OSCE 10

Communication station:   Candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the mother. The clinical scenario provided was as follows:
You are the intensivist in charge of the unit where a 15 year old boy (John) is critically ill having been a pedestrian hit by a motor vehicle. He has sustained severe chest injuries complicated by significant blood loss.

It is now day 3 into his admission, he is sedated and mechanically ventilated. The patient and his mother are both Jehovah’s Witnesses and his mother has refused administration of blood products to her son during this admission.
His clinical condition is such that he is now developing end-organ dysfunction and a lactic acidosis associated with a haemoglobin of 23g/L. He has re-commenced bleeding out one of his chest drains, and needs to go to the operating theatre.


Despite all you have done to cope without blood products it is your opinion in conjunction with the surgeons that blood products are required to save his life. Your legal standing on this matter has been clarified: you are allowed to transfuse this child without consent in order to save his life. Please enter this room where his mother is situated, update her on the condition of her son and the necessity for a blood transfusion.

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.