A 75-year-old man has suffered chest trauma with multiple fractured ribs after falling off a ladder. There is no other significant injury after a tertiary survey and a trauma radiology series. His past history includes a history of depression treated with sertraline, chronic renal dysfunction with a creatinine of 190 µmol/L (normal range 60-120 µmol/L) and a heavy (10 standard drinks/day) alcohol consumption. He has just arrived in the ICU via radiology and is intubated and ventilated.
1. For this patient, what are the pharmacological options that you would consider for adequate sedation and analgesia, and why would you choose them?
The rest of the viva focussed on the value of daily cessation of sedation, the management of encephalopathy and the pharmacology of dexmedetomidine.
Areas of weakness identified by examiners:
Few candidates seemed to have a structured approach and some were not familiar with dexmedetomidine and the recent trial data. No broad overview of sedation and analgesia agents with reference to the above patient considering the simplicity of the question. Many not familiar with dexmedetomidine pharmacology regardless of practical experience with the drug
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.