Viva 3

You are asked to review an 88-year-old man who has fallen from a ladder. He is in the ED with a large subdural haematoma (SDH) and significant mid-line shift. His GCS is 6/15. He has a past medical history that includes ischaemic heart disease (CABG in 2008), chronic airflow limitation (inhaled bronchodilators and oral steroids), atrial fibrillation (warfarin and digoxin), chronic renal impairment (creatinine 190umol/L), non-insulin-dependent diabetes and mild memory impairment.

1.   What are the factors in this patient’s story that suggest his outcome might be poor?

The rest of the viva focussed on severity scoring and the management of the elderly critically ill patient

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.