Viva 1

You are the treating consultant on call for the ICU. At 0130 hr you receive a phone call from your ICU registrar with whom you have not previously worked.

The call is about a 36-year-old female who has been in ICU for 5 days. She was admitted 5 days ago for a subarachnoid haemorrhage, World Federation of Neuro Surgeons (WFNS) grade 3 from a right middle cerebral artery (MCA) aneurysm. She underwent emergency coiling for the same.

She has been extubated for 24 hours. She has an external ventricular drain, currently set to drain at 10 cmH2O. Her Glasgow Coma Score (GCS) has been 10-12 until tonight when she was noted to be “not herself” for 1-2 hours. She is now drowsy and is becoming difficult to rouse.

What is your response to the clinical problem presented in this phone call?

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.