OSCE 3

Clinical case 2.

Case presented regarding investigation and management of a patient with burns (including arterial blood gas). Introductory material and initial questions were: "A 52-year-old man is rescued from a house fire. He sustained burns to his body and was deeply unconscious at the scene. On arrival in the Emergency department, he was promptly intubated and ventilated. He was resuscitated with 3 litres of Hartmann's solution and underwent a primary and secondary survey. Relevant clinical findings prior to transfer to your intensive care unit were: Orally intubated (9.0 endotracheal tube); Ventilated (SIMV: FiO2 1.0); Blood pressure 90/50 mmHg, heart rate 130 bpm. Urinary catheterisation drained 500mL clear urine, and 10 mL in the preceding hour. Glasgow Coma Score (prior to sedation): 3/15. Remainder of clinical examination is normal: Normal chest examination. Normal abdominal examination. No abnormalities detected on cervical spine, chest and pelvic X-rays. No long bone fractures. He has been sedated with fentanyl and midazolam. He has received tetanus immunoprophylaxis. The burns have been washed with cold water and dressed with silver sulphur diazine (SSD). His burnt body surface area has been recorded on a body chart."

"What is the estimated burnt body surface area from the burn chart (and show how you arrive at this)?"

“Prescribe a fluid regimen for the next 48 hours for this patient (and show your calculations).”

Fifteen out of sixteen candidates passed this station.

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.