Viva 4

A 74-yr-old man with a past history of hypertension and NIDDM has just undergone a 3- vessel graft and aortic valve replacement for aortic stenosis.  You are on duty when the patient is transferred to ICU postoperatively.

On admission, you note the following vital signs and haemodynamic observations:

Temperature  35.5 0 C            

Heart rate 66 bpm, sinus rhythm
Serum  HCO3   19 mEq/L        

Systemic blood pressure 94/60 mm Hg
Serum lactate 2.4 mmol/L      

Pulmonary artery pressure 22/10  mm Hg
Cardiac index 1.7 L/min/m2 
Systemic vascular resistance index 1600 dynes. sec. cm-5

What would you like to know about his pre-operative health status and work-up that would influence your post-operative management?

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.