iv1="1" name="temperature" dv="0"/>
    <mold value="1" var="checkTemperatureEar" time="10180"/>
<aide time="10180"/>
<mold value="0" var="checkTemperatureEar" time="10480"/>
<mold value="Stopped" var="time" time="10880"/>
<mold value="Started" var="time" time="10880"/>
<aidb time="10900" id="108" iv2="0" iv1="1" name="insertIVArm" dv="0"/>
    <mold value="arm" var="ivplacement" time="10900"/>
    <mold value="inserting" var="ivinsertion" time="10900"/>
<aide time="10900"/>
<aidb time="11740" id="295" iv2="0" iv1="1" name="flush" dv="0"/>
    <mold value="0.02" var="saltWaterAutoDose" time="11740"/>
<aide time="11740"/>
<mold value="Stopped" var="time" time="12900"/>
<mold value="Started" var="time" time="12900"/>
<aidb time="12920" id="425" iv2="26" iv1="1" name="racemicepinephrine" dv="0.00025"/>
    <mold value="0" var="slowInfuse" time="12920"/>
    <mold value="0.00025" var="doseEpinephrineNebulisor" time="12920"/>
    <wait value="1" var="nebulizorPresent" time="12920"/>
        <mold value="6" var="oxygenRate" time="12920"/>
    <endw time="12920"/>
    <mold value="1" var="drugGiven" time="12920"/>
<aide time="12920"/>
<mold value="1" var="auscultateLungs" time="15260"/>
<aidb time="15760" id="37" iv2="0" iv1="0" name="auscultateLungs" dv="0"/>
    <mold value="0" var="auscultateLungs" time="15760"/>
<aide time="15760"/>
<mold value="Stopped" var="time" time="16400"/>
<mold value="Started" var="time" time="16400"/>
<aidb time="19500" id="425" iv2="26" iv1="1" name="racemicepinephrine" dv="0"/>
    <mold value="0" var="slowInfuse" time="19500"/>
    <mold value="0" var="doseEpinephrineNebulisor" time="19500"/>
    <mold value="1" var="drugGiven" time="19500"/>
<aide time="19500"/>
<aidb time="19900" id="425" iv2="26" iv1="1" name="racemicepinephrine" dv="0.00025"/>
    <mold value="0" var="slowInfuse" time="19900"/>
    <mold value="0.00025" var="doseEpinephrineNebulisor" time="19900"/>
    <mold value="1" var="drugGiven" time="19900"/>
<aide time="19900"/>
<aidb time="21920" id="702" iv2="0" iv1="1" name="cbg" dv="0"/>
    <mold value="1" var="cbg" time="21920"/>
<aide time="21920"/>
<mold value="0" var="cbg" time="22420"/>
<aidb time="22440" id="24" iv2="0" iv1="1" name="bloodGlucose" dv="0"/>
    <mold value="1" var="checkGlucose" time="22440"/>
<aide time="22440"/>
<mold value="0" var="checkGlucose" time="22940"/>
<aidb time="23520" id="209" iv2="0" iv1="0" name="chestXRay" dv="0"/>
<aide time="23520"/>
<mold value="1" var="chestXRayDebriefEvent" time="23520"/>
<mold value="1" var="auscultateLungs" time="26200"/>
<aidb time="26700" id="37" iv2="0" iv1="0" name="auscultateLungs" dv="0"/>
    <mold value="0" var="auscultateLungs" time="26700"/>
<aide time="26700"/>
<mold value="1" var="onlyOneRescuer" time="27220"/>
<mold value="0" var="onlyOneRescuer" time="27720"/>
<mold value="1" var="chestXRayEvent" time="27720"/>
<wait value="¤p|(crying)" var="forcePatientSpeak" time="27960"/>
    <mold value="0" var="patientDelayedSpeak" time="27960"/>
    <mold value="0" var="speakFX" time="27960"/>
    <mold value="" var="forcePatientSpeak" time="27960"/>
    <wait value="" var="forcePatientSpeak" time="27960"/>
        <mold value="0" var="patientDelayedSpeak" time="27960"/>
        <mold value="0" var="speakFX" time="27960"/>
    <endw time="27960"/>
<endw time="27960"/>
<mold value="1" var="auscultateLungs" time="29100"/>
<wait value="¤p|(crying)" var="forcePatientSpeak" time="29160"/>
    <mold value="0" var="patientDelayedSpeak" time="29160"/>
    <mold value="0" var="speakFX" time="29160"/>
    <mold value="" var="forcePatientSpeak" time="29160"/>
    <wait value="" var="forcePatientSpeak" time="29160"/>
        <mold value="0" var="patientDelayedSpeak" time="29160"/>
        <mold value="0" var="speakFX" time="29160"/>
    <endw time="29160"/>
<endw time="29160"/>
<aidb time="29600" id="37" iv2="0" iv1="0" name="auscultateLungs" dv="0"/>
    <mold value="0" var="auscultateLungs" time="29600"/>
<aide time="29600"/>
<mold value="1" var="auscultateLungs" time="29640"/>
<aidb time="30140" id="37" iv2="0" iv1="0" name="auscultateLungs" dv="0"/>
    <mold value="0" var="auscultateLungs" time="30140"/>
<aide time="30140"/>
<wait value="¤p|(crying)" var="forcePatientSpeak" time="30400"/>
    <mold value="0" var="patientDelayedSpeak" time="30400"/>
    <mold value="0" var="speakFX" time="30400"/>
    <mold value="" var="forcePatientSpeak" time="30400"/>
    <wait value="" var="forcePatientSpeak" time="30400"/>
        <mold value="0" var="patientDelayedSpeak" time="30400"/>
        <mold value="0" var="speakFX" time="30400"/>
    <endw time="30400"/>
<endw time="30400"/>
<mold value="0" var="chestXRayResultDone" time="30720"/>
<mold value="1" var="tryTransferEvent" time="30740"/>
<wait value="¤p|(crying)" var="forcePatientSpeak" time="31640"/>
    <mold value="0" var="patientDelayedSpeak" time="31640"/>
    <mold value="0" var="speakFX" time="31640"/>
    <mold value="" var="forcePatientSpeak" time="31640"/>
    <wait value="" var="forcePatientSpeak" time="31640"/>
        <mold value="0" var="patientDelayedSpeak" time="31640"/>
        <mold value="0" var="speakFX" time="31640"/>
    <endw time="31640"/>
<endw time="31640"/>
<mold value="1" var="tryTransferEvent" time="31860"/>
<wait value="¤p|(crying)" var="forcePatientSpeak" time="32900"/>
    <mold value="0" var="patientDelayedSpeak" time="32900"/>
    <mold value="0" var="speakFX" time="32900"/>
    <mold value="" var="forcePatientSpeak" time="32900"/>
    <wait value="" var="forcePatientSpeak" time="32900"/>
        <mold value="0" var="patientDelayedSpeak" time="32900"/>
        <mold value="0" var="speakFX" time="32900"/>
    <endw time="32900"/>
<endw time="32900"/>
<wait value="¤p|(crying)" var="forcePatientSpeak" time="34220"/>
    <mold value="0" var="patientDelayedSpeak" time="34220"/>
    <mold value="0" var="speakFX" time="34220"/>
    <mold value="" var="forcePatientSpeak" time="34220"/>
    <wait value="" var="forcePatientSpeak" time="34220"/>
        <mold value="0" var="patientDelayedSpeak" time="34220"/>
        <mold value="0" var="speakFX" time="34220"/>
    <endw time="34220"/>
<endw time="34220"/>
<mold value="1" var="tryTransferEvent" time="34740"/>
<mold value="1" var="tryTransferEvent" time="34880"/>
<mold value="TransferICU" var="gameStopReason" time="34880"/>
<mold value="1" var="gameStopped" time="34880"/>
<wait value="1" var="requestBuiltInPatientConclusion" time="34880"/>
    <mold value="¤Upper airway obstruction causes respiratory distress that is most apparent during inspiration. The primary goal of initial treatment for respiratory distress or failure is to support or restore adequate airway, oxygenation and ventilation. To achieve this goal, you should anticipate and recognize respiratory distress or failure and begin treatment as soon as possible. " var="gmessage" time="34880"/>
<endw time="34880"/>
<wait value="0" var="gameStopped" time="34880"/>
    <mold value="Stopped" var="time" time="34880"/>
<endw time="34880"/>
</modeltrace>

Replay [Show/Hide]

<applicationLog buildVersion="25433d37b3d6-2017-10-27-16-8-636447172968859504" appName="HeartCode PALS" seed="420556843" patientName="¤Jason Nguyen" patientId="PALSLaryngitisdistress-20100909">
    <messages>
        <User time="520">
            <pauseTimeClicked/>
        </User>
        <User time="2104">
            <selectTab id="Breathing"/>
        </User>
        <User time="3320">
            <attachPulseOximeter v="1"/>
        </User>
        <Engine time="3504">
            <rescuerSpeak v="¤r|The {patient} has increased work of breathing and an occasional harsh, barky cough."/>
        </Engine>
        <User time="3672">
            <RadioGroupBreathing item="auscultate"/>
        </User>
        <User time="4232">
            <selectTab id="Examine"/>
        </User>
        <User time="4352">
            <RadioGroupExamine item="auscultate"/>
        </User>
        <User time="4504">
            <auscultateLungs v="1"/>
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        <Engine time="5024">
            <rescuerSpeak v="¤r|There is nasal flaring and a lot of high-pitched noises are coming from the airway"/>
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        <User time="5428">
            <pauseTimeClicked/>
        </User>
        <User time="5604">
            <selectTab id="Airway"/>
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        <User time="7616">
            <headtilt v="1"/>
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        <User time="7880">
            <pauseTimeClicked/>
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        <User time="8452">
            <selectTab id="Examine"/>
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        <User time="9032">
            <RadioGroupExamine item="measureVitals"/>
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        <User time="10480">
            <selectTab id="Misc"/>
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        <User time="10816">
            <selectTab id="Response"/>
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        <User time="11052">
            <askQuestion i="300"/>
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        <Engine time="11052">
            <rescuerSpeak v="¤r|What happened? "/>
        </Engine>
        <Engine time="11132">
            <parentSpeak v="¤par|{He} has been feeling sick since yesterday. But now it has gotten worse"/>
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        <User time="11604">
            <askQuestion i="301"/>
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        <Engine time="11604">
            <rescuerSpeak v="¤r|When did the problems start?"/>
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        <Engine time="11748">
            <parentSpeak v="¤par|Yesterday"/>
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        <User time="11964">
            <askQuestion i="303"/>
        </User>
        <Engine time="11964">
            <rescuerSpeak v="¤r|Have you noticed any change in behavior and mood?"/>
        </Engine>
        <Engine time="12236">
            <parentSpeak v="¤par|{He} has been sick and cranky since {he} woke up yesterday"/>
        </Engine>
        <User time="12616">
            <askQuestion i="304"/>
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        <Engine time="12616">
            <rescuerSpeak v="¤r|Has {he} been coughing or had a hoarse voice?"/>
        </Engine>
        <Engine time="12860">
            <parentSpeak v="¤par|Yes. Both. And {he} has a strange barky cough"/>
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        <User time="13176">
            <pauseTimeClicked/>
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        <User time="13616">
            <selectTab id="Breathing"/>
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        <User time="14260">
            <RadioGroupBreathing item="procedures"/>
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        <User time="14608">
            <RadioGroupBreathing item="supplementaryOxygen"/>
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        <User time="15012">
            <oxygenMaskHudson v="1"/>
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        <User time="15404">
            <setOxygenRateBreathing v="5"/>
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        <User time="15564">
            <warmHumidifyOxygen v="1"/>
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        <User time="15976">
            <selectTab id="Examine"/>
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        <User time="16236">
            <nibpSetup v="1"/>
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        <User time="17264">
            <capillaryRefillTime v="1"/>
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        <Engine time="17580">
            <rescuerSpeak v="¤r|The capillary refill time is less than two seconds."/>
        </Engine>
        <User time="17820">
            <checkSkin v="1"/>
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        <Engine time="17940">
            <rescuerSpeak v="¤r|{He} appears flushed and {his} skin is warm and dry"/>
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        <User time="18292">
            <BroselowTapeExamine/>
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        <Engine time="18820">
            <rescuerSpeak v="¤r|The length-based weight estimate is [weight] kg."/>
        </Engine>
        <User time="19236">
            <pauseTimeClicked/>
        </User>
        <User time="19816">
            <selectTab id="Misc"/>
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        <User time="20648">
            <selectTab id="Examine"/>
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        <User time="20868">
            <selectTab id="Response"/>
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        <User time="21316">
            <askQuestion i="305"/>
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        <Engine time="21316">
            <rescuerSpeak v="¤r|Has {he} wet {his} diapers within the last twelve hours?"/>
        </Engine>
        <Engine time="21612">
            <parentSpeak v="¤par|Yes. It has been as usual."/>
        </Engine>
        <User time="21880">
            <askQuestion i="308"/>
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        <Engine time="21880">
            <rescuerSpeak v="¤r|When did {he} last have anything to eat or drink?"/>
        </Engine>
        <Engine time="22316">
            <parentSpeak v="¤par|{He} drank about an hour ago"/>
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        <User time="22556">
            <pauseTimeClicked/>
        </User>
        <User time="23652">
            <selectTab id="AdminDrugs"/>
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        <User time="24292">
            <selectTab id="Misc"/>
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        <User time="24992">
            <measureTemperature v="1"/>
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        <Engine time="25296">
            <rescuerSpeak v="¤r|The temperature is [temperature;temperature;C]"/>
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        <User time="25704">
            <pauseTimeClicked/>
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        <User time="26428">
            <selectTab id="Breathing"/>
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        <User time="26916">
            <RadioGroupBreathing item="procedures"/>
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        <User time="27288">
            <RadioGroupBreathing item="procedures"/>
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        <User time="27904">
            <selectTab id="AdminDrugs"/>
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        <User time="28212">
            <RadioGroupAdminDrugs item="adminDrugs"/>
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        <User time="32980">
            <RadioGroupAdminDrugs item="adminDrugs"/>
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        <User time="33568">
            <RadioGroupAdminDrugs item="manageIV"/>
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        <User time="33944">
            <insertIvArmRight v="1"/>
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        <Engine time="34656">
            <rescuerSpeak v="The IV is inserted."/>
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        <User time="34780">
            <RadioGroupAdminDrugs item="adminDrugs"/>
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        <Engine time="34820">
            <rescuerSpeak v="¤r|Flushing"/>
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        <User time="35956">
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        <User time="36152">
            <selectTab id="Examine"/>
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        <User time="42564">
            <selectTab id="AdminDrugs"/>
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        <User time="53032">
            <adminDrug AdminRoute="NEBULIZED" AdminValue="0.25" DrugName="Racemicepinephrine" CapValue="0" SlowInfuse="false" ivPos="None" Unit="mL"/>
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        <User time="54592">
            <selectTab id="Breathing"/>
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        <User time="54592">
            <RadioGroupBreathing item="supplementaryOxygen"/>
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        <User time="55204">
            <RadioGroupBreathing item="auscultate"/>
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        <User time="55376">
            <auscultateLungs v="1"/>
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        <Engine time="55892">
            <rescuerSpeak v="¤r|There is nasal flaring and a lot of high-pitched noises are coming from the airway"/>
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        <User time="56532">
            <pauseTimeClicked/>
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        <User time="66532">
            <playTimeClicked/>
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        <User time="66876">
            <selectTab id="Examine"/>
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        <User time="67056">
            <nibpRemeasureExamine/>
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        <User time="67056">
            <nibpTimerRestart/>
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        <User time="68324">
            <selectTab id="AdminDrugs"/>
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        <User time="69624">
            <adminDrug AdminRoute="NEBULIZED" AdminValue="0" DrugName="Racemicepinephrine" CapValue="0" SlowInfuse="false" ivPos="None" Unit="mL"/>
        </User>
        <User time="70016">
            <adminDrug AdminRoute="NEBULIZED" AdminValue="0.25" DrugName="Racemicepinephrine" CapValue="0" SlowInfuse="false" ivPos="None" Unit="mL"/>
        </User>
        <User time="71732">
            <selectTab id="Diagnostics"/>
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        <User time="72032">
            <capillaryBloodGas v="1"/>
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        <Engine time="72552">
            <rescuerSpeak v="¤r|The blood sample has been sent to the lab for analysis"/>
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        <User time="72556">
            <checkGlucose v="1"/>
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        <Engine time="73072">
            <rescuerSpeak v="¤r|The glucose is [Signs_glucoseUnit;glucose;g/L]."/>
        </Engine>
        <User time="73636">
            <chestXRay v="1"/>
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        <Engine time="73652">
            <rescuerSpeak v="¤r|Chest X-ray has been ordered."/>
        </Engine>
        <User time="75196">
            <selectTab id="Breathing"/>
        </User>
        <User time="75196">
            <RadioGroupBreathing item="supplementaryOxygen"/>
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        <User time="76104">
            <RadioGroupBreathing item="auscultate"/>
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        <User time="76316">
            <auscultateLungs v="1"/>
        </User>
        <Engine time="76652">
            <rescuerSpeak v="¤r|We'll leave the room while the X-ray machine operates."/>
        </Engine>
        <Engine time="76944">
            <rescuerSpeak v="¤r|A lot of noises are coming from the airway"/>
        </Engine>
        <Engine time="77852">
            <rescuerSpeak v="¤r|The X-ray has been sent to radiology for processing. The results will arrive shortly."/>
        </Engine>
        <Engine time="78092">
            <patientSpeak v="¤p|(crying)"/>
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        <User time="79228">
            <auscultateLungs v="1"/>
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        <Engine time="79292">
            <patientSpeak v="¤p|(crying)"/>
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        <Engine time="79732">
            <rescuerSpeak v="¤r|The breath sounds are normal"/>
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        <User time="79752">
            <auscultateLungs v="1"/>
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        <Engine time="80272">
            <rescuerSpeak v="¤r|The breath sounds are normal"/>
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        <Engine time="80532">
            <patientSpeak v="¤p|(crying)"/>
        </Engine>
        <Engine time="80852">
            <rescuerSpeak v="¤r|X-ray results have arrived."/>
        </Engine>
        <User time="80888">
            <transferdialog NoActionButton="showTransferDialog"/>
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        <Engine time="81552">
            <rescuerSpeak v="¤r|The results of the capillary blood gases analysis have arrived"/>
        </Engine>
        <Engine time="81772">
            <patientSpeak v="¤p|(crying)"/>
        </Engine>
        <User time="82000">
            <transferdialog NoActionButton="cancelTransfer"/>
        </User>
        <User time="82288">
            <selectTab id="Diagnostics"/>
        </User>
        <User time="82504">
            <viewDiagnosticsResults v="1"/>
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        <User time="82512">
            <MedicalRecordController button="show"/>
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        <User time="82512">
            <MedicalRecordController button="XRay"/>
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        <Engine time="83032">
            <patientSpeak v="¤p|(crying)"/>
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        <User time="83308">
            <MedicalRecordController button="BloodSamples"/>
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        <Engine time="84352">
            <patientSpeak v="¤p|(crying)"/>
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        <User time="84596">
            <MedicalRecordController button="close"/>
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        <User time="84884">
            <transferdialog NoActionButton="showTransferDialog"/>
        </User>
        <User time="85028">
            <transferdialog NoActionButton="transfer(TransferICU)"/>
        </User>
        <User time="85028">
            <DebriefingLauncher gameState="gameStop"/>
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