Viva 6

The first few minutes of this viva is a simulated environment. In the scenario, you are the ICU consultant covering the high dependency unit in a small metropolitan hospital. It is early on Saturday morning.

You are urgently called from your rounds to the ward to review a 70 year - old man who is day 1 post a total hip replacement. He has been perfectly stable overnight and has just received a single dose of intravenous Cephazolin. He now has obvious stridor at rest with a generalized urticarial rash and evolving swelling of his face and tongue. His BP is 105 systolic and oxygen saturation is 85% in room air .

On the ward you have a competent nurse and an inexperienced junior doctor available to help you (the examiners). They will be helpful, but not take initiative. Other senior help is at home and at least 30 minutes away. The operating room is closed a nd the staff is not expected for another hour. There is simple resuscitation equipment on the ward trolley. A range of airway equipment is available in your high dependency unit.

Please manage this situation .

Additional comments: Some candidates were unable to appropriately manage anaphylaxis and/or were unable to describe a safe management approach for an airway emergency

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.