Viva 1

A 30 year old man  has  been  admitted to hospital  with  severe  multiple  injuries following a motor vehicle accident.

On day 2, his intracranial pressure has stabilised  and his head CT shows scattered punctate haemorrhage with subarachnoid blood, with no mass lesion requiring evacuation.   His pelvic fracture and  right tibial/fibula fracture have been managed  with external fixation and  a left leg femoral fracture has undergone open reduction and internal fixation.

He has been in good health, but had a DVT 3 years ago and is not on any regular medication.

Outline your approach to prophylaxis for venous thrombo-embolism in this patient.

The other questions focussed on priniciples of DVT prophylaxis, use of various agents in a variety of clinical situations, HITTS and management of DVT prophylaxis in TBI.

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.