Viva 4

You have taken over the care of a previously well 55-year-old female following a World Federation of Neurosurgeons Score (WFNS) 1, Fisher 3 subarachnoid haemorrhage from an anterior communicating artery aneurysm which occurred yesterday.

She has been stable in the ICU with a Glasgow Coma Score (GCS) of 15, a blood pressure of 120/80 mmHg and no focal neurological deficit since her admission.

She has just returned from an endovascular procedure to secure the aneurysm. Her current vital signs are:

GCS 14 (confused)
Heart rate 59 beats/minute Blood pressure 140/80 mmHg


 

How would you assess this patient? Describe your initial management.

(This viva dealt with subarachnoid haemorrhage.)

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.