Mr Soul is an 82-year-old man who, despite severe dementia, has been living at home with his elderly wife. He is fully dependent for activities of daily living and was assessed last year as requiring high-level nursing care. He was admitted to your hospital 2 days ago with drowsiness. A CT scan of his head shows a large acute subdural haematoma. The neurosurgeon has said she is prepared to operate if the family so wish.
Last night a MET call was instituted because the nurse was worried about his breathing. The night Registrar assessed his GCS as 8, admitted him to ICU and intubated him before discussing the case with you.
You have now completed your morning ward round and have been asked to meet with his son/daughter Nick. The bedside nurse tells you he/she has medical power of attorney and is upset and unsure how to proceed.
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.