A 74-year-old obese female with type 2 diabetes is transferred to your ICU from a district hospital with a diagnosis of ascending cholangitis. Ultrasound has confirmed an impacted gall-stone in the common bile duct.
Her vital signs are: Temperature is 34.5oC. Cold clammy peripheries Capillary refill time 4 secs
Heart rate 130 beats/min, sinus rhythm Blood Pressure 90/50 mmHg
SpO2 100% on 4 LO2/min via nasal prongs
Her examination findings are:
GCS 13 being confused and opening eyes to commands. Normal heart sounds with no murmurs or added sounds.
Bibasal inspiratory crepitations, with no wheeze or bronchial breathing.
Abdomen soft with right hypochondrial tenderness, but no rebound tenderness or guarding.
No residual urine in the bladder after catheterisation.
Outline your initial management of this patient.
Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.