Viva 4

A 63 year old woman was admitted to the Intensive Care Unit 4 days ago. She has suffered a cardiac arrest in the community, was resuscitated by Ambulance Officers and was treated with urgent cardiac angiography and stenting of a significant left main coronary artery lesion.

Her clinical condition:

•    On moderate sedation, she has started to obey commands this morning
•    Intubated and ventilated since admission. Currently FiO2 = 0.6, PaO2 = 120
•    Right internal jugular central line, left radial arterial line, right cephalic vein peripheral IV line – all inserted on admission

•    She is being treated with clopidogrel, ranitidine and intravenous heparin.
•    She has been in atrial fibrillation since admission

This morning she developed a temperature of 38.8°C. What are the likely causes of fever in this lady?

The rest of the question focused on the approach to the febrile critically ill patient.

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.