Viva 2

An 18-year-old male has been involved in a high-speed motor vehicle accident. His initial GCS at the scene was 5 (E2,V2,M1) and he was intubated without any drugs. He has been a primary retrieval from the crash scene to your hospital.

On arrival he is intubated and has a hard collar in place. There is poor chest wall movement on the left side. He has a dilated left pupil and is noted to be bleeding from the left ear and nose. He has an obviously fractured left femur and shortened and externally rotated left leg.

Vital signs:
Heart rate       130/min sinus rhythm
BP                   85/50 mmHg
SpO2               90% (FiO2  1.0) on Oxylog transport ventilator
Temp               34.0C

1.   How would you initially manage this patient?
The rest of the viva  focussed on  the immediate and the subsequent management of the multi-trauma patient together with a discussion of cervical spine clearance as well as coagulopathy.

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.