You are the Intensivist on call, working with a new ICU Registrar who is in the first year of Advanced Training. This is your first shift with this trainee but your colleagues have found him/her to be competent. A 72-year-old lady, Mrs May Brown, has been admitted following a Medical Emergency Team call to the ward. On arrival of the MET team, May was deemed to be close to respiratory arrest and she was intubated by the ICU Registrar. Intubation was followed by cardiac arrest. After 10 minutes of unsuccessful resuscitation, a senior nurse questioned the position of the endotracheal tube and it was discovered to be in the oesophagus. The tube was re-positioned correctly and after a further 10 minutes of resuscitation, return of spontaneous circulation was achieved and May was transferred to the ICU. She is currently requiring ventilation with Fi02 1.0, she is haemodynamically unstable on an adrenaline
infusion at 1 mcg/kg/min and she has myoclonic jerks.
The ICU Registrar has been waiting for you to arrive to talk to you.
Areas of weakness identified by examiners:
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.