A 30 - year - old haematology inpatient, Donna /David Smith was transferred to your intensive care unit with neutropenic septic shock 4 hours ago. She /he received induction chemotherapy 14 days ago for newly diagnosed Acu te Lymphoblastic Leukaemia. She /he developed left leg pain 24 hours ago, which has rapidly progressed. Overnight she /he was assessed by junior medical staff who prescribed increasing doses of morphine. She /he has now been sedated, intubated and ventila ted for shock requiring high and escalating doses of inotropic and vasopressor support. She /he is coagulopathic and thrombocytopenic. Initial clinical examination in ICU revealed crepitus up to the level of the knee, which has spread rapidly to the lower back. Following surgical assessment in theatre by consultant orthopaedic and plastic surgeons, your anaesthetic colleagues hand over to you that it was agreed that it is too late for operative intervention and the patient is returned to your ICU without debridement.
You are about to meet her husband David /his wife Donna . He /she has just arrived at the hospital having been informed by the ward staff that Donna /David was transferred to ICU. Prior to the meeting you review Donna /David , noting she /he is n ow on 100 mcg/min of a drenaline and 100 mcg/min of n or - adrenaline with a mean arterial pressure of 55 mmHg.
Candidates who passed this station conveyed the key issues in simple language with appropriate non - verbal communication and wit h no misinformation, whilst listening to the actor and acknowledging his/her concerns
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.