Scenario: A thirty (30) year old male driver has a high speed collision with a tree. He has a GCS of 8, multiple right sided injuries and fractures, and had been intubated and resuscitated by the trauma team in your Emergency Department. Orthopaedic surgery is planned and you are asked whether you have an ICU bed. You review in the Emergency Department and are told that he was a difficult intubation with a grade 3-4 larynx. He is nasally intubated, on a transport ventilator with 100% FiO2, VT 900ml and respiratory rate of 10. His SBP is 100 mmHg, pulse rate is 130/min. His abdomen is soft. He has one 14 G IV line with Hartmann’s running.
X-rays: # ribs (R 2-3), # pelvis, # R femur, # R tibia (complex)
Chest: diffuse opacities both lungs consistent with ARDS
Cervical: (AP and lateral) normal to C6
Thoracic: # T4
CT head scan: # base of skull
Introductory question: What is your immediate management?
Sixteen out of twenty-three candidates passed this section.
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.