A 76-year-old male presents following a fall down stairs. He is found to have multiple (>5) fractured ribs on the right side of his chest. Otherwise he has no other injuries.
His past history includes depression, he requires a hearing aid and has a 30 pack-year smoking history. His daughter says he has recently become quite "forgetful" since his wife passed away.
He is admitted to your intensive care unit for respiratory and analgesic management.
When you meet this man he is in considerable discomfort with a pain score of 9/10.
What medications would you use to provide analgesia for this man and give the pros and cons of each?
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.