Viva 6

You are asked to review a 68-year-old male. He is two days post aortic valve replacement for aortic stenosis with good left ventricular function. His recovery has been uneventful other than a junctional bradycardia of 40 bpm that has required VVI pacing at 80 bpm via an epicardial right ventricular wire placed at the time of surgery. His nurse asks for your help as his blood pressure has been falling. He is on nasal prong oxygen, and remains conscious.

His bedside monitor looks like this: (Image removed from report.)

How would you approach this problem??

(This viva focussed on issues relating to temperature control and therapeutic hypothermia.)

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.