Viva 6

You  are the  intensivist  caring for Mrs June  Hay,  a  56 year old  lady  recently  admitted comatose  to  the  ICU  following  a  subarachnoid  haemorrhage,  but  who  had  made  good progress to the point of obeying commands  and had been discharged to the ward with a tracheostomy in situ.

She was readmitted to ICU following a prolonged resuscitation in the ward. It transpired that she had suffered a major anaphylactic reaction to Flucloxacillin that  had been prescribed by an  intern for a presumed infection  around the tracheostomy  site. This was despite  the fact that  she  had  clearly  documented penicillin  allergy  and  she  wore  a  Medic-Alert  bracelet indicating  her allergy.  The husband has been appraised about the drug error.

It is now 3 days later, she is deeply comatose and has clearly suffered irreversible neurological damage based on clinical assessment and CT scan studies.

You  organize  a  meeting  with  him  to  discuss  his  wife’s  condition   and   to  outline   your management plan.

This station was not well performed by the candidates.
°     Candidates on the one hand were giving reassurance to the next of kin about likely patient recovery and in the next breath went on to discuss brain death and organ donation
°     Lack of empathy on the part of some of the candidates was mentioned by the actors
°     Few candidates expressed regret and sorry over the turn of events although things happened outside the ICU.

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.