Viva 4

Respiratory/ventilation

“You receive a young patient involved in a high-speed motor vehicle accident. He has fractures of his  femur  and  humerus.  He  has  returned  from  the  operating  theatre  following  a  negative, exploratory  laparotomy.  He  has  had  a  hypoxaemic  arrest  in  the  operating  theatre.  Bilateral intercostal catheters were inserted and he returns to ICU intubated, hand ventilated with SaO2 75% on FIO2 1.0, pulse 100 bpm and SBP 108 mmHg on an adrenaline infusion. His first arterial blood gas demonstrates:
Normal Range

Please interpret this arterial blood gas and the most likely reasons for the derangement?”

“His first chest radiograph only demonstrates bilateral diffuse infiltrates.
How would you manage his ventilatory settings to improve his gaseous exchange? ”

Fourteen out of sixteen 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.