Read the scalars. Then turn a knob.
Twenty ventilator cases with a live console: modes, airway pressures, auto-PEEP, leaks, asynchrony, tension physiology, abdominal compartment syndrome, and crises such as malignant hyperthermia. Numbers move continuously. The waveform is the physical exam.
Introductory session
A stable patient. Just the console.
No briefing, no guided questions, no free-play goals. Turn VT, rate, FiO₂, PEEP, flow, and mode. Watch the scalars, loops, gases, and vitals — a small screen names what changed.
Case library
20 scenarios
- VCintro6 min
Case 01 — Post-intubation
Aspiration, just intubated. VC 700 mL, PBW 66 kg, PIP 34, PEEP 8, FiO₂ 0.6. Nobody has done a hold.
Open console - VCintro6 min
Case 02 — Overnight pressure alarm
COPD night. PIP jumped 28 → 44. Flow still square. You have not done a hold.
Open console - VCintro6 min
Case 03 — Hypoxemia on the vent
Bilateral pneumonia, just intubated. FiO₂ 1.0 / PEEP 5, SpO₂ 86%.
Open console - VCintro6 min
Case 04 — Volume discrepancy
Hiss at the mouth. Set VT 450, expired 260, open FV loop, SpO₂ drifting.
Open console - VCintro7 min
Case 05 — Obstructed night
COPD, RR 22, I:E nearly 1:1. Flow scalar never returns to zero. MAP 64.
Open console - VCintro6 min
Case 06 — Frequent cycling
Total RR is double the set RR. Second flow pulse before expiration. Ti 0.55 s on VC.
Open console - VCintermediate7 min
Case 07 — Fighting the ventilator
Large distressed man, VC, VT 480 mL, Ti 1.0 s. Paw is concave during inspiration. He is fighting the machine.
Open console - VCintermediate6 min
Case 08 — Unexpected extra breaths
Deeply sedated, set RR 16, total 32. Water in the expiratory limb. Tiny flow oscillations.
Open console - VCintermediate7 min
Case 09 — Persistent dyspnea on AC
COPD, PEEP 5. Small negative Paw blips in expiration that never become a breath. He looks like he is working.
Open console - VCintermediate6 min
Case 10 — After central access
Five minutes after a central line. Sudden high PIP and Pplat, SpO₂ 78%, MAP 52, no right chest rise.
Open console - VCintermediate8 min
Case 11 — ARDS, day 2
ARDS day 1. VT 8 mL/kg because he looked comfortable. ΔP 22, Pplat 34, PEEP 8, FiO₂ 0.8.
Open console - VCintermediate8 min
Case 12 — Sudden loss of volume
Status asthmaticus. Auto-PEEP 16 on the last hold, MAP 50, RR 20, Ti 1.1 s. The bag is hard to squeeze.
Open console - VCadvanced9 min
Case 13 — Rising pressures, oliguria
Pancreatitis, massive resuscitation. Tight abdomen, PIP and Pplat both 38, urine 5 mL/h, MAP 56. Bladder pressure not measured.
Open console - VCadvanced8 min
Case 14 — Extra cycling
Sedated ARDS on VC. Mandatory breaths look passive, then an effort during inflation and a second cycle follows.
Open console - VCadvanced8 min
Case 15 — Persistent bubbling
Necrotising pneumonia, chest tube already in. Inspired 480 / expired 180. PEEP will not hold.
Open console - VCadvanced8 min
Case 16 — After a PEEP change
ARDS, PEEP 16, SpO₂ 94%, MAP 54, CVP 18, lactate climbing. Echo from the doorway: large RV, small LV.
Open console - VCadvanced9 min
Case 17 — After recruitment
Trauma, 12 L of product, now labeled “ARDS.” Pplat 36, PEEP 14, oliguria, tight belly. Night team already recruited. Bladder pressure not measured.
Open console - PS/CPAPadvanced7 min
Case 18 — Rapid cycling on PS/CPAP
Post-cardiotomy, deeply sedated on PS/CPAP. Rate 34, flow trigger 1 L/min. Expiratory flow shivers with each systole.
Open console - VCadvanced9 min
Case 19 — After RSI
RSI with succinylcholine 20 minutes ago. Jaw was tight. Now EtCO₂ 78 despite high VE, temp 39.6, rigid chest, K 6.1.
Open console - VCadvanced9 min
Case 20 — PACU fever
PACU after a sevoflurane laparotomy. Transport vent still in use. EtCO₂ 70, temp 40.1, dark urine, mixed acidosis.
Open console