A graded case is marked out of 100 from four decisions — the airway, the mode, the settings and the outcome — then adjusted for what happened while the patient was on the machine.
A graded case is scored out of 100 from four decisions. Each one is scored as a percentage of its own weight.
The total is clamped between 0 and 100. Causing a death costs more than failing to prevent one: a run the clinician's own hand ended is capped lower than one where a problem was simply not acted on. The floor for the standard adult starting set is applied above those caps, so a patient who did not survive still fails the run however tidy the settings were.
Nothing here is a bare right or wrong. Every choice is scored on what it does to the patient in front of you.
Escalating from non-invasive support to a tube adds 5 points on top of the total. Over-intubating is scaled by acuity: a dangerous arrival picture — hypoxic, tachypneic or hypercapnic — lifts the case one band.
A wrong mode also scales the settings score down with it, in proportion to how wrong it is — the right numbers delivered the wrong way are still the wrong numbers.
For a patient who arrived dry, volume tolerance is folded into this figure: mean airway pressure beyond what their preload could carry is a worse outcome, however tidy the numbers looked.
What a service stocks is not the clinician's decision, so only an agent that works against the patient's physiology is marked down hard.
Marked on whether the chest was under tension, not on whether the needle was used. The pneumothorax step of the DOPE checklist is the decompression itself, so it earns the same.
Every control the running mode offers is scored against the case's own target, and the weighted average of those is the settings score. A value inside the full-credit tolerance earns all of it, and a near miss earns 40%.
Not every dial costs the same to get wrong. Tidal volume and the pressures that set it are where the harm is, so they carry the most; the oxygenation settings are corrected in seconds and carry the least.
| Setting | Full credit | Near miss |
|---|---|---|
| PEEP (cmH2O) | ±1 | ±3 |
| EPAP / PEEP (cmH2O) | ±1 | ±3 |
| Insp. Pressure (cmH2O) | ±3 | ±6 |
| IPAP (cmH2O) | ±2 | ±5 |
| Target Min Vent (L/min) | ±1 | ±2.5 |
| Inspir. Time (s) | ±0.2 | ±0.5 |
| Pressure Support (cmH2O) | ±3 | ±6 |
| Trigger (L/min) | ±0.5 | ±2 |
A fixed number of units is a different error at every target — ten points of FiO2 is a large difference at 30% and almost nothing at 90%. These are judged proportionally instead, with a floor so a small target is not held to an impossible standard.
| Setting | Full credit | Near miss |
|---|---|---|
| FiO2 | ±12% (min ±4) | ±25% (min ±8) |
| Resp. Rate | ±10% (min ±1.5) | ±22% (min ±3) |
| Backup Rate | ±10% (min ±1.5) | ±22% (min ±3) |
Tidal volume is graded in steps rather than against one number. The case's own target is the ideal, but a lung of this size takes a range, so a volume near the target — or anywhere inside the patient's predicted 6–8 mL/kg band — is treated as defensible rather than wrong. It is also the single heaviest setting in the score.
A near miss on any other setting earns 40% of its weight.
The score becomes a letter grade. The debrief also reports accuracy — a separate figure that blends how well the case was run, without counting the outcome twice.
A patient who does not survive is graded F whatever the score would have been, and the score itself is capped — at 25 when the death came from the clinician's own hand, and at 45 when it came from a problem that was there to be found and was not acted on. Causing a death costs more than failing to prevent one.
SpO2 within 2% of the case's target and EtCO2 within 4 mmHg of it, at the same moment.
SpO2 more than 7% below target, EtCO2 more than 12 mmHg off it, or the patient no longer alive. The share of the case spent here is what the score is docked for, up to 20 points.
These two run in the simulator like any other case but are never given a score or a grade.
The patient never deteriorates and nothing is scored. You get the run report — what you changed, and what the gases did in answer.
Its creator chose not to have it scored, so it ends as a practice run: the report, and no grade. Whoever is running the case judges it.
The clinical targets a case is scored against come from the sources below — the tidal volumes, pressure limits, saturation windows and CO2 targets are drawn from published critical care practice. The weighting and tolerances on this page are this simulator's own design, built so a clinically sound run scores well.
Each case also carries its own citations — the specific sources its targets and recommended strategy were drawn from. Those appear on the debrief, and in the downloaded report.