Viva 5

You are asked to urgently review a 25-yr-old male with isolated traumatic brain injury. He has had a percutaneous tracheostomy inserted within the last 30 minutes to facilitate weaning from mechanical ventilation. The bedside nurse is concerned about bleeding from the tracheostomy tube.

He has the following observations:

• SpO2 88% on FiO2 80% (increased from FiO2 40%)
• SIMV+VC mode, tidal volume 400 ml, PEEP 5 cmH2O, normal peak and plateau airway pressure
• Heart rate 120/ min and blood pressure 180/110 mmHg
• Patient is sedated and paralysed

Discuss your initial approach to the management of this patient.

List your differential diagnoses for her presentation.

(This viva dealt with complications of percutaneous tracheostomy.)

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.