Viva 7

John is 64, and is a committed Jehovah’s Witness admitted to ICU following surgery for colonic bleeding, with an admission Hb of 42g/L.

He has atrial fibrillation, stable on warfarin. Ten days prior, John had an uneventful colonoscopic snare excision of a colonic polyp. Warfarin had been ceased for the procedure, and was re-commenced day 3 post-op.

John presented to the hospital Emergency Department today with massive PR bleeding and hypotension. He has had an emergency R hemicolectomy, with formation of a colostomy. Vitamin K was given for warfarin reversal; the presentation INR was 3.2.

John was transferred to ICU one hour ago, intubated and ventilated with FiO2 of 0.6. His mean arterial pressure is 75 mmHg on 15 mcg/min nor-adrenaline with cool peripheries and urine output 10-20 ml/hr. Haemoglobin = 42 g/L, platelets = 32, INR = 2.6, pH = 7.28, lactate = 2.3 mmol/L. There is fresh blood in the surgical drains and the colostomy.

So far John has not received any blood products, the anaesthetist reports that he re-affirmed his wishes not to receive blood prior to induction of anaesthesia. John’s next-of-kin has been waiting to see him since he went to theatre.

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.