Cardiopulmonary Resuscitation and Shock States — WACS Viva & Clinical Scenarios (Acute Medical Care and Intensive Care Medicine)

Exam-style cardiopulmonary resuscitation and shock states viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 58-year-old male with an anterior wall ST-elevation myocardial infarction develops sudden hypotension (blood pressure 75/40 mmHg), cold clammy extremities, oliguria, pulmonary crackles bilaterally, and a heart rate of 118 beats per minute. Central venous pressure is elevated at 18 mmHg. Contrast the hemodynamic profile of this patient with that of distributive and hypovolaemic shock, delineate the immediate pharmacological and mechanical stabilization strategy, and state the target mean arterial pressure.
• SCENARIO 2: You are leading the medical emergency team for an in-hospital cardiac arrest in a 45-year-old female presenting with sudden collapse. The initial cardiac monitor reveals coarse ventricular fibrillation. Demonstrate your step-by-step management over the first three cycles of cardiopulmonary resuscitation, including defibrillation energy selection, drug administration timing and dosages, airway management, and systematic evaluation for reversible causes.
• SCENARIO 3: Discuss the physiological determinants of systemic oxygen delivery (DO₂) and oxygen consumption (VO₂). Explain the pathological alterations that occur in the DO₂-VO₂ relationship during progressive shock states, the concept of critical oxygen delivery, and the utility of central venous oxygen saturation (ScvO₂) and blood lactate clearance in assessing resuscitation adequacy.
• SCENARIO 4: A 62-year-old septic patient remains hypotensive despite initial crystalloid loading. Detail the physiological rationale and clinical technique for assessing dynamic fluid responsiveness using the passive leg raise maneuver and stroke volume variation versus static indices. Outline the first-line vasopressor selection, receptor pharmacology, dosing titration, and indications for secondary vasopressor or inotropic support.
• SCENARIO 5: A 50-year-old male achieves return of spontaneous circulation (ROSC) after 18 minutes of cardiopulmonary resuscitation for out-of-hospital ventricular fibrillation. Outline the protocolized post-resuscitation bundle of care, including targeted temperature management parameters, hemodynamic goals, mechanical ventilation settings to avoid secondary brain injury, and the timing and modalities required for multimodal neurological prognostication.