Viva 8

You are the duty Intensivist arriving for the first day of your ward service week. One of your patients is a previously independent 60 year old female, Mrs. Jane Smith, who was admitted 5 days ago with community-acquired pneumonia. She has improved, but remains ventilated with progressive renal dysfunction. It was decided last evening to commence renal replacement therapy.

Overnight a registrar inserted a right internal jugular vascath under ultrasound guidance. Local swelling developed, and transducing the line revealed intra-arterial placement. The patient was subsequently transferred to theatre where the vascath was removed and the carotid artery laceration repaired.

This morning the patient was noted to have new left sided weakness. Urgent CT brain reveals   early   changes   consistent   with   a   very   large   right-sided   ischaemic   stroke.

The bedside nurse tells you that the family is upset, mainly because the only communication they have received was a phone call from the vascular surgery registrar last night. This call was to obtain consent for an operation “to fix the problem caused by ICU putting the line in the wrong place”. Also, they are worried that she is not moving one side today, and want to know the results of the CT scan.

You are about to meet Mrs. Smith’s next of kin.

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.