Leona, a 38-year-old female, who is 16 weeks pregnant, was admitted to ICU with grade 5 subarachnoid haemorrhage (SAH) 2 weeks ago. Foetal monitoring has been reported to be normal during this time. Her stay has been complicated by severe vasospasm and her latest CT brain scan shows a hemispheric infarct. She has been off sedation for 48 hrs.
Since 0600 hr this morning her pupils have been 5 mm and fixed. She has no observed cough, gag or spontaneous respiratory effort.
The Neurosurgeons have recommended palliation.
You are the ICU Consultant In-charge for her care. Her partner and her partner’s sister are anxiously waiting to talk to you.
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.