VitalSaver

Critical Event Simulator

What this is

VitalSaver is a real-time simulator for anesthesia emergencies. You watch the monitor, choose interventions against the clock, and find out whether the patient stabilizes. A companion module, VitalSaver: Sedation, covers procedural sedation, and Quiz Mode works through the same decisions at your own pace.

Designed for CRNAs, SRNAs, anesthesiologists, and other anesthesia professionals.

Developed and supervised by

Haruto Fujita, MD

Representative, FJ Anesthesia Consulting
Department of Anesthesiology, Keio University School of Medicine

Every scenario, drug dose, and package-insert summary in this application was written and reviewed by a practicing anesthesiologist. Where a value is a simplification made for teaching rather than a clinical recommendation, the application says so.

Support this project

VitalSaver is free and carries no advertising. If it has been useful to you, you can help cover its running costs.

♥ Support the project

Contributions are voluntary — every feature is free either way. See the Refund and Cancellation Policy.

Important limitations

This is an educational simulator. It is not a medical device and must never be used to guide the care of an actual patient.
It does not provide continuing education (CE/CME) credit and confers no certification of any kind.
Drug doses, package-insert summaries, and physiologic responses are simplified for teaching. Always follow the current FDA prescribing information, the current guidelines of your professional body, and your institution's protocols.
Content is based on publicly available guidelines at the time of writing and may become outdated or contain errors.
The developer accepts no liability for any loss or harm arising from use of this application.
If you are facing a real emergency, call 911 or activate your institution's emergency response system immediately.

Legal

The full terms under which this application is offered, what it does with your data (in short: nothing), and how contributions are handled:

Terms of ServiceVitalSaver is a free educational simulator. It is not a medical device and must never be used to care for a real patient.
Privacy PolicyWe do not collect your personal data. There are no accounts, no cookies, and no analytics. Your progress stays in your own browser.
Refund and Cancellation PolicyEverything here is free. Support payments are voluntary contributions, so they are normally non-refundable — but we will always correct a duplicate or mistaken charge.

Guidelines referenced

Scenarios are built from the sources below. Nothing is reproduced verbatim — always read the current original.

Practice Guidelines for Moderate Procedural Sedation and Analgesia— American Society of Anesthesiologists (ASA)
Practice Guidelines for Management of the Difficult Airway (2022)— American Society of Anesthesiologists (ASA)
ACLS Algorithms— American Heart Association (AHA)
Checklist for Treatment of Local Anesthetic Systemic Toxicity— ASRA Pain Medicine
Managing a Malignant Hyperthermia Crisis— MHAUS

Per-scenario references (10)

Anaphylaxis
- Anaphylaxis: A 2023 Practice Parameter Update(Joint Task Force on Practice Parameters (AAAAI / ACAAI))Intramuscular epinephrine to the anterolateral thigh is the only first-line treatment. Antihistamines and corticosteroids are adjuncts and do not prevent biphasic reactions; observation is risk-stratified rather than a fixed number of hours
- Drug Allergy: A 2022 Practice Parameter Update(Joint Task Force on Practice Parameters (AAAAI / ACAAI))Perioperative anaphylaxis: neuromuscular blocking agents, antibiotics and chlorhexidine as culprit agents, and the evaluation after the event
Airway Emergency (CICV)
- 2022 Practice Guidelines for Management of the Difficult Airway(American Society of Anesthesiologists (ASA))Limit the number of intubation attempts, assess ventilation after every intervention, and move to an emergency invasive airway (cricothyrotomy) when noninvasive ventilation has failed
- APSF update on the 2022 ASA difficult airway guidelines(Anesthesia Patient Safety Foundation (APSF))What changed: the awake-intubation decision tree, awareness of task fixation and elapsed time, videolaryngoscopy, and early consideration of ECMO
Status Asthmaticus
- GINA Pocket Guide (treatment of exacerbations)(Global Initiative for Asthma)Oxygen to SpO2 93-95% plus repeated inhaled short-acting beta-2 agonist is the core of initial treatment
- Expert Panel Report 3 (EPR-3), Section 5: Managing Exacerbations of Asthma(NHLBI / National Asthma Education and Prevention Program (NAEPP))The US guidance on acute exacerbation care. Note that the 2020 NAEPP Focused Updates revise six chronic-management topics and do not address exacerbations
Tension Pneumothorax
- Advanced Trauma Life Support (ATLS)(American College of Surgeons Committee on Trauma)Clinical diagnosis, immediate decompression, then a chest tube. From the 10th edition the adult needle site is the 5th intercostal space in the anterior axillary line
- ATLS 11th edition(American College of Surgeons Committee on Trauma)Current edition of the course. Needle length matters as much as site — a 5 cm catheter may never reach the pleura through a thick chest wall
Laryngospasm
- Pedi Crisis Critical Events Checklists(Society for Pediatric Anesthesia (SPA))Laryngospasm: remove the stimulus, 100% oxygen with CPAP and jaw thrust, then succinylcholine. Watch for hypoxic bradycardia
- Laryngospasm in children — management algorithm (review)(Paediatric Anaesthesia / PMC)Remove the stimulus, 100% O2 with CPAP, Larson pressure, then deepen anesthesia or paralyze
Malignant Hyperthermia
- Managing an MH Crisis(Malignant Hyperthermia Association of the United States (MHAUS))Stop all triggers, dantrolene 2.5 mg/kg repeated to effect, hyperventilate on 100% oxygen, cool, treat the hyperkalemia. Hotline 1-800-644-9737
- What Should Be on an MH Cart(Malignant Hyperthermia Association of the United States (MHAUS))Which dantrolene your facility stocks decides the first few minutes: Ryanodex 250 mg in 5 mL of sterile water, versus Dantrium/Revonto 20 mg in 60 mL — nine vials for a 70 kg patient
Local Anesthetic Systemic Toxicity (LAST)
- Checklist for Treatment of Local Anesthetic Systemic Toxicity (2020)(ASRA Pain Medicine)Lipid emulsion is the specific treatment. Reduce epinephrine to 1 mcg/kg or less; avoid vasopressin, calcium channel blockers, beta-blockers and any further local anesthetic
- The Third ASRA Practice Advisory on Local Anesthetic Systemic Toxicity (2020)(Reg Anesth Pain Med)Weight-based lipid dosing (70 kg and above: 100 mL bolus over 2-3 min, then 200-250 mL over 15-20 min) and the monitoring periods after CNS and cardiovascular events
Intraoperative Cardiac Arrest (VF/pVT)
- Adult Cardiac Arrest Algorithm (VF/pVT/PEA/asystole)(American Heart Association (AHA))Early high-quality CPR plus early defibrillation. The algorithm diagram itself
- AHA ACLS algorithms (complete set)(American Heart Association (AHA))Post-cardiac-arrest care and the reversible causes (the Hs and Ts)
Total Spinal Anesthesia
- Practice Guidelines for Obstetric Anesthesia (ASA task force with SOAP)(American Society of Anesthesiologists (ASA))Neuraxial anesthesia for cesarean delivery, and the equipment and readiness expected for a high or total spinal block
- Consensus Statements and Practice Advisories(Society for Obstetric Anesthesia and Perinatology (SOAP))Maternal resuscitation with left uterine displacement, and vasopressor choice for spinal hypotension (phenylephrine first-line, ephedrine when the heart rate is low)
Ventilator Alarm (ICU)
- Clinical Practice Guideline: Patient-Ventilator Assessment(American Association for Respiratory Care (AARC))Systematic assessment of the ventilated patient: which alarm is sounding, Ppeak versus Pplat, and what a widening gap between them means
- Advanced Trauma Life Support (ATLS)(American College of Surgeons Committee on Trauma)A tension pneumothorax under positive pressure ventilation is decompressed on clinical grounds without waiting for imaging

← Back to the simulator