Mr John Smith was an independent, 80-year-old male admitted 10 days ago with profound sepsis in the context of pancreatitis. Imaging has revealed a suspicious lesion in the head of his pancreas which is likely to be malignant, although he has not had a tissue diagnosis yet.
John is in established multi-organ failure with severe ARDS, circulatory failure on very high doses of vasopressors (Noradrenaline dose 50 ug/min and Vasopressin dose 0.04 u/min) and on renal replacement therapy. You are seeing him today on your first day of a clinical week.
Medical consensus is that he has irretrievable multi system organ failure and that he is unlikely to survive. Medical recommendation is in favour of transitioning care from a curative to a palliative intent. Vitamin C administration was considered but not undertaken.
The Intensivist who looked after the patient previously has been updating family on early severe illness but has yet to initiate discussions on end of life. His son Kevin, and daughter Kylie are John’s next of kin.
You’re about to meet Kevin and Kylie to initiate a conversation on John’s end of life care.
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.