Participant should identify continued respiratory distress without any improvement. RR has increased as well as HR. Learner should attempt to use BiPAP since nonrebreather did not help. (+SIRS criteria as well as PMHx of DVT will most likely distract the learner.) Participant should create a differential diagnosis. Only labs ordered should result. Continue to State 3 when methemoglobin level is ordered. If it is not ordered, proceed to State 4. The gene discussed is HBG2; the disease is systemic inflammatory response syndrome.