You are the intensivist caring for Sandra Merton, a 75-year-old female with respiratory failure and shock. She was transferred to ICU last night from the ward. Sandra lives independently and has had little contact with the health system over the years. She was admitted to hospital with a diagnosis of multi-lobar pneumonia and commenced on antibiotics and supplemental oxygen.
Last night she deteriorated and a medical emergency team, including the ICU senior registrar, attended. Her physician was called, who confirmed that ‘everything should be done’. She was transferred to ICU and was intubated.
On your ward round you note Sandra’s general frailty. She is paralysed and sedated. She has saturations in the low 90s on an FiO2 of 0.55. She is receiving a moderate dose of noradrenaline and has progressively worsening oliguria.
The bedside nurse tells you that Sandra’s son / daughter is their next of kin. They were phoned for the first time this morning and informed of events overnight. The nurse tells you they were upset.
You are about to meet her son / daughter.
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.