A 65 year old male with a past history of ischaemic heart disease is admitted to the ICU after a motorcycle crash having sustained long bone fractures of the lower limbs. He has no head, chest or abdominal injuries. Prior to surgery, his GCS was 15 and SpO2 was 98% on 4l oxygen via Hudson mask with a normal chest X-Ray. He required prolonged operative fixation of his fractures and that was complicated by significant blood loss. Intra-operatively, he also developed increasing oxygen requirement. On arrival in ICU, his most recent ABG on an FiO2 of 0.7 shows a PaO2 55 mmHg.
Q1: What are the possible differential diagnoses for his respiratory failure?
The rest of the viva focussed on progressing to TRALI related respiratory failure, pathogenesis of
TRALI and other complications of blood transfusion- storage lesions and infections.
Areas of weakness identified by examiners:
° Very few candidates could clearly articulate the diagnostic criteria and the mechanisms of TRALI
° Candidates also had difficulty in outlining the storage lesions.
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.