CFRN Environmental and Toxicological Emergencies 5

Question 1

A patient is transported after ingesting methanol. Metabolic acidosis with a high anion gap and elevated osmol gap is present. What is the mechanism of methanol toxicity?

Accepted Answer

Conversion to formaldehyde and formic acid by alcohol dehydrogenase

Answer

Alcohol dehydrogenase metabolizes methanol to formaldehyde and then formic acid, which causes optic nerve damage and severe metabolic acidosis.

Question 2

During transport of a hypothermic patient (core temp 30°C) with a stable cardiac rhythm, which intervention should be avoided?

Accepted Answer

Rough handling or jostling of the patient

Answer

Rough handling of a hypothermic patient can precipitate ventricular fibrillation due to myocardial irritability at low core temperatures.

Question 3

A patient presents with mydriasis, dry flushing skin, urinary retention, tachycardia, and delirium after ingesting an unknown substance. Which toxidrome is present?

Accepted Answer

Anticholinergic toxidrome

Answer

The classic anticholinergic toxidrome ('mad as a hatter, red as a beet, dry as a bone, blind as a bat, hot as Hades') includes mydriasis, hyperthermia, dry skin, urinary retention, and delirium.

Question 4

A scuba diver develops joint pain, mottled skin, and neurological symptoms during air transport after a rapid ascent. The flight nurse should:

Accepted Answer

Fly at the lowest safe altitude and arrange immediate hyperbaric recompression

Answer

Decompression sickness requires flying as low as possible (maximizing atmospheric pressure) and urgent transfer to a hyperbaric facility for recompression therapy.

Question 5

A patient who ingested a large quantity of opioids is given naloxone with good effect, but 45 minutes later becomes unresponsive again. What is the most appropriate action?

Accepted Answer

Initiate a continuous naloxone infusion and arrange for extended monitoring

Answer

Many opioids outlast the duration of naloxone (30–90 min); a continuous infusion prevents renarcotization while the opioid is being metabolized.

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Environmental and Toxicological Emergencies 5