Viva 3

A 25-year-old cyclist has just been admitted to your ICU after a crash at 40 km/h. His Glasgow Coma Score (GCS) was 4 at the scene, and he has been intubated. CT brain demonstrates several petechial haemorrhages at the grey-white junction but no extra-axial mass lesion. No other injuries have been identified on thorough imaging and clinical evaluation. Currently he is sedated with morphine and midazolam (5 mg/hr each).

He is intubated and ventilated with SIMV: ventilator rate 14 breaths/min, tidal volume 550 ml, PEEP 10 cmH2O.

His observations are as follows: Temp 36.5°C, Heart rate 90 beats/min, BP 100/55 mmHg, SPO2 96% on FiO2 0.3, EtCO2 40 mmHg (5.2 kPa).

Outline your management that is specific to the patient's head injury.

This viva focussed on the management of traumatic brain injury

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.