A 68 year old man had both legs trapped under a heavy concrete slab for 4 hours. He has just been admitted to the ICU, 8 hours post injury, following adequate resuscitation and definitive operative wound debridement. His observations are that he is, fully conscious, his blood pressure is 110/70 mmHg, pulse 86 beats/min and respiratory rate 24 breaths/min. He is anuric, and has been for the past 3 hours.
Relevant blood results at that time are:
Venous biochemistry |
||
|
Test |
Value |
Normal Range |
|
Sodium |
138 mmol/L |
135 -145 |
|
Potassium* |
7.1 mmol/L |
3.5 - 4.5 |
|
Chloride |
100 mmol/L |
95 -105 |
|
Bicarbonate* |
11 mmol/L |
22 - 26 |
|
Urea* |
29 mmol/L |
2.9 - 8.2 |
|
Creatinine* |
310 mol/L |
70 -120 |
|
Calcium* |
1.71 mmol/L |
2.10 – 2.55 |
|
Phosphate* |
4.31 mmol/L |
0.65 – 1.45 |
|
Creatine Kinase* |
> 80,000 U/L |
0 - 270 |
In reference to the above results, what process would the creatine kinase be reflective of and how would this affect the kidney?
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.