Viva 1

Management of a multi-trauma patient

A 16 year old man is hospitalised after crashing a mountain bike into a tree at high speed. Initial observations in the Emergency Department were GCS 15 ,HR. 135/min, BP 130/85, and SpO2 91% on partial non rebreather mask. Obvious injuries included.

1..   multiple right sided rib fractures
2..   a displaced midshaft fracture of the right femur

3.   midshaft fractures of right radius and ulna.

He was intubated and taken to the CT scanner.
1.  CT brain and neck were normal.
2.   CT chest revealed pulmonary contusions and a small anterior pneumothorax
on the right
3.   CT abdomen revealed a grade 2 hepatic injury and a 'burst' right kidney..

Surgeons request conservative management for the abdomen. He is taken to theatre for a Steinmann pin to the right tibia (for traction) and then transferred to the ICU.

What are your immediate priorities in managing this patient?

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.