Mixed Deck — All CFRN Topics Flashcards

Which pupillary finding is most consistent with uncal herniation in a TBI patient?

Answer: Unilateral fixed and dilated pupil ipsilateral to the lesion

Uncal herniation compresses CN III on the ipsilateral side, causing a fixed, dilated pupil on the same side as the expanding lesion.

During flight transport of a postpartum patient with uterine atony unresponsive to oxytocin, which second-line uterotonic is CONTRAINDICATED in a patient with asthma?

Answer: Carboprost (Hemabate)

Carboprost (15-methyl PGF2α) is contraindicated in patients with asthma because it can cause severe bronchospasm.

Henry's Law is most clinically relevant for the flight nurse when managing a patient with:

Answer: Decompression sickness after SCUBA diving

Henry's Law states that the amount of gas dissolved in liquid is proportional to its partial pressure; decompression sickness results from nitrogen bubbling out of solution as pressure decreases.

A neonate is born with gastroschisis. During transport, the exposed bowel should be managed by:

Answer: Covering the bowel with saline-moistened warm gauze and a plastic wrap or bowel bag

Exposed bowel in gastroschisis must be kept moist and warm with saline-moistened gauze and covered with plastic wrap or a bowel bag to prevent heat and fluid loss.

Which flight physiology principle explains why sinusitis or ear pain may worsen during aircraft descent?

Answer: Boyle's Law — gas compression in blocked cavities

During descent, atmospheric pressure rises and gas in blocked sinuses or middle ear cannot equalize, compressing trapped air and causing pain or barotrauma.

During air transport, a patient develops a wide-complex tachycardia at 180 bpm with a pulse. The patient is hemodynamically stable. What is the most appropriate initial intervention?

Answer: Amiodarone 150 mg IV over 10 minutes

For stable wide-complex tachycardia of unknown origin, amiodarone 150 mg IV over 10 minutes is the preferred pharmacologic treatment.

A flight nurse is assessing a patient from a high-speed MVC who complains of mid-sternal chest pain and has a new right bundle branch block on ECG. What injury should be strongly suspected?

Answer: Myocardial contusion

Myocardial contusion from blunt chest trauma can cause dysrhythmias, conduction abnormalities such as RBBB, ST changes, and reduced cardiac output, and must be monitored closely during transport.

What is the correct management for a patient with status asthmaticus who is not responding to bronchodilators during transport?

Answer: Consider IV magnesium sulfate and early preparation for intubation if needed

IV magnesium sulfate causes bronchial smooth muscle relaxation and is a key adjunct in refractory asthma; intubation preparation is critical if ventilatory failure is imminent.

When preparing a patient with a PASG (pneumatic anti-shock garment) for air transport, the flight nurse should:

Answer: Monitor and adjust pressure during altitude changes

PASG compartments expand at altitude so pressure must be monitored and released incrementally to prevent over-inflation.

A hiker is found unconscious in a cold environment with a core body temperature of 29°C (84.2°F). The patient has a weak, slow pulse and shallow respirations. Which rewarming strategy is most appropriate for this patient during transport?

Answer: Administration of warmed, humidified oxygen and warmed IV fluids.

In moderate to severe hypothermia (core temp <32°C), the priority is active core rewarming. Administering warmed, humidified oxygen and warmed intravenous fluids provides heat directly to the patient's core. This method helps prevent 'rewarming shock' or 'afterdrop,' a dangerous phenomenon where cold, acidotic blood from the periphery returns to the central circulation, potentially causing a further drop in core temperature and precipitating ventricular fibrillation. Active external rewarming of the extremities should be avoided until the core temperature begins to rise.

A flight nurse administers adenosine 6 mg IV push for SVT. The patient does not convert. What is the correct next dose?

Answer: 12 mg

If the initial 6 mg dose of adenosine does not convert SVT, the recommended second dose is 12 mg IV push.

A flight nurse is transporting a 2-day-old neonate who becomes jittery and lethargic. A point-of-care blood glucose is 28 mg/dL (1.6 mmol/L). What is the most appropriate immediate intervention?

Answer: Administer an intravenous bolus of 2 mL/kg of D10W.

Symptomatic hypoglycemia in a neonate is a medical emergency requiring immediate correction with intravenous dextrose. The appropriate concentration for a neonate is D10W to avoid the hyperosmolarity and potential for venous damage associated with higher concentrations like D25W or D50W. The standard bolus dose is 2 mL/kg of D10W. While feeding is important, it is not rapid enough for a symptomatic infant. Glucagon is a second-line option if IV access cannot be obtained.

A flight nurse is preparing for the extrication of a patient who has been trapped under a concrete slab for approximately 5 hours. Which life-threatening metabolic derangement should the nurse be most prepared to treat immediately upon the release of the crushing force?

Answer: Hyperkalemia

Crush syndrome results from prolonged muscle compression, leading to rhabdomyolysis. When the pressure is released, reperfusion washes out toxic byproducts from the damaged muscle cells into the systemic circulation. The most immediate life-threatening substance released is potassium. The resulting acute hyperkalemia can cause fatal cardiac dysrhythmias, including ventricular fibrillation and asystole.

A 34-week pregnant patient is transported by air with a BP of 160/110 mmHg, 3+ proteinuria, and severe headache. Which medication is the FIRST-LINE treatment for severe-range hypertension in this setting?

Answer: Labetalol IV

Labetalol IV is the first-line agent for acute severe hypertension in pregnancy due to its rapid onset, predictable response, and safety profile.

A flight nurse is managing a patient with a penetrating brain injury. Which action is most appropriate regarding the impaled object?

Answer: Stabilize the object in place and do not remove it

Impaled objects should be stabilized in place, as removal can cause massive hemorrhage and worsen brain injury; removal occurs in the OR.

Which medication is used to rapidly reduce intracranial pressure during air transport of a TBI patient?

Answer: Hypertonic saline (3% NaCl) or mannitol

Hypertonic saline or mannitol creates an osmotic gradient that draws water out of brain tissue, acutely reducing intracranial pressure.

A patient is brought in after ingesting a large quantity of acetaminophen 4 hours ago. Which laboratory value is most important to guide treatment decisions?

Answer: Serum acetaminophen level plotted on the Rumack-Matthew nomogram

The Rumack-Matthew nomogram uses a timed serum acetaminophen level (4–24 hours post-ingestion) to determine whether N-acetylcysteine is indicated.

What does the aviation term 'hot loading' refer to in the context of air medical operations?

Answer: Loading or unloading patients while the rotor is still turning

Hot loading refers to patient loading or unloading while the rotor is still spinning, which requires strict safety protocols to prevent rotor strike injuries.

When an asthmatic patient is transported by air, noninvasive ventilation is started. The patient experiences considerable hypotension shortly after takeoff, although the oxygen saturation level stays at 95%. This deterioration's most likely source is

Answer: Hyperinflation

In the given scenario, where noninvasive ventilation is initiated during the air transport of a patient with asthma, and the patient becomes significantly hypotensive while maintaining an oxygen saturation of 95%, the most likely cause of this deterioration is hyperinflation.

A patient in cardiogenic shock is being transported with an intra-aortic balloon pump (IABP). The CFRN understands that the primary physiological goals of IABP counterpulsation are to:

Answer: Decrease cardiac afterload and augment coronary artery perfusion.

The IABP works on the principle of counterpulsation. It inflates during diastole, which displaces blood and increases pressure in the aortic root, augmenting coronary artery perfusion. It deflates just before systole, creating a vacuum effect that reduces the pressure the left ventricle must overcome (afterload), thereby decreasing myocardial oxygen demand and improving cardiac output.