You pivot. RSI. Full stomach. Suction ready.
You do. You compress. You push epinephrine. But the mannequin does not wake up. Because in this simulation, you already made the fatal error 90 seconds ago. The exam is not about rescue. It is about prevention.
“You induce. The LMA doesn’t seat. You try twice. Now the SpO2 is 88%. The patient is desaturating. What next?”
For the next seven hours, their lives will be reduced to a series of flickering pixels: an ECG strip, a cryptic blood gas value, a simulated malignant hyperthermia crisis. The air smells of industrial carpet cleaner and anxiety. Outside, the sun is rising over Lake Michigan. Inside, it is always 2:00 AM in the ICU.
He took a leave of absence. He hired a coach—a former oral board examiner who charged $400 an hour to simulate the SOE in a hotel conference room. He practiced until he could recite the ASA Difficult Airway Algorithm in his sleep.
