CFRN Flight and Transport 4 — Questions and Answers
Question 1: During a long fixed-wing transport at FL250 (25,000 feet), the aircraft loses pressurization. The flight nurse's FIRST priority is:
- Don supplemental oxygen for crew and patient immediately (Correct answer)
- Notify medical direction of the emergency
- Reassess the patient's SpO2 every 2 minutes
- Request diversion to the nearest Level I trauma center
Correct answer: Don supplemental oxygen for crew and patient immediately
At 25,000 feet the time of useful consciousness is approximately 3–5 minutes; immediate oxygen use is the first and critical survival action.
Question 2: The primary advantage of a rotor-wing aircraft over a ground ALS unit for trauma transport in a congested urban area is:
- Lower cost per transport mile
- Ability to bypass traffic and deliver point-to-point care (Correct answer)
- Availability of more pharmacological interventions en route
- Reduced vibration compared to an ambulance on city streets
Correct answer: Ability to bypass traffic and deliver point-to-point care
Helicopters bypass traffic, travel directly to the receiving facility, and can dramatically reduce scene-to-definitive-care intervals in congested areas.
Question 3: Which physiological stress of flight is most likely to worsen a patient with a closed head injury by increasing ICP?
- Hypoxia from decreased PaO2 at altitude (Correct answer)
- Thermal stress from cold cabin temperatures
- Decreased barometric pressure reducing PaCO2
- Noise-induced stress response elevating blood pressure only
Correct answer: Hypoxia from decreased PaO2 at altitude
Hypoxia causes cerebral vasodilation and increased ICP; even moderate altitude-related hypoxia can be dangerous in TBI patients.
Question 4: A flight nurse is managing a chest tube during transport. During ascent, the drainage chamber should be:
- Clamped to prevent air entry at altitude
- Left on water-seal and monitored for increased bubbling (Correct answer)
- Converted to a Heimlich valve for all flights
- Placed on suction at -40 cmH2O to compensate for altitude
Correct answer: Left on water-seal and monitored for increased bubbling
The chest tube should remain on water-seal; increased bubbling during ascent may indicate expansion of residual pneumothorax and requires close monitoring.
Question 5: Which of the following statements about gravitational forces (G-forces) during air medical transport is correct?
- +Gz forces during banked turns push blood toward the head, causing flushing
- Negative Gz forces experienced in turbulence can transiently reduce preload (Correct answer)
- +Gx forces in the head-to-foot direction reduce venous return from the lower extremities
- G-forces only affect flight crew, not supine patients
Correct answer: Negative Gz forces experienced in turbulence can transiently reduce preload
Negative Gz forces in turbulence can cause cephalad blood shift and transiently reduce cardiac preload, which is significant in hemodynamically unstable patients.
Question 6: The maximum safe time for a patient to remain in a cold helicopter cabin without active warming during winter transport is best determined by:
- A fixed 30-minute limit established by aviation regulations
- The patient's core temperature, risk factors for hypothermia, and cabin temperature (Correct answer)
- SpO2 and heart rate trends alone
- The referring physician's transport order
Correct answer: The patient's core temperature, risk factors for hypothermia, and cabin temperature
There is no fixed time limit; the decision must account for patient baseline temperature, trauma, age, medications, and actual cabin environmental conditions.
Question 7: A CFRN is planning a scene response for a patient with an impaled object in the chest. The correct in-flight management priority is:
- Remove the object before loading to prevent further injury during transport vibration
- Stabilize the object in place and monitor for pneumothorax development (Correct answer)
- Pack the wound around the object with hemostatic gauze and apply compression
- Request the pilot hover stationary to allow surgical extraction mid-flight
Correct answer: Stabilize the object in place and monitor for pneumothorax development
Impaled objects must always be stabilized in place to prevent further vascular or pulmonary injury; removal is only done in the OR.
CFRN Flight and Transport 4
During a long fixed-wing transport at FL250 (25,000 feet), the aircraft loses pressurization.
The flight nurse's FIRST priority is: