Viva 1

You  are asked  to  review  a  64  year  old  man  who  has  been  brought  to  the  emergency department having  been rescued  from a house fire.   There is no coherent history available from the patient  and you observe that he is drowsy and confused, and, has a persistent cough.

His  heart rate is 120 bpm,  blood  pressure 88/52 mmhg,  respiratory rate 28 and  oxygen saturations are 94 % on high flow oxygen via a non re-breather mask.

Q1: What are the initial priorities in management?

The other questions focussed on resuscitation, airway management, recognition of airway burns and management of burn shock

Areaof weakness identified by examiners:

Although this viva in general was answered well by most candidates, lack of precision in the answers was the main concern.
°     Candidates demonstrated good core knowledge regarding specific problems encountered in the resuscitation of patients with burn injury.
°     Specifically, the interpretation of Lund-Browder charts, and, controversies in fluid resuscitation in this patient population, including limitations in the use of (for example) the Parkland formula were well discussed.

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.