Viva 4

A 23-year-old female is admitted to your Intensive Care Unit following a seizure at work.

A collateral history suggests that she had been acting unusually for a few days before she was seen to collapse this morning with a tonic-clonic seizure. Midazolam 5mg IV was administered by the paramedics but she continued to seize.

In the emergency department she was given additional midazolam IV (2 mg, 5 mg, 5 mg) and was loaded with Levetiracetam (1g IV). After 20 minutes she continued to have sporadic seizure activity with a best Glasgow Coma Scale of 6 and a decision was made to intubate her (Propofol 180 mg and Rocuronium 100 mg).

She has arrived in your unit on a Propofol infusion at 20 mg/hr. She is ventilated on SIMV with SpO2 100% on FiO2 0.3. Mean arterial pressure is 75 mmHg on no supports and she is warm and well perfused.

Outline your approach to her care over the next 12 hours?

The viva focussed on the management of refractory status epilepticus

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.