Viva 3

You are asked to review a 64-year-old male who had an emergency abdominal aortic aneurysm repair last night. His sedation has been ceased in anticipation of extubation, but the bedside nurse is concerned that he appears to be in a lot of pain.

His relevant co-morbidities include ischaemic heart disease, type 2 diabetes mellitus and chronic back pain for which he has been on long term opioid treatment.

Outline how you would assess the situation.

(This viva focussed on issues relating to assessment and management of pain in critically ill

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.