CFRN Flight and Transport 3 — Questions and Answers
Question 1: A patient being transported via helicopter at 5,000 feet cabin altitude has a SpO2 of 88% on 4 L/min NC. The flight nurse's priority action is:
- Apply a non-rebreather mask at 15 L/min (Correct answer)
- Notify medical direction and document
- Administer a fluid bolus of 500 mL NS
- Request the pilot to descend to reduce altitude effects
Correct answer: Apply a non-rebreather mask at 15 L/min
Switching to a non-rebreather mask maximizes FiO2 immediately, which is the fastest intervention to correct hypoxia at altitude.
Question 2: Which of the following is the BEST indicator of proper oxygen cylinder management for a 2-hour fixed-wing transport of a ventilated patient on 10 L/min?
- Verify at least one full E-cylinder per hour plus a 30-minute reserve
- One H-cylinder is always sufficient for any adult transport
- Calculate tank duration and confirm sufficient supply before departure (Correct answer)
- Oxygen will auto-regulate so cylinder size is not critical
Correct answer: Calculate tank duration and confirm sufficient supply before departure
The flight nurse must calculate O2 consumption (flow rate × time) and confirm that on-board supply exceeds estimated need plus reserve before departure.
Question 3: During air medical transport, the phenomenon of 'flicker vertigo' is caused by:
- Sudden changes in cabin pressure affecting the inner ear
- Sunlight flickering through rotating rotor blades at 4–20 Hz (Correct answer)
- Hypoxia-induced visual disturbances
- Electromagnetic interference from avionics on the visual cortex
Correct answer: Sunlight flickering through rotating rotor blades at 4–20 Hz
Flicker vertigo occurs when sunlight pulses through rotor blades at 4–20 cycles/second, potentially triggering photosensitive seizures or spatial disorientation.
Question 4: A CFRN is preparing to transport a neonate requiring 40% FiO2. At a flight altitude resulting in a cabin altitude of 6,000 feet, the equivalent FiO2 needed to maintain the same PaO2 is approximately:
- 40% — no adjustment needed for neonates
- 50–55% (Correct answer)
- 60–65%
- 80–100%
Correct answer: 50–55%
At 6,000 feet cabin altitude, barometric pressure drops approximately 20%, so FiO2 must increase proportionally to roughly 50–55% to maintain equivalent PaO2.
Question 5: The 'sterile cockpit' concept in air medical operations means:
- The cockpit is cleaned between transports using hospital-grade disinfectants
- Non-essential communication with flight crew is prohibited during critical flight phases (Correct answer)
- All medical communication must go through a recorded radio channel
- Patients are separated from the cockpit by a certified barrier
Correct answer: Non-essential communication with flight crew is prohibited during critical flight phases
Sterile cockpit prohibits non-essential crew communication during takeoff, landing, and other critical flight phases to prevent distraction-related accidents.
Question 6: When transporting a patient with a suspected spinal injury via helicopter, the primary challenge unique to this environment compared to ground transport is:
- Inability to use a long backboard
- Limited ability to reassess neurological status due to vibration and noise (Correct answer)
- Magnetic interference with the MRI-compatible collar
- Vibration that reliably reduces spinal cord edema
Correct answer: Limited ability to reassess neurological status due to vibration and noise
Helicopter noise and vibration significantly limit neurological reassessment, so the flight nurse must perform a thorough assessment before boarding.
Question 7: A flight nurse must refuse a transport mission. Which scenario is the MOST appropriate reason for mission refusal?
- The patient is combative and unrestrained
- Weather conditions exceed the program's safety minimums (Correct answer)
- Medical direction has not been contacted yet
- The referring hospital is outside the program's primary service area
Correct answer: Weather conditions exceed the program's safety minimums
Weather conditions exceeding program safety minimums (ceiling, visibility, icing) represent an absolute contraindication to flight due to unacceptable safety risk.
CFRN Flight and Transport 3
A patient being transported via helicopter at 5,000 feet cabin altitude has a SpO2 of 88% on 4 L/min NC.
The flight nurse's priority action is: