Viva 8

Mavis is a 77-year-old female, previously fiercely independent who has been very clear as to her end of life wishes with her family. She collapsed in a shopping centre, with a grand mal seizure, and was intubated and ventilated by the paramedics. She was transferred to the Emergency Department and a CT scan showed an acute sub-arachnoid haemorrhage with a moderate amount of blood and no midline shift. She has been ventilated in your ICU overnight.

Assessment of Mavis this morning shows the following:

  • Receiving infusions of Propofol @ 150 mg/hr and fentanyl @ 100 µg/hr
  • CPAP/PS 5 cmH2O / 5 cmH2O
  • Tidal volume: 450 ml
  • Respiratory rate: 20 breaths/min
  • Glasgow Coma Scale: E1 VT M5
  • Blood pressure: (no vasoactive agents) 145/75 mmHg (MAP 82)
  • Afebrile

The neurosurgeons have planned to proceed with a digital subtraction angiogram (DSA) and coiling of the aneurysm later today.

Her son/daughter has arrived this morning. You have been told that he/she is upset and angry that Mavis is on life support as this is something she has never wanted.

You are about to meet her son/daughter.

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.