CFRN Respiratory Emergencies and Mechanical Ventilation 1 — Questions and Answers
Question 1: During air transport, a mechanically ventilated patient has decreasing SpO2 and increasing peak airway pressures. What is the first assessment the flight nurse should perform?
- Increase the FiO2 to 100%
- Use DOPE mnemonic to troubleshoot (Displacement, Obstruction, Pneumothorax, Equipment) (Correct answer)
- Sedate the patient more deeply
- Switch to manual bagging immediately
Correct answer: Use DOPE mnemonic to troubleshoot (Displacement, Obstruction, Pneumothorax, Equipment)
The DOPE mnemonic (Displacement, Obstruction, Pneumothorax, Equipment failure) guides systematic troubleshooting of acute ventilator deterioration.
Question 2: What is the recommended tidal volume for lung-protective ventilation in a patient with ARDS during transport?
- 10–12 mL/kg IBW
- 6–8 mL/kg IBW (Correct answer)
- 4–5 mL/kg IBW
- 12–15 mL/kg IBW
Correct answer: 6–8 mL/kg IBW
Lung-protective ventilation uses 6–8 mL/kg ideal body weight to minimize volutrauma and barotrauma in ARDS patients.
Question 3: A flight nurse suspects tension pneumothorax in an intubated patient. What is the immediate intervention?
- Chest X-ray confirmation before treatment
- Needle decompression at the second intercostal space, midclavicular line (Correct answer)
- Increase PEEP to re-expand the lung
- Reposition the ETT
Correct answer: Needle decompression at the second intercostal space, midclavicular line
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression without waiting for imaging due to rapidly fatal hemodynamic collapse.
Question 4: Which ventilator mode allows the patient to initiate breaths while the ventilator provides a set backup rate if the patient becomes apneic?
- Controlled Mandatory Ventilation (CMV)
- Synchronized Intermittent Mandatory Ventilation (SIMV) (Correct answer)
- Pressure Support Ventilation (PSV)
- Continuous Positive Airway Pressure (CPAP)
Correct answer: Synchronized Intermittent Mandatory Ventilation (SIMV)
SIMV delivers mandatory breaths synchronized to the patient's effort while allowing spontaneous breaths between, with a guaranteed backup rate if the patient is apneic.
Question 5: In altitude physiology, what happens to air trapped in a pulmonary bulla as the aircraft ascends?
- It compresses due to increased atmospheric pressure
- It expands due to decreased atmospheric pressure, risking rupture (Correct answer)
- It remains unchanged
- It absorbs into surrounding tissue
Correct answer: It expands due to decreased atmospheric pressure, risking rupture
According to Boyle's Law, gas expands as pressure decreases with altitude, making pulmonary bullae at risk for rupture and pneumothorax during ascent.
Question 6: What is the correct management for a patient with status asthmaticus who is not responding to bronchodilators during transport?
- Increase supplemental oxygen only
- Consider IV magnesium sulfate and early preparation for intubation if needed (Correct answer)
- Administer IV furosemide
- Apply CPAP at 15 cmH2O
Correct 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.
CFRN Respiratory Emergencies and Mechanical Ventilation 1
During air transport, a mechanically ventilated patient has decreasing SpO2 and increasing peak airway pressures.
What is the first assessment the flight nurse should perform?