Viva 3

A 23 year old woman is the driver of a car involved in a high-speed motor vehicle crash and is brought to your hospital. She had been trapped for some time by her lower limbs, and at the time of extrication from the vehicle, she was talking and obeying simple commands.

On arrival, she has obvious facial and scalp lacerations and localises bilaterally to pain, but does not open her eyes or vocalise. She has blood in her mouth, her breathing sounds noisy and obstructed with a respiratory rate of 22 per minute, and oxygen saturations are 91% on high flow oxygen.

Her heart rate is 130/minute, systolic BP is 60mmHg. Paramedics have splinted her left lower leg, which was significantly deformed.

Outline your immediate management.

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.