Severe Tetanus, Envenomations and Toxicological Crises in ICU — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style severe tetanus, envenomations and toxicological crises in icu viva scenarios with examiner probes and model answers for ANAESTHESIA fellowship…

Scenarios covered

SCENARIO 1: A 38-year-old male farmer (ASA IE) presents to ICU 6 days after stepping on a rusted nail with generalized muscle spasms, severe risus sardonicus, trismus (inter-incisor distance 5 mm), and episodes of spontaneous reflex spasms triggered by ambient sound. Over the next 12 hours, his blood pressure fluctuates between 220/120 mmHg and 70/40 mmHg with sinus tachycardia of 160 bpm alternating with severe bradycardia. Detail your comprehensive airway, muscle spasm, and autonomic storm management strategy.
SCENARIO 2: A 24-year-old female (ASA IE) was bitten on her right ankle by a carpet viper (Echis ocellatus) 18 hours ago in a rural farm. She arrives in ICU with extensive leg swelling, bleeding from venepuncture sites, hematuria, and an uncoagulable 20-minute Whole Blood Clotting Test (20WBCT). Blood pressure is 85/50 mmHg and hemoglobin is 5.2 g/dL. Outline your immediate resuscitation, blood component therapy, and antivenom administration protocol.
SCENARIO 3: A 45-year-old agricultural worker (ASA IVE) is brought to ICU comatose with pinpoint pupils, generalized muscle fasciculations, excessive bronchorrhea, severe wheezing, heart rate 42 bpm, and blood pressure 80/40 mmHg following accidental pesticide exposure. Formulate your step-by-step resuscitation, atropinization protocol, and protective measures for healthcare personnel.
SCENARIO 4: A 19-year-old male (ASA IE) is admitted to ICU 6 hours post-ingestion of kerosene in an alleged suicide attempt. He is tachypneic (respiratory rate 44 bpm), grunting, with an SpO2 of 81% on room air, extensive bilateral coarse crackles, and diffuse chemical pneumonitis on chest radiography. Discuss your respiratory management and the contraindications regarding gastric decontamination.