A 69 yr old male is admitted to Emergency Department with 3 day history of central abdominal pain and vomiting. His past surgical history includes a total colectomy four years ago for a perforated sigmoid carcinoma followed by chemotherapy and no evidence of recurrence.

Past medical history: Hypertension, and he has a Body Mass Index (BMI) of 40.

Medications:    Perindopril and metoprolol.

Examination: He is confused, has a respiratory rate of 36/min and is receiving 3l O2/min by nasal prongs. His oxygen saturation is 90% and his blood pressure is 90/40 mmHg. He is in atrial fibrillation with a heart rate of 110 BPM.

Take us through your initial priorities for management

Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.