You are the intensivist caring for a patient Mr James Wilson, a 70 year old man admitted to your ICU last night with aspiration pneumonitis associated with a bowel obstruction. He had been in hospital for 4 days prior to admission to the ICU. He is sedated, intubated, ventilated on 80% oxygen and requiring inotropic / vasopressor support.
At the morning hand-over round you are told of an attempt by the new night ICU Registrar to insert an internal jugular central venous catheter just an hour ago that has resulted in technical difficulties with the guidewire being accidentally pushed into the venous circulation. It is seen on X-ray to be in the right atrium, ventricle and pulmonary artery.
The patient's son/daughter has arrived and wishes to speak to someone about their father's condition. You are asked to enter this room and update the patient's relative about the condition of their father.
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.