Cases, tutorial, Crimson Circuit & procedural quiz

Academic cases and half-day figures

Teaching cases map stages to available history, hemodynamic values, rhythm/finding, oxygenation and pressure morphology. Progression reveals the next stage and its interpretation rather than exposing all later facts initially. The main-page case mode applies the linked stage to the simulator and retains discussion details in its case panel.

Case waveform profiles give distinct appearance to relevant physiology. A distributive teaching example can retain high output despite hypotension. SV, SVR and PVR use the supplied output and pressures; a selected high-flow value is an illustrative phenotype, not a requirement for anaphylaxis. An explicitly selected profile can supply illustrative respiratory timing when no measured rate is available; this is identified in trace help and does not add a measured rate or oxygen saturation to the case. A selected acute mitral-regurgitation profile enlarges the delayed wedge V wave while preserving mean wedge; it does not impose a giant RA V wave. PAPi uses (PA systolic − PA diastolic) / RA mean; interpretation depends on the clinical setting rather than a universal cutoff. When illustrative arterial extrema are explicitly assigned to a mean-only source, trace help identifies them and the synthesized pulse is calibrated to the supplied MAP at each stage. Unassigned mean-only channels remain flat mean-pressure lines. Pressure and pleth use the same breath. Supplied case pressures anchor end-expiration; inspiration modifies the atrial pressure baseline and ventricular/arterial pulse amplitude without changing the staged source readings. Pleth/oxygen values appear as the case data become available. Core half-day static waveforms illustrate two cycles per trace; their stationary inspection uses the known signal and phase, not an embedded textbook recording.

The separate two-axis perfusion/congestion teaching widget is a deliberately simple LV-failure illustration: cardiac index varies from 3.6 to 0.8 L/min/m² with perfusion loss, while wedge independently varies from 6 to 30 mmHg with congestion. Its midlines are CI 2.2 and wedge 18; CO uses an assumed BSA of 1.8 m². It is not the full multi-pathology sandbox solver.

Tutorial and Crimson Circuit

The tutorial performs a scripted sequence of real interface actions on the embedded sandbox: selection, pause, ECG, inspection and intervention. It uses presentation timing and target visibility handling; the moving logo is a demonstrator, not control of the user’s operating-system mouse. Manual/automatic stage progression changes the tour, not the physiology. Short stage prompts stay visible; Lesson details retains the fuller explanations and clinical source links. Two classroom stages reuse the Teacher/Student UI and demonstrate session start, an example code, and code entry followed by Join. The student monitor is withheld until the example code is accepted, then shows live ECG Lead II, arterial pressure, pleth and PAWP from the same local model state. Its custom selection omits other channels, studies, overlay, table and 12-lead access; the headline BP stays hidden. These choices apply only to the tutorial. The tutorial never creates, joins or publishes a networked classroom room, reads a saved host token or copies a session link; live networking remains disabled. Replaying restores the example session to its unjoined state, and exiting restores local sandbox controls.

Crimson Circuit uses authored dossiers and explicit diagnostic/management decisions with selected recovery snapshots. Its arterial sampler retains the shared aortic-regurgitation runoff contour and the scenario pressures; acute regurgitation is not assigned the chronic wide pulse pressure. NSVT strips start two seconds before a modeled burst, with the same absolute window for original and recovery states. The displayed axis stays at 0–6 seconds; inspection uses the underlying simulation time. Pressure means cover the full NSVT sequence rather than a fixed-rate interval that samples only part of the sequence. Some successful answers appropriately leave a trace unchanged because the decision is assessment or referral rather than a simulated cure. Easter eggs, points and unlocks are educational presentation features, not patient outcome probabilities.

Procedural quiz generation

The quiz chooses a diagnostic family and varies loading, output, resistance, rate and compatible rhythm. It solves those values through the shared circulation, rejects samples that no longer retain the intended phenotype, then builds four qualitative options from curated answer/foil families. A final constrained fallback prevents endless rejection.

There are five question kinds: dominant pattern, mechanism, atrial filling pattern, LVEDP interpretation and combined LA/LV filling interpretation. Wording templates and diagnostic families are finite; numerical waveform instances are procedurally generated. It is therefore incorrect to present the number of mathematical combinations as a count of independently authored questions.

Answer truth and score

Answers use the solved pressure metrics. Samples near rounding boundaries are checked so whole-number labels support the stated answer. Diagnosis and calculations are revealed after answering; arithmetic is not the scored task. Answer/next transitions prevent repeated credit for a single round.

Acute PE participates in the predominant-RV-failure family. Generated PE examples retain low output, hypotension, high right-sided filling pressure, elevated PVR and a relatively low wedge. The scored pattern does not claim that pressure traces diagnose an embolus or establish how long RV disease has been present.

Generated questions are not guaranteed to encompass every disease combination or be uniquely diagnostic from pressure alone. Families deliberately group causes that invasive tracings cannot reliably distinguish. Scores measure performance in this teaching exercise, not clinical competence.