As the Intensive Care specialist on call in a regional hospital, you are asked to assist in the management of a 3 week old infant who has presented in extremis to the Emergency Department.
There was a 2 day history of Upper Respiratory Tract Infection (URTI) symptoms, and poor feeding for the last 8 hours.
There were no problems at delivery. There is no family illness other than URTI.

On examination the following vital signs have been recorded: T 35oC, HR 189, RR 68

Child is pale, cold to touch with a thready pulse. The child is unresponsive to pain. There is no rash.

What is your assessment of this child ?

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.