You ever get a team who is doing everything right and the patient remains just outside the range for a selected objective to be warranted?  This is a problem we ran into also.  In the near future we will alter the vital signs to allow for a team to meet those requirements for objectives sooner.  In the meantime we created a nifty new button we labeled as a challenge button.  This will trigger the patient to decompensate.  Is it due to self extubation, pneumothorax, or something else?  We can let you discuss the possibilities with the team.  This button can be used multiple times in order to nudge the team to think critically to meet the needs of the lesson.  As for now this button will live right under the oxygen settings in dual tablet mode and under the call for assistance button in single tablet mode.  This button will likely move to its new home next to the SpO2 reading in the future.  Let me know what you think by sending me a message at jason@stepsinsitu.com.