You have taken over the care of Matthew, a 28 year old male, admitted to the Intensive Care Unit overnight following a motor bike accident. His GCS was 3 at the scene and was intubated and ventilated by the paramedics. He was noted to have dilated non reactive pupils, and feeble respirations, prior to intubation. An urgent CT head showed severe diffuse axonal injury with a 1.5 cm midline shift, evidence of transtentorial herniation but no drainable intracranial collection. The consensus opinion of the neurosurgical and ICU team was that the outcome was dismal and would not be altered by ICP monitoring and neuro protective measures. The findings on your clinical assessment the following morning are as follows: GCS -3, Pupils 5mm not reactive to light, absent corneal cough and gag reflexes. Spontaneous respirations present (6-8 breaths per minute). He has been off sedation, analgesics and neuromuscular blocking agents since admission.
The patient’s next of kin (Pat) is waiting to talk to you. The nursing staff informs you that while Pat was briefed by senior registrar (John) over night about the poor outcome, Pat was hoping for a miracle.
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.