Procedure station 2.

Candidates were expected to demonstrate that they could safely insert a pulmonary artery catheter. Marks were allocated under headings of “Patient preparation”, “preparation of catheter for insertion”, “insertion of the catheter”, and “confirmation of placement and calibration”.

Introductory material was:

“A 62 year old man has cardiogenic shock. A dobutamine infusion of 7 mcg/kg/min is running. He is intubated and ventilated, on 50% O2 and PEEP 10 cm H2O. He is lightly sedated on morphine and midazolam, but rouses to voice and is interactive. You have decided to insert a continuous cardiac output oximetric pulmonary artery catheter in to the right internal jugular vein. Describe exactly how you will go about this.”

Some candidates had difficulty in reproducing expected pressure waveforms.

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.